Questions about Sexual Intimacy

When caring for a life partner with a chronic disability, you may have questions about what is possible and/or advisable in terms of sexual intimacy. Keep lines of communication open between you and your partner, but also between both of you and your loved one’s physician and other healthcare providers.

Both partners should take responsibility for dealing with relationship issues. You are in it together. You may need to educate yourself about new or different methods of sexual expression than you have experienced before. Start with exploring your own and each other’s bodies. Engage in cuddling, petting and masturbation before resuming intercourse. There is no hurry; you have the rest of your lives.

Assistive devices (e.g., aids, prostheses) can help couples overcome some of the barriers imposed by disability. Staff in shops selling sex toys are supportive and often remarkably knowledgeable about engaging in sexual activity when one or both parties have a physical disability.

No general guide can give definitive answers that fit the situations of all individuals. The following information is provided to address some common myths and identify areas to explore with medical professionals.

This question often arises when the loved one has experienced a spinal cord injury. Approximately 50% of men and women with spinal cord injuries report experiencing orgasm. The level of spinal cord injury affects the male's ability to have an erection and the female's ability to lubricate and experience orgasm.

A male with spinal cord injury can experience psychogenic and reflex erections. A psychogenic erection takes place as a result of stimulation from the brain associated with sexual fantasy, viewing of erotic materials or participation in sexually-stimulating activities. A reflex erection is a response to direct physical contact with the penis or other erotic areas, such as the ears, nipples or neck. A reflex erection is involuntary and can occur without any sexual or stimulating thoughts.

The nerves that control erection are located in the sacral segments (S2/S4) of the spine. Spinal cord injury above these segments results in loss of the ability to have psychogenic erections. Thus, the male with a spinal cord injury at S1 or above is no longer able to achieve an erection by becoming emotionally or mentally excited; however, physical stimulation may lead to reflex erections.

Males with spinal cord injuries can experience orgasm, especially when concentrating on their partner's arousal. The ability to ejaculate, however, decreases dramatically after spinal cord injury.

Viagra and Levitra have been found to be effective for the management of erectile dysfunction in individuals with spinal cord injury who have either a complete or an incomplete lesion. No adverse side effects, such as autonomic dysreflexia, have been reported with the use of these medications.

People with spinal cord injuries usually require a much longer period of stimulation to achieve orgasm than before the injury. The majority of individuals with spinal cord injuries report sexual satisfaction, even if they do not experience orgasm.

Many individuals worry that vigorous sexual activity may be dangerous or will cause their chronic disability to worsen. For example, individuals who have had a heart attack may fear that sexual intercourse will lead to another heart attack.

For many years, it was thought that individuals with MS should not engage in sexual intercourse for health reasons. However, in recent years this myth has been debunked. This does not mean that all forms of sexual expression and all positions are equally comfortable and enjoyable. Spasticity can cause cramping or uncontrollable leg spasms. Pain can interfere with pleasure. Incontinence can be an issue. But sex is not a prohibited activity.

If you or your loved one has any concerns that sexual activity might negatively affect health, it is important to ask a physician who knows your loved one’s medical history and situation. If the physician gives the go-ahead, the next step is to find out whether particular activities or positions will be more comfortable and pleasurable than others. Your physician can recommend knowledgeable resources on sexuality and disability. Open communication and a sense of adventure will help you maintain a strong and intimate relationship with your partner in the face of chronic disability.