Communication

My 40-year-old wife has resisted sexual relations with me since her radical mastectomy and breast reconstruction about eight months ago. I'm sensitive to her feelings, but have become frustrated. What do you recommend?

Your wife's hesitation may involve several obstacles. "Psychologically, this is a huge issue and it must be handled delicately," advises Mary Jane Minkin, MD, board-certified obstetrician/gynecologist and clinical professor at Yale University School of Medicine. Remember that the surgery—lifesaving a procedure as it may be—has most likely left your wife with psychological as well as physical scars.

By bringing the issues out in the open, you hopefully can work through them together. The object is to make your wife as comfortable as possible in all ways. "Acknowledge that this is an intimate matter," says Dr. Minkin. "The most important thing is to say, ‘I still love you and want you.' Encourage her to express whatever anxiety she has. Get her to say, ‘I'm concerned about this and embarrassed about that.' If you need a counselor, that's okay, too."

Beyond your wife's possible self-image issues, there could be physical causes for resistance. For instance, chemotherapy often causes vaginal dryness. This is a subject, Dr. Minkin notes, that women are reluctant to discuss. She recommends the use of vaginal lubricants, such as the non-hormonal product Replens. "If there are other physical issues," adds Dr. Minkin, "she should talk to her healthcare provider."

My mom's in her 80s and still drives, though I don't think she does it well. What are telltale signs of her being a bad driver and how can I get her to stop—or at least curtail—her driving?

There are several warning signs to look out for, says Sharon Brangman, MD, member of the American Geriatric Society and chief of geriatrics at SUNY Upstate Medical University in Syracuse, NY. “Unexplained dents in the car, fender benders, unsafe lane changes, being hesitant at intersections, not going the right speed, the stereotypical leaving the directional signal on for miles. These are all hints,” notes Dr. Brangman. “Also, memory problems; she might be getting lost in familiar places.”

There is, without a doubt, no easy fix for this. “It’s a tough situation,” Brangman admits. “Driving is such an indication of independence.” In terms of curtailing her driving though, you have to take into consideration Dr. Brangman’s caveat: “The less frequently you drive, the more difficult it is to remain comfortable behind the wheel.”

But there are strategies to use when discussing the issue. Dr. Brangman suggests you put a positive spin on public transportation or the occasional hiring of a car service. “Appeal to the economics of it,” she says. “Economics of no insurance and car upkeep and gas costs, and that money being diverted to a car service. Or appeal to your mom’s sense of ethics and morality; she doesn’t want to hurt someone else or herself. That line of reasoning can sometimes help.”

I find it hard to argue with my ill wife about things she does that bother me. As a result, I find myself resenting her, feeling that I can't voice my opinion. Is this healthy for me—and for us?

"No, it's not healthy," says Kitty Stein, PsyD, a psychologist in Lincoln, MA. "You must be in communication," she insists.

That, Dr. Stein says, entails a three-step process. "Recognize that this illness creates resentment in you both. For different reasons, you both wish she didn't have it. Share the different levels at which you recognize what's going on. You need to talk about how your life has changed."

After recognition, says Dr. Stein, comes "renegotiation—figuring out new ways to do things. Then, regeneration—how you grow in this new place." Dr. Stein also suggests you seek couples counseling to help elicit conversation about this turn in your lives.