Asthma affects around one in 13 people, but no one knows exactly what causes the condition—nor why people experience it so differently. Some people’s asthma is more extreme than others; a given trigger—aka, any environmental irritant, activity, or even emotional state that can set off asthma symptoms—may not bother one person, but have severe effects on another; and people’s triggers and symptoms often change as they age. What's clear across the board is that asthma attacks, which often involve shortness of breath, a tightness in the chest, and wheezing and coughing, can be traumatic or even deadly.
Despite the prevalence and seriousness of asthma, people with (and experts on) the condition have traditionally avoided talking about how it can affect sex. That’s not because such effects are rare or minor: Well over half of all adults with asthma surveyed on the issue said the condition interferes notably with their sex lives. Many reported feeling self-conscious about using inhalers or other visible asthma management tools in front of partners, or anxious about how a partner might react to an asthma attack during sex. These concerns can be detrimental to asthmatics' sexual desire or enjoyment, and, in some cases, increase the risk of attacks. Outside of emotional considerations, episodes triggered by stress or irritants (which can include any number of things—dust, scented candles, even latex condoms) before or during sex, or by the exertions of sex itself, usually put a hard and frustrating stop on intimacy.
Although there is no cure for asthma, medical experts stress that, as long as people are aware of their current triggers and adhere to individualized treatment plans, they can avoid most or all attacks. In terms of sex, that may mean keeping track of acts or positions that seem to trigger episodes, making sure there are no irritants around, taking medications beforehand, talking openly with partners about asthma and how to handle attacks, and stopping sex to mitigate symptoms. That sort of awareness, communication, and self-advocacy can be hard to learn and practice without active support and guidance.
Major asthma advocacy and education organizations have begun to develop relevant support resources on asthma and sex. In recent years, some experts have also called for more study, education, and discourse on this matter. Still, outside of online communities, most materials on the intersection between sex and asthma to date have come from academics and doctors, rather than from people with the condition themselves.
VICE reached out to Lee, who has moderate-to-severe asthma, and her husband, John, to talk about how the condition affects their sex life and how they manage it.
This interview has been edited for length and clarity. Names have been changed for privacy reasons.
Lee: I was diagnosed with asthma when I was two. In my childhood, my attacks were usually exercise-induced. My parents managed my care well, so by the time I was a teenager, I still had occasional attacks, but I thought I was outgrowing it. That was naïve. I also felt ashamed of carrying my inhaler in public and using it in front of other people—well into my 20s, actually. I almost wanted to pretend that I just didn’t have asthma.
John: I didn’t know much about asthma. My father figure taught me that things like that are just in your head, so that mentality shaped my responses to other people’s health conditions until my early 20s.
Lee: John and I are in our mid 30s, but we met as teenagers, and he's known about my asthma since then. When we started going out, soon after we met, I mostly worried internally about whether I'd encounter triggers at the places where we went out together.
At that point in my life, exercise had become less of a trigger, so there weren’t many instances where we had to stop having sex because the activity itself triggered my asthma. But dust mites and pet dander had become more of an issue. I’d try to plan ahead to avoid those things, because if I’m having shortness of breath or tightness in my chest, I’m not able to get in the mood for sex later. I need to take my inhaler and rest for a while. I usually wouldn’t vocalize those concerns, though.
John: Early on, I avoided acknowledging Lee’s asthma. I treated it like it didn’t exist. I had no empathy about it.
Lee: I have this memory of driving around in John’s car and he was smoking a cigarette. I said, “You’ve got to put that out. I can’t breathe.” He was just like, “Oh, it’s fine, I’ll just open a window.” That created a lot of tension between us. But I wanted to feel accepted, so I went with the flow.
John: When we were younger, I didn’t notice Lee’s asthma having much of an effect on our sex life. We could usually have sex anytime, anywhere.
Lee: My asthma wasn’t a big issue in those early days, so I could set it aside to some extent. Throughout college, my asthma got worse, and I developed new triggers, like fragrances—I can’t do scented candles, perfume, or cologne. John liked it when I wore perfume. It helped him get into the mood. So, he missed that.
John: Lee couldn’t do more things that we used to, like sitting by a wood fire at night, and it put a damper on our intimate life. A night could go from good to bad just like that if something triggered her asthma. When the chance of us having sex was shot, or we had to stop having sex, sometimes a word of frustration would turn into a fight and me sleeping alone.
Lee: He’d say things like, “Ugh, OK, fine,” with a real tone. I was frustrated too, honestly.
John: My attitude towards all of this changed after I saw her have a food allergy-induced anaphylactic episode. It was the first major attack of any kind I’d seen her go through.
Lee: Food allergies and eczema often go hand-in-hand with asthma, and there’s some similarity between severe asthma attacks and anaphylaxis. I’m allergic to pine nuts, among other things.
John: We were 22. We went to this restaurant we’d gone to all the time, and Lee ordered a quesadilla with pesto. The menu said it wasn’t made with pine nuts, and she’d had it before and it hadn’t been an issue. But I guess that night it had pine nuts. Like with asthma, I’d been raised to believe that if you have an allergy, you just need to drink some water and suck it up. But I saw her fingernails and face turn blue, and she was struggling to breathe. I took her to the ER. I realized, I’ve been wrong about this stuff my whole life. This is serious. I started to pay more attention whenever Lee talked about her triggers and attacks, and to get educated about asthma. I developed more empathy and knowledge.
Lee: A couple years later, I had a bad asthma attack triggered by dust. John talked me through it and helped me take my inhaler and check my breathing. Contrasting that to his attitude before I had that quesadilla really helped me feel like I could trust him and lean on him when I was going through attacks. It gave me the confidence that I could speak up when I was having trouble breathing, instead of just trying to tough it out. Now, whenever I have an issue before we have sex or when we’re having sex, instead of that Ugh sort of thing, he says, “OK, that’s cool—if things have gotten in the way of us having sex tonight, there’s time later.”
Fortunately, we hit that point of improved communication and understanding right around our mid 20s, which is when my asthma advanced to a new level and became an issue more often.
John: We never had a big sit-down conversation about how Lee’s asthma affects our sex life. Usually, we’d just be moving toward sex, and then she’d start having an attack, so we’d stop. Once she was feeling better we’d talk about what might have triggered that attack, make a note of it, and try to avoid it in the future. It was just these little sidebar conversations. But we started to develop a checklist of things that we have to think about in order to make sure she doesn’t have an episode before or during sex.
Lee: The biggest issue is that our dog likes to sleep in our bed. When he does, we need to wash the sheets or else I’m definitely going to have an asthma attack and we’re not going to be able to have sex. Also, we know that our neighbors sometimes have fires outside and the woodsmoke can get in and instantly make my chest tighten up and take sex off the table for the night.
John: If we think we might want to have sex later, I’ll need to make sure the dog is off the bed, the sheets are clean, and the windows are sealed. We have to make a clean room, basically.
Lee: John is more of the checklist executioner.
John: I mean, I’ve gotta keep my eye on the prize, you know? [Both laugh]
It’s not a literal checklist; it’s these little things you just learn to do as you start to understand your partner's triggers. I'll admit it does take me out of it sometimes when I think about how we never used to need this checklist to have sex.
Lee: It's frustrating for me, as well. We still both get frustrated if we have to stop having sex because I’m having an attack, too. It’s an ongoing learning process, figuring out how my triggers are changing and that, like, Nope, can’t do that anymore.
Now that we have a kid, we almost have to schedule sex. I think that helps us to accept and adhere to our checklist—to feel less frustrated about it. We have limited time to be intimate with each other, so we’ve just got to keep the windows closed, the dog off the bed, and the A/C on if we want to have sex. Our sex is a little more efficient.
John: I definitely agree with that. Our sex is more lean, to use a manufacturing term. [Laughs]
Lee: It’s important, when you have asthma, to know that you have a partner who understands the condition and takes it seriously, and who you can talk to about your triggers and attacks. It’s important to be able to use your own voice, rather than ignoring things, to speak up to say, “Hey, I can’t breathe right now.”