Sex and breathlessness

For many people sex is, or has been, an important part of their lives. But people with lung disease may worry about sex because they are afraid that they will become too short of breath, or need to cough up phlegm. This page aims to help you to enjoy a fulfilling sex life.

Sexual activity includes expressing affection by talking, hugging and touching, as well as intercourse. Both partners need to take responsibility for the sexual relationship and express their concerns and wishes to each other. You must communicate with each other, and be open-minded.

Sexual activity needs energy and makes demands on your heart and lungs. You breathe more and your heart rate and blood pressure go up for a short time. This is the same for everyone. They return to normal levels quickly. The energy you use during orgasm is similar to the energy needed to climb stairs or take a brisk walk.

The following are some suggestions for you.

Have sex when you feel rested and your breathing is normally best. This might be when your medication is most effective and your energy is not at a low ebb, so you may need to plan ahead. However, don’t change your habits if this is stressful for you.
Be comfortable and relaxed. If you are too cold or too hot, you won’t be relaxed. If you’re feeling stressed or tired, having sex could increase these feelings. All of this could make your breathing more difficult.
You might want to cough up phlegm before sex, or avoid having sex in the morning, when you will probably be producing more phlegm.
Avoid sexual after a heavy meal, or alcohol. Your breathing might be more difficult if you have a full stomach and feel bloated. And alcohol can decrease your sexual function. A small drink, however – if it’s allowed under your medical regime – may help you to relax.
Remember that some changes in your sex life are just part of getting older – not because of lung disease. Slower erections and delayed orgasms are normal in middle and later life.
Taking one or two puffs of your prescribed bronchodilator (blue) inhaler before starting sexual activity may relieve shortness of breath or wheezing. Some people also find that oxygen increases stamina.
If you use oxygen at home, using it before and after, or during sexual activity will help stop you getting too short of breath. It may be useful to ask for a nasal cannula for this, rather than using a mask.
If you become very short of breath during intercourse, try pausing to take some slow, deep breaths from your diaphragm, rather than stopping altogether.
Some medications may cause a decrease in sex drive or sexual function. If you have any problems in this area ask your doctor about the side effects of your medicines. There are various methods and devices that may be able to help you with this.
All intimacy should be for your enjoyment and fun. Laugh and talk about any difficulties that either of you are experiencing. Be prepared to try different ways to express your affection and tell each other what feels nice!
Ask your nurse or GP for advice if you have problems.
Positions: the key is to keep the diaphragm free and not to weigh down on the chest. The person with lung disease should probably try to use positions that require less energy to maintain.

You could try:

Both partners lying on their sides, either facing toward each other (fig 1) or with one behind the other (fig. 2).
If you prefer a top/bottom position, sometimes the less active underneath position is better for the person with lung disease. But make sure there’s no pressure on their chest.
The woman kneeling on the floor, bending over with her chest resting on the bed (fig 3)
The man on his back with the woman on top (fig 4)
The woman sitting on the edge of the bed, feet on the floor, with the man kneeling on the floor in front (fig 5).

fig 1 fig 2 fig 3 fig 4 fig 5

And finally, remember that holding, hugging, kissing and caressing can also be fulfilling expressions of love and affection