A disability or chronic condition, whether it results in muscle weakness, pain, paralysis, or loss of sensation doesn’t necessarily have to cripple your sex life. Some impairments will directly affect your sexual functioning in a negative way, but fortunately there are treatments available. Others will indirectly affect your sexual life by throwing a monkey wrench into your usual sexual routine or messing with your head. Many will do both. As an expert on sex and disability and in my role as a sexuality educator, sexual counselor and sex coach I'm always promoting communication, creativity, and adaptive equipment as key ingredients in creating accessible sex.
• For men, talk to your doctor. Disability keeping you down? Whether the cause is neurological, vascular, or medication side effects, there are at least a handful of solutions for erectile dysfunction. These include oral medications, vacuum pumps, constriction devices (otherwise known as cock rings), penile injections, urethral suppositories, and if all else fails, surgical implants. While you’re at it, ask about the sexual side effects of the medicine you are taking and if there are any adjustments that can be safely made. If erection is your goal, no problem.
• For women, talk to your doctor. Feeling all dried up? A disability or chronic condition, or the related treatments, can interfere with vaginal lubrication and cause inflammation of vaginal tissue as a result of deterioration of the tissue. These problems can make intercourse painful and also results in vaginal itching, burning, frequent urination, or abnormal vaginal discharge. Treatments include over-the-counter vaginal lubricants applied before and during sexual activity, topical estrogen creams or tablets, estrogen releasing vaginal ring, oral estrogen (HRT), and Replens (applied daily or at other regular intervals independent of sexual activity). Also, ask about the sexual side effects of the medicine you are taking and if there are any adjustments that can be safely made.
• Schedule sexual activities when symptoms are least problematic and energy is highest. The idea of scheduled sexual activities may not seem very sexy but it can result in more and better sex. When we’re tired, fatigued, or in a lot of pain is not the best time to go for it. Morning sex or an afternoon delight should be on the menu.
• Take pain-controlling or antispasmodic medications prior to sexual activity. Timing is everything. While spontaneous sex can be great, in practice few of us have that luxury, except perhaps on vacation. As long as we’re planning, take any medication for pain or spasticity well enough in advance, approximately 30 minutes, so that the full benefits kicked in before you get physical. Taking the edge off the pain and spasticity leaves more room for pleasure.
• If sphincter control has been lost or compromised, empty bladder & bowel before sexual activity. Worrying about continents can be a drag. Unless you’re into water sports or scat, take precautions; nothing in; nothing out. Refrain from heavy intakes of fluids and spicy foods several hours before game time. Use the facilities to freshen up just before.
• Avoid extremes of temperature. The only heat of the moment should be a sex flush, or the fireplace and warm cozy blankets if it is too cold. Depending on your condition, extreme hot or cold can aggravate symptoms. If the temperature is too hot and you can’t control it, try adding ice to the mix or moving the party to the shower or the top.
• Experiment with sexual positions and activities that minimize pain and maximize mobility. Here’s your opportunity to be creative. There are hundreds of variations of sex positions to choose from. Get a nice picture book to keep on your coffee table or by your bed and adapt to your needs. Have plenty of pillows around for support. Fortunately there are more disability friendly sex products available these days, from the InternetRider, designed specifically for people with mobility impairments, to the Liberator foam wedges and Velcro Sport Sheets to help keep your body parts in place for maximum function and comfort.
• Spend time engaged in other sexual, erotic, and intimate activities that do not involve intercourse. Intercourse is not the be all and end all of sexual activity. Erotic massage, mutual masturbation, oral sex, and watching erotica can all result in delightful pleasures.
• Stimulate your partner orally. Communication about practical issues is key but so is sexual talk. Tell your partner exactly what feels good and what is painful. Described to them what you’re doing if they don’t have sensation. Tell them what you would like to do or what you plan to do to them in the future.