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Sex and Disability

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sexual dysfunctions - information, advice and treatmentEveryone is sexual and has a right to express his or her sexuality. That goes for people who are physically or mentally disabled just as much as for those who have no handicap.

For too long people with a physical or mental handicap have been further handicapped by societal attitudes that said they should not expect and could not have a satisfactory sex life.

This has applied to people born with a disability as well as to those whose disability occurred later in life.

This attitude has several sources.

Health-care personnel have often fostered it and sometimes disabled people themselves have created barriers limiting their own sexual potential. Fortunately, attitudes are changing.

While the facts on every type of disabling disease and condition and their effects on sexual functioning are not yet fully researched and understood, it is gratifying to see that disabled people's sexuality and sexual rights are now being recognized.

Of great importance here is the recognition that sexual interest is best expressed when the other dimensions of personality are functioning properly.

More professional attention is being paid to sexuality within the context of an integrated approach to disabled people's difficulties.

These are some of the important advances made in the area of sexual health and the disabled.

Childhood and adolescent sexuality has become a concern of parents, teachers, health practitioners; the whole range of sensual and sexual experiences are being accepted as normal and natural for the disabled young person as well as for those who are not disabled; issues of sexual identity and gender role have finally become important in both general health care and in the socialization of disabled young people.

Programs in sexuality for the visually impaired and deaf are beginning to emerge in schools, residential treatment centers and training centers.

And parents are often involved in these programs so they can overcome their own handicapping attitudes and learn to help the deaf and visually impaired to express their sexuality; issues like self-understanding, relationships, relationship, parenthood, birth control and abortion are being addressed more thoughtfully and seriously than ever before.

The mentally disabled are being recognized as sexual just like everyone else, as maturing physically at the same rate and with the same sexual drive as those who are not; multiple sclerosis sufferers have been discovering new ways of achieving sexual satisfaction.

Men and women with M.S. and many other health-care personnel are working toward reducing the fears and anxieties that form barriers preventing those with the disease from dealing with their sexual lives and relationships with realism and understanding

  • sexual behavior after a heart attack can be resumed gradually along with other activities unless specific problems lead doctors to order restrictions; unless cardiac disease is severe, the full range of sexual expressions is available to sufferers; even if limits have to be imposed, there are alternative, less stressful sexual activities than intercourse that can be enjoyed
  • privacy for the handicapped is being recognized as a right, especially in residential treatment settings
  • young people and adults with cerebral palsy are being encouraged by parents, teachers, health-care workers and society to meet, mate and form lasting relationships like others in the community; the problems caused by spasms are being overcome by exploring alternative positions and a variety of sexual activities
  • the limits on movement that the pain of arthritis had dictated are being combated by discussion, teaching and a new literature describing positions, techniques and ways of giving and getting pleasure
  • a greater understanding of colostomy, ileostomy and urostomy and their effects on sexual functioning has reduced fear and helped many men and women resume their sex lives in fulfilling ways; special ostomy clubs now help those with ostomies to adjust
  • as the sexual needs of disabled people are more fully recognized, health-care facilities are being extended to singles and gays; it isn't only in relationship that the sexuality of the disabled is a central issue.

The range of physical and mental disabilities is so great that it would take an entire book to describe them.

Even then, the degree to which an individual is affected will modify any general statements, as will the progress of the disease if it is progressive and the readiness and ability of the person to adapt.

But to get some idea of how a disability can affect sexual expression and of how its effects can be met by resourcefulness and appropriate care let us look at one fairly common physical disability spinal cord injury - and then at a fairly common mental disability.

An injury to the spinal cord due to accident, disease or congenital defect can be complete or incomplete. The injury can be high, low or at mid-level on the spine and can interrupt all or some of the continuity of the nerves.

Although a thorough evaluation of the injury and its relationship to physical sexual function is important and helpful, the effects of spinal cord injury are unpredictable, vary from case to case, and even change from time to time in the same person.

In men, spinal cord injury may interfere with the ability to have an erection in the usual way. However, a reflex erection caused by direct stimulation of areas around the penis is possible for some paraplegics and quadriplegics.

Body movements, positions and room temperature all may be important in determining whether a reflex erection will occur.

Practice helps develop the proper technique and some doctors and health-care workers knowledgeable about sexual functioning and disability will discuss this with a man and his partner. Psychogenic erections resulting from sight, sound, or smell stimuli, also occur in men with spinal cord injury.

The nervous system pathways that make this type of erection possible are not fully understood.

His partner, using proper hip movement and vaginal muscle control can keep the penis in the vagina and both can achieve pleasure.

If the man cannot maneuver into a man on top position, stuffing can be achieved with the woman straddling him and getting the penis into the vagina that way.

Side-by-side and front-to-back are among the other positions commonly used by disabled men and women.

Urine collection apparatus may interfere in some of these positions but that can be overcome by patience and willingness to try new things together. Movements, positions, techniques and the use of the hands and mouth all help.

Obviously it is unlikely that premature ejaculation will be a problem, and the need for a man to find ways to delay his ejaculation is rather low in most cases.

Orgasm and Pleasure

Orgasm is possible and is most frequently reported by men with incomplete lower lesions.

Ejaculation is also most common among men with this type of disability. Psychological stimulation (fantasy) has produced orgasm among some disabled men, so direct genital stimulation is not essential.

Having intercourse is a problem for women with spinal cord injuries. The nature of the problem varies from woman to woman, but it is not insurmountable.

Sometimes the disability prevents natural vaginal lubrication from occurring but using a lubricant, which can be purchased at a pharmacy, will overcome that. Keeping the vagina lubricated throughout intercourse prevents irritation of the vaginal tissue (which some women do not feel because of their disability).

Various positions can be used, according to movement ability, dealing with apparatus (such as a urine collection device), and how best to reduce the chances of spasm during lovemaking.

Water beds are popular with some disabled couples because they provide easy motion for the couple in their lovemaking.

The quality of orgasm in women may vary according to the physical and emotional effects of the disability.

Some women believe that the loss of sensation around their genitals prevents them from having an orgasm. This is not true, as it is possible for disabled women to have orgasm not only by physical contact as in intercourse but through breast stimulation, anal stimulation and fantasy.

Touching, caressing, cuddling and many other non-genital acts are largely unexplored areas which have enormous potential for producing intensely satisfying erotic and sexual experiences.

Q: Do spinal cord injured women menstruate?

A: Yes. A spinal cord injury usually does not interfere with hormone production so menstruation occurs as usual. Sometimes the menstrual flow is interrupted for several months right after a disabling spinal cord injury occurs, but it will usually resume.

Q: Is it true that spinal cord injured women can get pregnant and have a baby?

A: Absolutely, yes, and they can breastfeed their babies as well. Specially trained doctors help disabled women through the birth process since there are some unusual aspects of this type of birth.

Labor pains may not be felt, for example, and bearing down during labor is difficult, if not impossible, for many women with spinal cord injury.

Caesarean deliveries are as common among women with spinal cord injury as they are among the rest of the female population. It follows then, that spinal cord injured women need birth control, can have abortions and can get and spread sexually transmitted diseases like the rest of the sexually active population.

Q: Can a man with a spinal cord disability ever have a natural baby?

A: "Yes. Some men with spinal cord disability have only limited problems with erection, ejaculation, orgasm and sperm production and some can have natural children. Other men with that kind of disability have difficulties with their fertility due to changing temperatures in the scrotum, frequent urinary infections and inflammation of the epididymes, all of which can reduce the sperm-producing powers of the testicles.

After a while these factors can lead to sterility. Some men with spinal cord injuries will be sterile for another reason - that they ejaculate backward, into the bladder rather than out of the penis.

Efforts by doctors to make semen leave the penis by using electrical stimulation on the genitals have been successful in some cases. The semen is collected in a sterile container and then placed in the wife's uterus by artificial insemination. Normal pregnancy and birth is not unusual if the semen is healthy.

Q: Can a person in a wheelchair have an orgasm?

A: Yes. Some people confined to wheelchairs can have orgasm, especially if their injury does not interfere with the reflex that triggers it.

However, even people whose injuries prevent their feeling orgasm can recollect the feelings they once had  and in the proper circumstances can have intense mental orgasmic experiences. It is also important to note that physical orgasm is not necessary for sexual pleasure, as many men and women have discovered whether or not they were disabled.

Q: So there really is such a thing as mental orgasm?

A: Yes. Some disabled men and women have described peak feelings during sexual activity of various kinds, including fantasy.

This type of orgasmic experience is probably unlike the orgasm they had before their disability but they nevertheless report intense satisfaction.

This psychological phenomenon is still another example of the possibilities for pleasure people have despite the appearance of limited potential.

Q: But what about those who never had an orgasm before they were injured?

A: Reports from some men and women who never had an orgasm before they were disabled indicate they can experience a whole body orgasm and feelings of orgasmic pleasure.

Q: Is it true that some disabled men use a penis implant for intercourse?

A: Yes. If a man can never get an erection or cannot get one when he wants, a penis stiffener or dildo can be used.

One type of penis stiffener requires surgery in which a medically safe substance is inserted, making the penis firm enough for intercourse. People who request this kind of implant are usually evaluated psychologically as well as physically before the surgery.

Another type of stiffener is a hollow, penis like form into which the disabled man slips his penis. It has a waist belt which holds it in place during intercourse. Sometimes a plastic penis called a dildo is inserted into the woman's vagina to provide her with the sensation of a penis.

Q: Can a person with a colostomy still have sexual intercourse?

A: Yes. Men and women with colostomies or urostomies have intercourse. The size and location of the collection point will determine the best position for each couple.

Movements during intercourse usually do not adversely affect the attachment. People with ostomies naturally pay special attention to cleanliness and emptying the collection pouch when preparing to make love, but otherwise they can continue normally once the couple has understood and accepted the ostomy.