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DISABILITY AND ILLNESS

Stroke   Heart Disease   Diabetes   Cancer   Spinal Cord Injury   Multiple Sclerosis   Parkinson's Disease                                                            

Being Disabled Does NOT Mean You're Not A Fully Sexual Person. Be Informed And Be Proactive!

Disability and illness impact sexual functioning in many ways. The more we understand how they affect us, the more we’re able to adjust and compensate so that we can continue to enjoy and cherish our sexuality.   

Many of the medications used to treat serious illness impact sexual functioning. If you experience diminished sexual functioning, ask your doctor about adjusting your medication.  

Hair loss, tremors, lack of bladder and bowel control, loss of sensitivity to touch, and the need to use an ostomy bag for the discharge of bodily waste, are just some of the conditions that those of us with illnesses and disabilities cope with. Cultivating a sense of humor, acceptance, compassion, and patience in dealing with your body’s natural functions is a key means of surviving emotionally intact and remaining sexually confident.  

It is crucial not to be defeated by illness and disability. If we search for methods of adjustment, we can so often find satisfying sexual options.  

 

Pain

Pain is distracting, depressing, and fatiguing. It interferes with our ability to relax and experience pleasure.  

To counteract these symptoms, time the use of pain-relieving medication so that it goes into effect while you’re making love. If your medication takes a half hour to work, take it a half hour before sex. 

In the meantime, gentle caressing, massage, a warm bath, a heating pad, or other overtures can begin the nurturing process of providing relief from pain and initiating erotic closeness.

 

 

Stroke

The sexual impact of a stroke is variable, depending on which, if any, parts of the body remain weakened or paralyzed in the long run. Assessing sexual function after a stroke usually takes time, because recovery occurs over weeks and months.  

Permanent paralysis of body parts, muscular spasticity, uncontrollable limb tremors, the loss of the sense of touch, confusion, forgetfulness and memory loss, and temporary or permanent loss of urinary and bowel control can all result from stroke. Sexual activity tends makes stroke sufferers particularly aware of these symptoms, and may exacerbate them. 

Making adjustments is the key to continued sexual expression and pleasure. For example: If one side is paralyzed, learn to prop that up side against the wall or with sturdy pillows. If sensation is dulled in the erotic zones of the body, explore eroticizing other parts of your body.  

A kind, patient, and interested partner can be a very great help in this process of discovery and adaptation. 

Men: In some cases when erectile ability has been lost through stroke but it remains important to you, a penile implant can provide this function. See Sexual Dysfunction for more information on penile implants, under Erectile Dysfunction. 

Heart Disease

When can you have sex after a heart attack or cardiovascular incident? In the long run, everyone’s sexual viability is affected differently by heart disease, and you should always discuss your individual condition with your doctor before having sex.  With that prerequisite in mind, a general rule is that when you can quickly climb twenty stairs without discomfort, you’re probably ready to try sex.  

There are other steps that can help, too. Create a relaxed, stress-free environment for your love-making. Avoid sex before a rigorous activity, and after drinking alcohol or eating a big meal.  

Something else to discuss with your doctor is the effect of any heart medicines on your sexual functioning. Some lower libido; others decrease circulation. If your sexual desire or functioning is inhibited by your medication, ask about possible adjustments. 

Diabetes

Diabetes generally affects sexual function in two ways:  

1. Nerve damage that decreases genital and erogenous sensation; and  

2. Circulatory impairment, which has the same effect as arteriosclerosis on the genitals by inhibiting the blood flow to the erectile tissues and preventing engorgement. A low fat, low cholesterol, low sodium, plant-based, whole food diet has been shown, in some cases, to reverse or decrease the circulatory issues caused by diabetes. 

With diabetes nerve damage- related  loss of sensation, you may need to devote more time to the caressing and arousal phase of love-making, and you may need more pressure and intense stimulation to feel sensation. Sometimes a vibrator can help. However, be careful to proceed cautiously and not injure your sensitive tissues, which heal more slowly with diabetes. Check your genitals for abrasions regularly. 

Cancer

All cancers have the potential to influence sexual functioning, both through the symptoms of the disease and the side-effects of its treatment.  

The intense physical effects of chemotherapy, radiation therapy, and surgery can all potentially impact our sexual health for short or long term durations.  

Our course of treatment, the degree to which we are informed about and prepared to cope with our illness, our personal attitude, and the support system we receive from partners, caregivers, family, and friends, can all contribute to the outcome of our illness and to our sexual survival within it. 

The Effects of Cancer Treatments 

Radiation Therapy

The energy waves generated by radiation therapy are fatal to cells as they divide. Cancer cells, which divide more rapidly than normal cells, are the focus of these lethal energy waves, but cells with fast metabolic rates such as hair and testicular cells, or delicate cells such as the mucosal urinary, genital, mouth, and intestinal cells, are also quite vulnerable to radiation waves. 

Sometimes radiation pellets are inserted into cancer-affected zones, especially of the reproductive system. Depending on the nature and placement of these pellets, they may be a danger to your partner, in which case you will have to avoid sex until they are removed or become inactive. Be sure to discuss this with your doctor, and to find out how long the treatment lasts and what precautions to take. 

Men

Sperm production may be lowered during radiation therapy, or even stop altogether.  If you are concerned about fathering children, it may be wise to have fertile sperm stored prior to radiation therapy, just in case sterility becomes a post-treatment issue. 

Hormonal imbalances such as lower testosterone levels may be a consequence of radiation, causing a decline in libido. In some cases, hormone replacement therapy may be an option to help restore sexual drive. 

Erectile dysfunction may occur as radiation irritates the nerves that produce penile erection. This effect often passes with time when treatment concludes, but is occasionally permanent. Erection is not essential to orgasm, but if erection is important to you, a penile implant may be a treatment option that can compensate for nerve damage. 

Women

Genital and bowel radiation can cause irritation, dryness and cracking in these delicate mucosal tissues, and result in a build-up of fibrosity that can interfere with organ elasticity and sexual engorgement. During and after radiation therapy, be very slow and gentle during any genital touching or penetration, and use lots and lots of lubrication.  

Be aware that fibrosis can cause the vagina to shorten a bit; having vaginal-penile sex or using a dildo 15 minutes a day will help keep the vagina stretched and open. If this is painful and lubrication (and a very gentle touch) doesn’t help, then stop: don’t ever continue if you feel pain. Rest a few days and then try again, resuming regular penetration as soon as you comfortably can. 

The ovaries often shut down during radiation, lowering hormone production. This can cause vaginal dryness; use a good lubricant during sex. 

Chemotherapy

Chemotherapy interjects chemicals and medicines into the bloodstream to act as toxins to rapid-growth cancer cells.  Side effects impacting sexuality can include fatigue, nausea and vomiting, mild to severe anemia, organ damage, inflammation of the mouth, stomach, and intestines, bone marrow destruction, decreased resistance to infections, lowered immune defenses, decreased nerve sensation, temporary or permanent infertility, decreased hormone production, and a lower sex drive. 

These symptoms can easily disrupt sexual desire. Make time for sex during the periods when you feel your best, and be compassionate, patient, and prepared for it if noxious symptoms manifest when you make love.  

Surgery

Surgery involves removing cancerous tissue to excise malignancy and prevent the cancer cells from spreading further. What sexual adjustments we need to make in order to stay sexually active depends on what tissue is removed. Whether removing all or part of the penis, breasts, testicles, or internal reproductive organs, or any other part of the body, with informed adjustments we can continue to be sexually fulfilled.  

Reconstructive surgery, adapting new sexual positions and techniques, and extending our erogenous zones, are only some of the tools we have to meet this challenge.

 

Spinal Cord Injury 

Men

With men, nerve reflex arcs to and from the spinal cord control erection and injury to the spinal cord can prevent or lessen erectile ability and/or orgasm and ejaculation, depending on the degree of nerve damage involved.  

Women

Women with spinal cord injury may be able to have sex and become pregnant with varying degrees of sexual pleasure and muscle control, depending on the degree of nerve damage incurred. 

In both cases, exploration to discover the degree of sensation and muscle function remaining is necessary. If damage prevents sensation in the genitals, you will need to focus on transferring your erotic center from your genitals to elsewhere in the body.

 

Multiple Sclerosis

People with MS can experience varying degrees of loss of muscular coordination, nerve sensation, mobility, bowel and bladder control, and brain function. MS tends to be progressive, with symptoms increasing exponentially over time. A healthy diet and life style, supplementary nutrients, avoiding stress, and taking appropriate medications can all help slow the diseases’ progress.  

People with MS often find that they have more energy earlier in the morning or afternoon, so take full advantage of this for love-making!

 

Parkinson’s Disease

Parkinson’s disease causes a progressive loss of muscular control, accompanied by involuntary tremors. All of the muscles in the body are susceptible to its progress.To compensate, have sex earlier in the day when you have more energy. Discover which positions ease the tremors and which increase them during different sexual activities so that you can use the easier positions.  

If you lose sensitivity or function in your genitals, explore eroticizing other areas of your body. If you lose erectile function and erection is important to you, a penile implant may provide this function.  

If dopamine is causing you to experience depression, talk to your doctor about adjusting the dosage, using a complimentary anti-depressant, or switching medications.

 
Disability And Illness: Shared Words

Sagit: "A spinal injury left me with erectile ability but compromised bowel control. At any time, my bowels can just let go. I dreaded the potential embarrassment during sex so much that I avoided any sexual involvement for a long time. When I finally did get sexually active, I was quietly worried every second in bed that it was going to happen, which made it impossible to be relaxed or trusting with my partner. Of course, eventually it did happen, and what a disaster! I never saw that person again.

It was tough: I wanted to see people, to have relationships, but I felt repulsive.

Finally I talked to my physical therapist about it. She suggested that I tell any potential lover in advance about my physical condition and talk it over with them before attempting sex. We worked on my attitude toward the natural bowel functions of my body, and she taught me some breathing and relaxation techniques so I wouldn’t tense up and get nervous during sex. She also lent me some great poop jokes to crack in case it happened.

When my attitude changed, everything changed. It took a while, but I found a fantastic partner. My occasional bowel accidents are just a part of my normal life now, not a looming threat."


Misha: "My cancer treatment necessitated the removal of my penis. So I thought: that’s it for sex, right? I asked my wife if she wanted a divorce. I mean, who wants to be stuck in a sexless marriage? Who wants to inflict that on someone you love?

She asked me why, and when I told her, she was furious. She told me no way, and that we were going to find a way to keep sex up front and center in our lives as always. To my amazement, when she caressed my penile stump, I had an orgasm – and even ejaculated through my urinary opening. Wow! Who knew? It seems enough nerve and erectile tissue were left to do the job.

Now sex is great – different, in ways, but great. Better than before, because we’re closer."


Jamal: "The hard thing for me after an IED took my legs was letting my lady take on a more active role. I was always the active aggressor before and I had to learn more about receiving. It was hard to let go of my ego and sense of macho, to accept that being together in a loving, intimate way could be different and okay. I'm still groping for this new place that lets me enjoy being given to sexually. Another surprise - I think she really likes the role change.

 Isha: "Though after my mastectomy I lost most sensation in my right breast after surgery, my left breast compensated by becoming ultra-sensitive. The slightest blowing, tickling, or air temperature change causes a seismic reaction! I thought it was the worst thing that ever happened to me, but I never would have experienced this level of exquisitely concentrated erotic pleasure if not for the operation. Who would have guessed there would be a silver lining like this?"

Coral: "After my mastectomy, I felt very vulnerable about the way my scar looked. My husband really couldn’t accept the way I looked, which hurt me terribly. After we divorced, I realized a lot of things had always been missing from our relationship.

Fortunately, I found a partner who was passionate about me. I knew I was desirable to her; more than that, I knew she was proud of me for fighting cancer. We found sexual positions that didn’t put a strain on my weak arm, too. Lying on my unscarred side works best. And that way I can look into her beautiful eyes."
 

More Shared Words


Q & A with Sex Educator Shain Stodt

Sex After Spinal Cord Injury

Q. My wife suffered the loss of motor coordination and about 50% of all sensation below her waist in a combat injury during which her spinal cord was damaged. As a result she’s been unable to have an orgasm. Sex is very much a part of our closeness and love, and her inability to have an orgasm is extremely distressing to me because I know how much she enjoyed it. It’s not fair for me to have orgasms while she can’t, and although she tells me she’s happy being intimate in every other way we can be, things are not the same between us. Most of the time I end up sneaking off and masturbating. 

Her doctor told us is that we need to adjust to her limitations and accept that she is non-orgasmic. I don’t want to give up on this, and I know that she feels the same way, but we have come to despair of any realistic options. Can you give us any suggestions?

                              ~ Lamonte

A. Many people discover a rich range of sexual expression after spinal cord injury. I'm proud of you both for your commitment to your sexual relationship despite your wife's injury. Absolutely do not give up! 

I believe it could be very helpful and productive for you to contact a sex counselor or therapist with experience in working with spinal injury cases. They can work with your wife's condition to help her individually and you together as a couple to maximize sexual capacity – which in most people is enormous, injury or no. 

Find a counselor you're comfortable with. Trust your instincts and don't be afraid to shop around for someone that you both connect with. It may benefit your wife or yourself to have some individual sessions with them, as well. Methods that you may explore are: 

1. Discovering and expanding areas of physical sensitivity. This includes an in-depth exploration of your wife's injured and non-injured body areas to pinpoint exactly what sensitivity levels she has where, and what pleases her. Sometimes small areas of sensitivity exist in even severely spinal cord injured people that can be acutely sensitive to stimulation. When this is the case, the only way to locate them is to search the body thoroughly by touch. Remember: sensual pleasure is not limited to the genitals, some very delicious sensations can arise from all over the body when caressed effectively. 

2. Maximizing sensate focus capacity through self-directed exercises exploring touch, massage, breathing, and lots of tender loving care. 

3. Building your wife's capacity to fantasize may be an important part of her sexual rehabilitation. The brain is the body's most powerful sex organ, and the imagination can create amazing subjective erotic experiences that can lead to orgasm. 

4. Sex researchers and therapists have recognized for a long time that non-genital orgasm, or orgasm in parts of the body other than the genitals, does exist for some people. Dr. Masters of the pioneering sex research and therapy team Masters and Johnson tells of a woman who, after a severe spinal injury rendered her unable to feel sensation in her genitals, had full and satisfying orgasms in her lips, which underwent the same pattern of engorgement and orgasmic release that her clitoral erectile tissue had previously. She and her husband had a very passionate and satisfying sex life.  

5. Lastly, this can be a process that requires a lot of listening, patience, love, and respect on both your parts. Talking honestly with each other will be pivotal to this whole process, and your counselor may suggest you use certain techniques of communication.  

And please, don't feel guilty or negative in any way about masturbating! For many people this is a very natural and healthy release while they are working through sexual issues with another person. Masturbation makes you more relaxed, and that can only help your relationship. 

A good contact for finding a counselor is AASECT: American Association of Sex Educators, Counselors and Therapists www.aasect.org 202-449-1099

Shain

Can You Have Orgasms Without Physical Touch?

Q. My friend tells me she has orgasms through sheer fantasy, without physically touching herself in any way. I find this amazing. Is this really possible, and can we all cultivated it? And if so, how? 

A. Yes people do have orgasms without touch, and yes, you can cultivate this practice. 

The chief sexual organ is the brain, and people have been known to have orgasms from purely mental stimulation. Individuals have discovered this capacity through varying means: when reading erotica, during phone sex, and during self-directed fantasy are some. The more positive your self-esteem and feelings about sex, pleasure, and leisure, the more access you will have to this lovely form of sexual expression. 

To describe the process pragmatically: this practice is most commonly cultivated through deep fantasy wherein the brain taps into the autoerotic kinetic sensations of the body in conjunction with arousing imaginative stimuli. An imaging technique called positron emission tomography (PET) has been used to take pictures of what goes on inside the brain when sexually stimulated, and a region called the claustrum showed the greatest increase in activity. The claustrum is associated with motivation and emotion. 

Ergo, cultivating ready access to your emotions and motivations will probably increase your ability to have this kind of orgasm. As will studying deep fantasy, body awareness, and relaxation techniques. 

However, it doesn't work for everyone. Some extremely sexually aware people have tried to have orgasms this way and couldn't. It's an enjoyable thing to pursue in a relaxed fashion, but don't get hung up worrying about it actually happening or not. Having or not having a fantasy induced orgasm without touch certainly doesn't mean that you are more or less sexual! 

Shain 

I Have To Have Radioactive Material Inserted Into My Penis. Is There A Risk To My Partner?

Q. I have penile cancer and need to have radioactive material placed into my shaft to fight the cancer. Does this pose any sexual risk to my lover?

A. Potentially, yes. It sounds like you are going to have radiation pellets inserted into the cancer-affected zones of your body. From Disability and Illness:

Depending on the nature and placement of these pellets, they may be a danger to your partner, in which case you will have to avoid sex until they are removed or become inactive. Be sure to discuss this with your doctor, and to find out how long the treatment lasts and what precautions to take.

The radiation emitted by these pellets may be enough to pose a risk to your lover. I know that’s hard – this is a time when gentle touch and TLC would be most welcome to your besieged penis – but if this is the case, then it is a necessary stricture you’ve got to live with until the pellets are removed or become inactive. Ask your doctor what the radiation range actually is, and be sure to get massages and loving touch in your unaffected body zones!

If you must avoid sex for a while, be careful not to become emotionally disconnected from your partner. Sex does not define you or your worth! Spend time laughing, playing, and enjoying yourself in other ways, and stay close.

Shain 

 
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