Sex and Disabilities Not Mutually Exclusive
The general attitude toward people in wheelchairs is that sexual activity is impossible. Nothing could be further from the truth. Because sex is never entirely genital, it can certainly be enjoyed by a person who is disabled or physically handicapped. In fact, some people with spinal cord injuries say that they are able to have an orgasm. They report areas of the body above the injury that become hypersensitive and, when stimulated, result in sexual arousal and sometimes orgasm.One common misconception following a spinal cord injury is that a single man or woman will never find a life partner, or that an existing partner will leave a relationship due to the complications of an injury. This is not the case.It is important to remember that the inability to move does not imply the inability to please your partner or to be pleased. The absence of sensation does not mean that there is an absence of feeling. A disabled person still feels desire even though the genitals may no longer function. The ability to enjoy intimacy and closeness persists even though the ability to perform may not. Couples can still enjoy a loving, close, and intimate relationship although it may be different from the one shared prior to the disability.
Physical Changes to ExpectIf the disability is the result of a neurologic lesion, such as a spinal cord injury, women might expect to have changes in sensations in the vaginal area, which might cause them to become either less or more sensitive. Vaginal dryness caused by reduced lubrication may also be a problem. Men may have difficulty or an inability to get an erection, and may notice less sensation in the penis. They may also note difficulty with ejaculation.Depending on how much of the spinal column is involved, spasticity might cause cramping of the adductor muscles of the thighs, making them difficult to separate. Pain syndromes can make response unpredictable, making what once felt stimulating now feel painful. Bladder or bowel incontinence can cause embarrassment and anxiety, and an indwelling catheter may lessen sexual interest. In addition, weakness, fatigue, and breathing difficulties can also be barriers to sex as it used to be.
Psychological FactorsLess easy to document are the psychological factors. Stress, depression, and grief are all barriers to decreased interest and often create performance anxiety. The pressures of not being able to work or of being seen as a burden also take their toll on a couple's sex life. You may also feel that a disability has changed the way you look, or that you have lost your independence or your ability to play the traditional role in your relationship. All of these factors may cause you to give up on sex. But help is close at hand.
Finding What WorksThere are treatments and options available that allow people with disabilities to enjoy a nearly normal sex life. Some of these require variations in positioning, while others involve altered forms of sexual activity of a non-intercourse nature such as touching, kissing, fondling, or oral-genital stimulation. Unfortunately, sensation cannot be restored to parts of the body affected by disability, but there are techniques you can use to increase your sexual stimulation.Set aside time to explore various parts of your body with your hands and to experiment with different kinds of touch, for example stroking, rubbing, and squeezing. Learn to use your mouth to kiss, suck, or nip. Play with different sensual sensations on the skin, such as lotions, oil, powders, feathers, silk, or a vibrator. Concentrate on stimulating a specific area without planning to move ahead to intercourse. These exercises emphasize intimacy and pleasure versus performance and orgasm.It is important for partners to communicate and experiment, remembering that intercourse is only a small part of sexual intimacy. The need to be open and experimental often leads couples who share a disability to discover a range of touching, caressing, positions, and pleasures that many able-bodied couples would envy.
Tips to Enhance LovemakingThe following are some tips to enhance lovemaking:
- You should feel free to engage in any sexual activity that is physiologically possible, pleasurable, and mutually acceptable. One priority is to find a comfortable position. Pillows and cushions can lend support or take pressure off of sensitive areas.
- Problems of lubrication can be helped by the use of water-soluble lubricants. Do not use petroleum jelly, which can cause infections.
- It is okay to leave a catheter in place during intercourse, as long as it is taped to the stomach or inner thigh to keep it out of the way.
- Muscle spasms and rigidity can be controlled with medications.
- You can compensate for reduced sensations in the genital area by using a vibrator.
- Try and keep track of your sleep patterns so you can make love at times when your energy is at a peak.
- Pain syndromes can often be controlled with medications. Other medications can be timed so that their benefit is coordinated with the desired time for sexual activity.
- A urologist can help you explore options to manage difficulties with erection, these might include medication, exercises, or prostheses.
- People with minimal use of their arms and legs can learn to stimulate their partners using other parts of their bodies.
National Spinal Cord Injury Association
Spinal Cord Injury Model System Information Network
The Canadian Federation for Sexual Health
Women's health matters
Disability and sexual issues. Better Health Channel website. Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Disability%5Fand%5Fsexual%5Fissues. Accessed September 9, 2013.
Rowles D. Spinal cord injury: sexuality. LIFE Center: Rehabilitation Institute of Chicago website. Available at: http://lifecenter.ric.org/index.php?tray=content&cid=2560. Accessed September 9, 2013.
Sexuality after SCI. SCI Network website. Available at: http://www.spinalcordinjury.net/Services/services%5Finfo%5Fsexuality.htm. Accessed September 9, 2013.
- Reviewer: Michael Woods, MD
- Review Date: 09/2013
- Update Date: 09/09/2013