Sexuality is an essential part of all of us, no matter what our age, gender, health and physical ability may be. A spinal cord injury/impairment (SCI) or traumatic brain injury (TBI) does not decrease a person's sexuality and rarely destroys his or her interest in being sexual. Sexuality includes many areas of our lives.
SEXUALITY AND DISABILITY
ALL PEOPLE ARE SEXUAL
Ironically, honest talk about sexual issues tends to be difficult for most people. Sex and sexuality are such basic components of human nature - yet they are often shrouded in mystery and misunderstanding. Perhaps it is because this area has many connotations depending on one's religion, culture, family upbringing, environment, personal values, biological and psychological makeup, or countless other factors.
Yet, all people are sexual in one way or another. This is also true for people with disabilities. A spinal cord or traumatic brain injury does not diminish a person's sexuality. Unfortunately, many people believe that people with disabilities are not sexual or capable of being so. Nothing could be further from the truth.
Certainly, physical disability may alter how a person expresses sexuality or acts on it. The traumatic experience of a spinal cord or brain injury may profoundly change a person's feelings about sex. It will certainly usher in a challenging and often difficult learning, change and growth period. But people with disabilities are sexual individuals with sexual desires and concerns. They should be treated as such.
Before my accident, I was like a lot of the public in thinking that people with disabilities are less sexual or not sexual at all. But I have realized that it is an integral part of a person.
--- Sherry
As Sherry notes, sexuality is an integral part of all of us. This is no more or less true for people with disabilities. Yet, perhaps the biggest myth about people with disabilities is that they are less sexual. This is untrue.
Other misconceptions surround sexuality. A partial list includes:
MYTH: Sex means sexual intercourse.
MYTH: Talking about sex isn't natural, proper or necessary.
MYTH: Sex is for younger people.
MYTH: Men should initiate sexual activities.
MYTH: You shouldn't start what you can't finish.
MYTH: Sex should be spontaneous.
MYTH: A firm penis is essential for satisfying sex.
MYTH: Good sex ends with an orgasm.
DEFINING SEXUALITY: Not just "Can you or can't you?"
When I first got injured, I was worried that I wouldn't be able to have sex any more. But I eventually realized that sex is more than just intercourse.
--- David
Sexuality is intangible and difficult to define in a single sweeping statement. In the broadest sense, sexuality encompasses all the feelings, attitudes and behaviours contributing to a person's sense of womanhood or manhood.
Our sexual character tends to have both a public and a private side.
The public side is reflected in how we present ourselves:
- · Our demeanour and character;
- · Our dress and grooming;
- · Our professional roles and our roles as parents and partners.
The private side tends to encompass:
- · Our deeper feelings about affection and attraction,
- · Sexual interest,
- · Confidence or lack of confidence,
- · Sexual values,
- · The physical expression of sexuality either alone or with a partner.
Sex is not just a matter of 'Can you or can't you?" While it may include the physical act of sexual intercourse itself, there is much more to it than that.
Components of Sexuality
- · Biological
This is the 'blueprint" for sexuality, including gender differentiation and identity, biological sex drive and physical appearance.
- · Socio-cultural
How we think and talk about sex and sexuality is usually influenced by the culture we come from and the society we live in. We speak, dress and act in certain ways that may or may not conform to society's expectations.
- · Moral
To a large extent, the expression of sexuality is determined by an individual's values and beliefs about which sexual practices are acceptable.
- · Physical
Sexuality may include sexual intercourse but also hugging and petting, sexual talking and preparatory routines.
- · Psychological
This component involves all of the above elements, how one interprets his or her sexuality and how one chooses to express it.
SEX: A difficult topic to talk about
Talking openly and honestly about sex is difficult for many people. Many people with SCI or TBI have told us that it is sometimes very difficult to get their questions about sexuality changes answered.
Spinal Cord Injury (SCI)
"Will I respond the same as before?"
Every spinal cord injury is different. The impact that a particular SCI has on sexual functioning varies and depends on many factors:
- ·Type of injury (complete or incomplete)
- · The level of the injury
- · Medications used.
There are no definite rules about how a person's sexual response changes after a spinal cord injury. Generally, when bowel and [bladder control: link to consumer bladder changes section] and genital sensation are affected, there will be changes in genital-sexual response.
My main concerns were whether I would be able to satisfy a woman and whether - physically - I would function the way I had before. And, could I function in a way that would satisfy me? Would the sensation be the same? These were my sorts of concerns
--- Byron
Complete Spinal Cord Injuries ( Women)
If a complete spinal cord injury has occurred, the following aspects of sexual functioning are likely to be affected:
- · Genital sensation or orgasm
For women and men with spinal cord injuries that are complete at any level, there is not likely to be any genital sensation or [orgasm: link to male orgasm page and female orgasm page] feelings resulting from stimulation, although some people learn to transfer erotic feelings from other parts of their bodies that do have sensation. (see below)
- · Erotic mental and physical feelings
A complete injury -regardless of the level - does not rule out erotic sexual feelings. Many people can shift their source of eroticism so that the brain receives sexual signals from body parts other than the genitals. The brain learns to react sexually to pleasurable touching in other body areas. For example, the ear lobes and the back of the neck can be erogenous areas. This experience will be different than before but can be as fulfilling; some people describe the feeling as less intense or more diffuse. A person's attitude is all-important here. If you are convinced that sex only means intercourse in a certain position, then there may be little room to explore other possibilities. If you are more open and creative, the possibilities are less limited.
- · Erection to touch (reflex erections)
Men who have injuries that are T10 and above are likely to experience uncontrolled reflexes [erections: link to male erection pages] in response to touch on the penis. This happens because the reflex arc (from the penis to the lower part of the spinal cord and back again) functions independently of the brain. Men with SCI often welcome this type of erection, which means they can get an erection for sexual activity. Sometimes men with SCI are unhappy with reflex erections because it may happen when they don't want it to - during catheterization or when the penis is touched. For some men with SCI, the reflex erection may not be completely reliable or last long enough for some sexual activity; in these cases, some form of [erection enhancement: link to erection enhancement pages] may be used.
- · Mental erection
When an injury occurs in the lower part of the spinal cord (below T10), reflex erection to touch is impossible. However, purely mental stimulation (a sexual thought or fantasy) can lead to some enlargement of the penis. Some seminal fluid - which can contain sperm -may flow. After this emission of seminal fluid, the erection is usually lost. Men with a complete SCI below T10 generally use some form of [erection enhancement: link to erection enhancement page].
- · Vaginal lubrication
For women, spinal cord injuries can affect [vaginal lubrication: link to section on vaginal lubrication in women's section]. Some women will no longer lubricate when they have sexual thoughts; others will not lubricate when touched in this area. These changes will vary. All women have changes to lubrication at different times in their monthly cycle and may experience changes following menopause. Some specific information on changes that may occur in women after injury.
- · Ejaculation
Most men with a spinal cord injury - complete or incomplete - experience some disruption in [ejaculation: link to male section on ejaculation]. However, ejaculation is a complex response with much variation between individuals.
Incomplete Spinal Cord Injuries
There is no clearly defined way to determine what genital response will be when the injury does not result in a completely damaged spinal cord. Factors such as the location of the injury and the amount of sensation and motor functioning can be important in predicting changes to sexual response. If you can control, your bowel and bladder generally predict normal or close to normal sexual functioning.
Spinal Cord Injury (SCI) (Men)
Will I respond the same as before?"
Every spinal cord injury is different. The impact that a particular SCI has on sexual functioning varies and depends on many factors:
- · Type of injury (complete or incomplete)
- · The level of the injury
- · Medications used.
There are no definite rules about how a person's sexual response changes after a spinal cord injury. Generally, when bowel and [bladder control: link to consumer bladder changes section] and genital sensation are affected, there will be changes in genital-sexual response.
My main concerns were whether I would be able to satisfy a woman and whether - physically - I would function the way I had before. And, could I function in a way that would satisfy me? Would the sensation be the same? These were my sorts of concerns
--- Byron
Complete Spinal Cord Injuries
If a complete spinal cord injury has occurred, the following aspects of sexual functioning are likely to be affected:
- · Genital sensation or orgasm
For women and men with spinal cord injuries that are complete at any level, there is not likely to be any genital sensation or [orgasm: link to male orgasm page and female orgasm page] feelings resulting from stimulation, although some people learn to transfer erotic feelings from other parts of their bodies that do have sensation. (see below)
- · Erotic mental and physical feelings
A complete injury -regardless of the level - does not rule out erotic sexual feelings. Many people can shift their source of eroticism so that the brain receives sexual signals from parts of the body other than the genitals. The brain learns to react sexually to pleasurable touching in other body areas. For example, the ear lobes and the back of the neck can be erogenous areas. This experience will be different than before but can be as fulfilling; some people describe the feeling as less intense or more diffuse. A person's attitude is all-important here. If you are convinced that sex only means intercourse in a certain position, then there may be little room to explore other possibilities. If you are more open and creative, the possibilities are less limited.
- · Erection to touch (reflex erections)
Men who have injuries that are T10 and above are likely to experience uncontrolled reflexes [erections: link to male erection pages] in response to touch on the penis. This happens because the reflex arc (from the penis to the lower part of the spinal cord and back again) functions independently of the brain. Men with SCI often welcome this type of erection, which means they can get an erection for sexual activity. Sometimes men with SCI are unhappy with reflex erections because it may happen when they don't want it to - during catheterization or when the penis is touched. For some men with SCI, the reflex erection may not be completely reliable or may not last long enough for some sexual activity; in these cases, some form of [erection enhancement: link to erection enhancement pages] may be used.
- · Mental erection
When an injury occurs in the lower part of the spinal cord (below T10), reflex erection to touch is impossible. However, purely mental stimulation (a sexual thought or fantasy) can lead to some enlargement of the penis. Some seminal fluid - which can contain sperm -may flow. After this emission of seminal fluid, the erection is usually lost. Men with a complete SCI below T10 generally use some form of [erection enhancement: link to erection enhancement page].
- · Vaginal lubrication
For women, spinal cord injuries can affect [vaginal lubrication: link to section on vaginal lubrication in women's section]. Some women will no longer lubricate when they have sexual thoughts; others will not lubricate when touched in this area. These changes will vary. All women have changes to lubrication at different times in their monthly cycle and may experience changes following menopause. Some specific information on changes that may occur in women after injury.
- · Ejaculation
Most men with a spinal cord injury - complete or incomplete - experience some disruption in [ejaculation: link to male section on ejaculation]. However, ejaculation is a complex response with much variation between individuals.
Incomplete Spinal Cord Injuries
There is no clearly defined way to determine what genital response will be when the injury does not result in a completely damaged spinal cord. Factors such as the location of the injury and the amount of sensation and motor functioning can be important in predicting changes to sexual response. If you can control, your bowel and bladder generally predict normal or close to normal sexual functioning.
Conclusion
It's time to start the conversation about people with disabilities having sex and how they can cope with the challenges they may face. Disabled individuals have every right to experience intimacy and pleasure like anyone else. Unfortunately, they are often overlooked, stigmatized, and denied the opportunity to explore their sexuality due to societal misconceptions and stereotypes. It's crucial to understand that disability does not equate to a lack of desire or capability to engage in sexual activities.
It's essential to empower individuals with disabilities with knowledge and support to help them navigate their sexual experiences safely and confidently. Educating healthcare providers, caregivers, and society about the importance of sexual health for people with disabilities is a crucial step towards creating a more inclusive and accepting world.
Everyone deserves the opportunity to experience the joy and fulfilment that comes with sexual intimacy. So let's work towards breaking down barriers, challenging stereotypes, and promoting a more inclusive society where individuals with disabilities can enjoy their sexuality on their terms without judgment or shame.