The Guide to Getting It On (167 page)

Chronic vs. Acute

There are disabilities that happen all at once. They don’t keep getting worse. This is true of most spinal-cord injuries. There are other disabilities, usually caused by diseases, which have symptoms that worsen over time.

For some people, it is easier to have a disability that starts off worse but stays the same. For instance, once people with spinal-cord injuries are able to learn how to deal with their disability, they can be pretty sure that their condition won’t worsen and they won’t have to learn a whole new set of skills just to stay even. People with chronic illnesses have a more uncertain future and may have to constantly readapt as their illness progresses. The uncertainty of a chronic illness makes it more difficult to get on with your life, as you never know when your disease is going to pull the rug out from under you. Of course, you can say that none of us has any guarantees for the future, but the uncertainty of everyday life is much easier to cope with than the uncertainty of a disease that is getting worse.

Even the recovery process is different for someone with an acute injury as opposed to a chronic illness. Consider a person who had his leg amputated after being run over in the parking lot at the 7-Eleven as opposed to having a leg amputated due to complications from diabetes. Outside of not getting to finish his Slurpee, the person who lost his leg at the 7-Eleven had no pre-existing condition and must face only the problems associated with the amputation. The person with progressive diabetes has to cope with numerous problems caused by the diabetes in addition to those that are specific to the amputation. Mind you, neither situation is enviable.

Also, the treatments for disabilities or illnesses can cause sexual problems. For instance, tricyclic antidepressants are often prescribed to help with the neurogenic pain that can occur after spinal-cord injury. These drugs can decrease the desire to have sex as well as the ability to have an erection and to ejaculate. The same is true for certain cancer treatments that adversely affect the sexuality of both men and women. (See Chapter 81:
Sex and Breast, Brain & Ball Cancer
.)

Double Your Trouble

As if it weren’t bad enough to have your spinal cord injured, accidents that cause the damage are often severe enough to also cause traumatic head injury. Not only does the person have to cope with possible paralysis from the spinal injury, but he or she may also experience low sexual drive, poor impulse control or unpredictable behavior from the brain injury.

Can Men in Wheelchairs Get Hard-Ons?

People sometimes wonder if guys in wheelchairs can get hard-ons, but they don’t wonder if women in wheelchairs can get wet! Why’s that? Contrary to what you might think, a lot of males who are in wheelchairs are able to get erections. The stimulation for the erection will often need to come from direct physical contact with the genitals rather than from feeling horny, as the link between the horny center in the brain and the genitals is often damaged. Guys with disabilities can often get good erections with the help of vacuum pumps or injections. Men with higher-level spinal-cord injuries (usually quads, not paraplegics) tend to get reflex erections. These happen when the penis is being touched and have little connection to feeling horny. They usually go down as soon as the touching stops, but some couples learn how to keep the stimulation going so they can have intercourse.

Able-bodied men often become aware of their own sexual arousal by feeling their penis grow. Men who are paralyzed have to rely on other signals to know when they are aroused, e.g. nipples getting hard, goosebumps, heavier breathing and a heart that beats faster. These aren’t any different from what able-bodied men experience, but how many guys notice subtle physical clues when their penises are screaming, “Look at Me!”

Women with spinal-cord injuries may find that the sexual wetness in their vagina is decreased or absent. Using a lubricant during intercourse can be helpful. Many women with spinal-cord injuries are able to have orgasms. Bregman and Hadley interviewed a number of women with spinal-cord injuries and found that their descriptions of orgasm were similar to those of women with no spinal-cord injury. Also, some people with spinal-cord injury have orgasms that are referred to as “para-orgasms,” which are different from genital orgasms but are quite compelling. Para-orgasms can be so strong that women who are injured above the T-6 level need to be aware of rapid changes in their blood pressure.

Both women and men who no longer have traditional orgasms can learn to experience a type of orgasm that is called an emotional orgasm. This kind of orgasm results in a rush of relaxation and calm in the rest of the body that’s like the afterglow of an orgasm.

Whether a person can or can’t have an orgasm, the good feelings that most able-bodied people get from being touched and loved are still massively satisfying for someone who is disabled. One person with a spinal-cord injury reported, “Before my accident I couldn’t get enough stimulation from the waist down; now I can’t get enough from the waist up!” When a person is paralyzed, areas such as the back of the neck and arms can become extremely sensitive in a sexual way. Also, plenty of disabled people report that watching a partner doing something sexual to them can be very satisfying even if they can’t feel the actual sensations. The brain is able to fill in the missing pieces.

Vibrator Note: Vibrators can be a helpful sexual aid for men and women with disabilities. They can supply the necessary stimulation when a hand is unable. If you tend to be incontinent, consider getting a vibrator that’s rechargeable or has batteries. Urine is a far better conductor of electricity than water, making plug-in models a wee bit risky. If your hands are too crippled to use a regular vibrator, it’s possible to embed one in a Nerf ball.

“Will I Be Able to Have Children?”

This seems like a simple, straightforward question. But it is often an indirect way of asking, “Will I be able to have sex?” “Will anyone want to have sex with me?” “How in the blazes do I have sex now that I’m like this?” The answer to all of these questions is usually yes, unless the person stays in a full-time funk and never transitions out of asking “Why me?” Try as they might, nobody but God or nature has an answer to the “Why me?” question, assuming there is an answer.

Most women with disabilities are able to become pregnant. This is why most disabled women need to use birth control, even if they are paralyzed from the shoulders down. Many men who are paralyzed have problems ejaculating. Physicians are having some success helping these men to ejaculate by sticking electrodes up their rears and shocking the crap out of nerves in the prostate region. Some guys with spinal-cord injuries above T-12 are able to ejaculate with the help of a vibrator on the penis.

Born with It vs. Got It Along the Way

Unless they are in a rock’n’roll band, most people who make it to adulthood have achieved a certain level of maturity. But if a person was disabled at a young age, it’s possible that this has gotten in the way of achieving the maturity to behave as a responsible and caring adult. For instance, how does a kid who is disabled at age 16 progress through the usual steps toward independence if he or she needs a parent to get them out of bed and dressed each morning? If in a rehab center, how does he or she get the privacy to explore sexually as other kids do? How do they masturbate with crippled hands?

Consider the following questions posed by a therapist who works with the disabled: “How does a young girl in a wheelchair learn how adults are sexual if her parents are afraid to be that way in front of her? How does she explore her parents’ drawers when they are out and find books, movies, condoms, sponges, lingerie and so forth—as many youths do—if she cannot get into their bedroom? How can she find her brother’s copies of sexually explicit publications if she cannot get under his bed where they are stashed?” [From “Performing a Sexual Evaluation on the Person With Disability or Illness” by Kenneth A. Lefebre in
Sexual Function in People with Disability and Chronic Illness,
Marca Sipski and Craig Alexander, Aspen Publishers, (1997).]

People who are disabled at a young age will become adults with the same sexual drives and desires as anyone who is not disabled. However, they may be missing a sense of appropriate ways to satisfy their sexual urges. To help fill in the missing pieces, parents and educators of disabled kids need to be more open rather than less about sexual issues.

Sex & People Who Are Developmentally Disabled

It is not likely that people who are developmentally disabled will be reading this book, although we know of one such woman by the name of Linda who loves looking at the pictures! People with developmental disabilities have the same sexual urges and desires as people without disabilities. They simply go through the stages of sexual development at a slower pace.

The developmentally disabled pose special problems when it comes to sexual training, because they may need a good deal of repetitive explanation about things that many adults feel uncomfortable saying even once. Also, in their drive toward sexual pleasure, developmentally disabled kids may be even less apt to use birth control than their nondisabled partners in crime.

If you are the parent of a disabled child, or you work with people who are disabled, you might be at a loss for finding good references to help you in dealing with your child’s sexual growth. We keep an extensive list of resources on this subject in the links section at GuideToGettingItOn.com.

Body Image

If a person has been disabled for a long time, particularly from a young age, his body image might also include a wheelchair or braces, scars from surgeries, hands that are twisted and not particularly dexterous, a voice that slurs words, a head that doesn’t sit straight on its shoulders or other features that aren’t always like those of his or her peers. It may be very difficult for a person who is disabled to feel attractive and effective if they can’t see themselves as separate from the devices that help them to survive. As a result, they might need plenty of feedback that you value them as a person in the same way that you do someone who doesn’t have a wheelchair, braces or disfigurements.

Dear Paul,

We both have spinal-cord injuries and are disabled. Yet we like watching porn that shows able-bodied people having sex. Is this weird? —Rhonda from Rolling Hills

Dear Rhonda,

None of us here have nine-inch penises, last forty-five minutes, come in buckets or have partners who like taking it ten different ways, but we like watching pornography, too. If most of it weren’t so boring, we’d watch it more often! Keep in mind that pornography is a fantasy. It helps us go places in our minds where many of us wouldn’t go in reality even if we could. Now here’s a question for you: I’ll bet you aren’t worried about watching able-bodied actors in TV or movies, so why when it comes to porn do you suddenly worry about being crippledly correct?

Explaining Yourself & Educating Others

“People do have all these kinds of curiosity, and you have to find ways of making them feel more comfortable around you at first.” —Steve, on the videotape
Sexuality Reborn

Just like people who are able-bodied, people who are disabled need to learn their own sexual strengths and weaknesses and then teach a partner about themselves. For someone who has had a stroke, it might be important to lie on their affected side so they can use their active arm for caressing a partner. Likewise, they might have a “visual field cut” which causes them to ignore one side of their partner’s body. The partner needs to let them know about this. (This example by way of social worker Sharon Bacharach.)

When it comes to enjoying sex, different disabilities pose different challenges. For instance, if you can’t use your hands in a way that allows you to masturbate, then figuring out how to do that will be one of your first challenges. If you need help breathing but want to give a partner oral sex, you might need to alternate sucking on your partner’s genitals with sucking breaths of air from your respirator hose. If you can’t have intercourse, then you’ll need to work out ways of pleasing both yourself and your partner without it. (This book has plenty of chapters that describe ways of doing that.) Perhaps your disability has left you with little nerve sensation in your genitals, but the opening of your anus is still sensitive; stimulating it might bring you to orgasm. Perhaps your neck, lips, cheeks or nipples are highly sensitized to touch. Maybe it helps if you take a warm bath or shower or to have a beer or glass of wine before having sex. This is just as true for able-bodied people.