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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.
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 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.
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 can 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.
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 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.
The following are some tips to enhance lovemaking:
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 to 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. Doctors are not trained to provide sexuality advice. Learn all you can about sexual issues and share them with your doctor. If you are 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 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 DVDs 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 is 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 healthcare, there is every reason to assume that sex will continue to be an important part of your life together.
Spinal Cord Injury Model System Information Network
United Spinal Association
The Canadian Federation for Sexual Health
Women's Health Matters
Intellectual disability and sexuality. Better Health Channel website. Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Intellectual_disability_and_sexuality. Updated April 2015. Accessed April 12, 2017.
Physical disability and sexuality. Better Health Channel website. Available at: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Physical_disability_and_sexuality. Updated April 30, 2015. Accessed April 12, 2017.
Sexuality after SCI. SCI Network website. Available at: http://www.spinalcordinjury.net/Services/services_info_sexuality.htm. Accessed April 12, 2017.
Last reviewed April 2017 by Michael Woods, MD, FAAP Last Updated: 4/28/2015