by Jill M. Shuman
Actor Christopher Reeve and his wife created national headlines when they spoke
in public about their plans for an active sex life, despite his catastrophic
spinal cord injury. But they are not alone. In fact, for many couples, sex can
be as good or even better after a disabling injury.
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, 50 percent of people with spinal cord injuries
report that they are able to have an orgasm. Many of them 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. The
divorce rate following spinal cord injury is only slightly higher than in other
populations, and thousands of people have been married and begun families after
a spinal cord injury
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
doesn't 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 expect
If 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 continence 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 factors
Less 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've lost your indepedence or your ability to play the traditional role in your relationship. All these factors may cause you to give up on sex. But help is close at hand.
Finding what works
There 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
even 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 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 such as K-Y Jelly or Astroglide. Do not use petroleum jelly, which
can cause infections.
- It is perfectly OK 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 or cold
packs. 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 such as
amitriptylline (Elavil, Sinequan). 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 their toes, or a towel, or their mouth and to gain pleasure from
being touched.
It is important to arrange private time for you and your partner. You need time
to be alone together to explore your sexual urges and share your thoughts as to
how best fulfill your needs and desires. It is possible to achieve orgasm even
when a significant part of your body has minimal sensation or motion. Or you may
attain sexual satisfaction in an entirely non-physical manner, relying instead
on the emotional or spiritual release that comes from an intimate, caring
relationship.
Be your own advocate. Health care providers are not necessarily trained to
provide sexuality advice. So you may be left to your own devices. Learn all you
can about sexual issues and share them with your doctor. If you're sexually
active, ask to receive the same information that is given to non-disabled
sexually active people, such as advice about birth control, sexually transmitted
diseases, and for women, regular pelvic exams. If your concerns are not met,
joining a support group or counseling with a psychiatrist or certified sex
therapist can help break through some of the roadblocks.
As a person with a new disability adjusts to a new physical reality, it may be
difficult to change self perceptions to accommodate the injury in a positive
way. There are pamphlets, books and videos that address the concepts of body
image and sexuality. You may find these books, in conjunction with candid
conversations regarding sex, self image and your body, to be helpful as you
search for different ways to express sexual feelings.
Remember that everyone has the potential for sexual growth. Sexual pleasure adds
to the quality of life for everybody, including people with disabilities. It's
simply another part of the rehabilitation process. It may not be perfect the
first, or even the second time, but with a loving partner and supportive health
care, there is every reason to assume that sex will continue to be an important
part of your life together.