Sex. Does that word make you blush? And even if not, is it still difficult to talk about? If it is, you’re not alone.

Intimacy is an important part of a relationship. And one of the ways we express intimacy is physical. Now, I want to start by emphasizing that there are many ways to be intimate with your partner. And physical intimacy is not only about sexual expression.

But you might not know that if you spend much time watching TV, reading magazines, or on the Internet. We are constantly bombarded with the message that intimacy is all about sex. Along with the related message that, if you aren’t having dynamite sex, then you don’t have an intimate relationship. And also driving home another message: There’s something wrong with you if you aren’t having whatever the author of the article defines as a “healthy” sex life.

Healthy. That’s a word that deserves closer consideration.

If you’re living with a chronic health condition, or your partner is, then thinking about the physical intimacy in your life in terms of whether it is “healthy” or not can leave you feeling kind of left out of the conversation. After all, your chronic condition can have an impact on your sex life. On days when you’re tired out or not feeling well, then sex may very well be the last thing on your mind, or your partner’s mind. The symptoms of your condition can affect both desire as well as ability to perform. So can the side effects of medication. And sex may be uncomfortable.

Often, my clients living with a chronic condition talk to me about how they feel diminished because they aren’t having what the media tells them is a healthy sex life. Or they talk about how they fear they are disappointing their partner. While their partners may also feel disappointed, they often tell me how much they value their relationship, in spite of the limitations that may affect their physical intimacy.

But so often, couples aren’t talking to each other about sex. And that’s sad.

Sex can become another one of those elephants in the room. Everybody knows it’s there. But who wants to acknowledge it?

Here are the results of not having this conversation. Going to bed at different times. Avoiding any demonstration of affection that you fear might lead to expectations for sex. Making comments about how tired you are or how badly you feel as a way to signal to your partner that sex is out of the question. But while you are avoiding that elephant, you are also avoiding each other.

Why not talk? Here are some of the reasons I hear: I don’t want to admit that sex is uncomfortable/difficult for me. I don’t want my partner to think he/she isn’t attractive anymore. I’m afraid that if I’m not available for sex, my partner might leave. Or, I’m afraid my partner will think I will leave if he/she isn’t up to having sex.

Look at it this way. If you’re thinking about the role of sex in your relationship, chances are your partner is, too. So how about bringing your concerns about sex out of the darkness and into the light of day? Wouldn’t that be a relief?

How to get started

First, take the pressure off yourself. Most couples I talk with about sex tell me that the ways in which they express their feelings for each other evolve over time. The importance of sex, along with the frequency, evolve as well. What you see on TV or on the Internet isn’t the gold standard for having a truly connected relationship.

Start out with some reassurance. Tell your partner how much you love him/her along with what’s really important in your relationship. Share a few memories. Invite your partner to do the same.

Ask if talking about sex is okay. It’s as easy as: “I’d like to talk about sex with you. Is this a good time?” If not, give it a try later. Don’t give up.

Let your partner know what’s on your mind. Take responsibility by using “I” words. For example: “I haven’t been feeling like having sex lately” or “I can’t participate in sex the way I would like to.” Let your partner know how you feel: “I am disappointed that our sex life isn’t like what it used to be.”

Avoid the impulse to place blame. It’s not your fault. It’s not your partner’s fault. It just is.

Invite your partner to respond. “I’m really concerned about how this is affecting you. Will you let me know?”

Listen. With an open mind.

Share information. If you aren’t sure if your partner understands why sex is difficult, then offer to explain. You might also invite your partner to have a conversation with you and your physician.

Talk about what you can enjoy together. Intimacy is not all about intercourse. It’s saying loving words. Holding each other. You might even let your partner know what you can enjoy. “I really love it when you…” And then ask your partner what he/she enjoys. Focus not on what isn’t but what could be.

Smile. And laugh. Feel free to giggle at how easy it is for two adults to blush when they talk about sex.

Look at the big picture. Remind each other of what real intimacy is in your relationship. What do you do to express how much you love each other? Couples learn to connect in many ways over the years, talking, sharing the workload, laughing together, and lots of hugs. Real intimacy is being close, not only physically, but emotionally and spiritually.

Repeat as needed. Your first attempt at having this discussion may be successful in exposing the elephant in the room and even forging a way forward. Or it may just be a door opener, to be continued. So don’t be surprised if this is a work in progress.

So don’t just talk about sex. Talk about intimacy. Intimacy is the connection you make with your partner: emotional, spiritual and, yes, physical. Keep the focus on what it means for you and your partner to be intimate.

More from Dr. Gary:
How About a Drink? Before You Pour, Consider Your Wellness!
Holiday Time! What Are You Saying "Yes" To?
Someone With My Condition Just Died. What Does That Mean for Me?