Sex and Specific Physical Disabilities
Disability can potentially impact any aspect of a person’s sexuality. People with disabilities may wonder if anyone will find them sexually desirable, if their partners will stay with them, if they will ever enjoy sex again, or if they can have children. Some may decide to ignore sexuality issues altogether because they believe these issues no longer apply to them.
It’s time to dispel the myths and misconceptions that surround sexuality and disabilities. Just like everyone else, people with disabilities are sexual beings. People with disabilities have sexual desires, they can be sexually aroused, and they can enjoy sexual intimacy. It just may have to happen differently, so understand ahead of time that you will experience difficulties and frustrations.
Let’s take a look at some specific physical disabilities and see how they can affect sexuality.
Multiple sclerosis is a disease of the central nervous system. A number of sexual issues can arise for a person with multiple sclerosis that can in turn affect sexual functioning. On an emotional level, the stress of having multiple sclerosis can affect sexual desire levels and functioning. On a physical level, the way in which multiple sclerosis affects the nervous system can alter how a person with multiple sclerosis experiences sexual arousal. Medications to treat multiple sclerosis can also affect sexual functioning, as can the symptoms that accompany a multiple sclerosis episode.
Heart Disease or Cardiac Conditions
People who have any kind of heart condition, including surviving a heart attack, often mistakenly think that their sex lives are over. Not true! Anyone managing a heart condition needs to ask their healthcare provider about sexual side effects of their medications (including blood pressure medications), and any recommended changes to their sexual behaviors or relationships.
Spinal Cord Injury
Spinal cord injury impairs messages from the brain to other parts of the body. Every spinal cord injury is unique depending on level and completeness of injury. Some type of change in sexual function (ability to attain or maintain an erection, to vaginally lubricate, to ejaculate, to have an orgasm, or to feel sensations in the genitals) is experienced by roughly 80-90% of people with spinal cord injury.
While there are expected changes in sexual function based on the level of spinal cord injury, the ability to experience sexual satisfaction and orgasm after spinal cord injury has not been significantly related to the level of injury. Factors associated with positive sexual adjustment include good sexual knowledge, openness and communication with your partner, and time since injury. Time since injury is associated with a general increase in self-esteem and an increase in sexual self-esteem.
Traumatic Brain Injury
Traumatic brain injury can affect people in many different ways, depending on the severity of the injury and the age at which the injury occurred. Sexual functioning can be affected in ways that include differences in sexual arousal and response. Changes in personality due to the traumatic brain injury can cause a person to either take more risks in their sexual relationships, or to disrespect the boundaries of their sexual partners.
Generally speaking, cerebral palsy itself does not affect a person's sexual desire or functioning level. Cerebral palsy can, however, limit a person's ability to use particular sexual positions and to give themselves or others pleasure in certain ways. Cerebral palsy can also affect body image in ways that can cause people to isolate themselves from sexual relationships.
Injury and stress can lead to pulled muscles, damaged joints, bulging or ruptured disks, and/or pinched nerves. Though there are myriad reasons for and descriptions of back pain, they can be placed into four broad categories as follow:
Any sexual activity can be made more pleasurable by preceding it with a gentle massage, a hot bath or shower, or the application of ice. Here is more specific information for the four different types of back pain:
Brittle back pain offers the most serious challenge. A person with this condition should lay on their back on a firm surface with pillows supporting the knees and head. Some find it comfortable to have a small hand towel rolled or folded and placed under the lower back. It may also work if both partners lay on their sides. The partner with the brittle back should take a passive role in having sex, with the other partner proceeding to introduce stimulation in a very relaxed, non-rushed manner. Vaginal sex may not be tolerated by some people with a very brittle back – these people should engage in other sexual activities that do not risk their back. These activities may include touching, massage, oral sex, and mutual masturbation.
A person with backward pain wants to find positions that allow for the forward bending of the back. For a female, comfortable positions may include lying on her back with the partner on top – with her legs bent toward her chest. Another position involves sitting on the edge of a chair or sofa while her partner kneels between her legs to stimulate her clitoris or to enter her vagina. For a male, lying on his back may not be tolerated. He may be more comfortable entering his partner from behind as they both kneel on the bed.
A person with forward pain will want to use positions that support the arching of the lower back. To help a male, a female partner can bend her knees toward her chest while on her back. A male can also lie on his back with a pillow under his lower back, or he can sit in a sturdy chair. A female with this type of back pain may feel more comfortable lying on her stomach with a pillow under her chest, allowing her partner to enter her from behind.
Persons with one-sided back pain generally feel better in any position in which they can bend one leg, or with both partners lying on their sides.
The nerve damage in spina bifida that affects urinary and bowel functions may also affect sexual functioning.
Males may have satisfactory erections, though they will not ejaculate. Other types of sexual dysfunction are also possible. Females are generally less affected in their sexual functioning. In males and females, altered genital sensation can affect - but does not prevent - arousal patterns and sexual functions. Orthopedic problems (for example, with lower limbs) can affect the ability to use some, but not all, sexual positions.
Most of the time, emptying the bladder and the bowel will allow for “accident-free” sex. A little urine leakage is harmless to both partners.
Neuromuscular Disorders, Including Muscular Dystrophy
There are a few exceptions, but for the most part, sexual function is not impaired by neuromuscular disorders.
Planning and timing, without being too hung up on the idea of spontaneity, is the key. Even if you end up having sex less frequently, identify your ideal conditions and time your sexual activities to coincide with them. Ask yourself, When am I most rested? When do I have the most energy?
People with neuromuscular disorders are more likely to develop respiratory and cardiac problems, and sex can be a strain in those situations. Some positions require less energy than others, so experiment. Many couples find it’s easier when both people lie on their sides. Also consider engaging in sexual activities that may be less strainful – including kissing, making out, massage, oral sex, and manual sex.
Be aware that certain medications can have unfortunate side effects on your sex life. For example, some drugs prescribed to lower blood pressure also cause impotence. If you think you may be taking a drug that's affecting your sex life, don’t stop taking the medication. Instead, talk with your health care provider – you may be able to safely switch to a less troublesome product. If not, you may be able to time sexual activity to coincide with the trough, rather than the peak, of drug side effects.
Adapted from articles by The Sexual Health Network. The original articles can be found on www.sexualhealth.com. Additional information was adapted from an article by Margaret Wahl. The original article, “Speaking of Sex: Common Myths About Sex And Neuromuscular Disorders,” can be found on www.mdausa.org. Information on spina bifida was obtained from an article entitled, “Sex and spina bifida.” The original article can be found on www.spinabifida-incontinence.info.