Tweet Sexual health must be understood holistically including both physiological and subjective sexual functioning. Physiological sexual functioning refers to physical aspects such as the sexual response cycle, frequency, and quality of sexual behaviour, whereas subjective sexual functioning reflects an individual’s appraisal of their sexuality, such as satisfaction with sexual function, or quality of current intimate relationships (Eisenberg et al., 2015). Both psychological and subjective sexual functioning can be negatively impacted by injury and/or disability. Unless you have been personally affected, or are connected to someone who has been affected by disability, you may have never had to imagine what it would be like to have sex under these limitations. Disability can be understood as a result of the interaction between characteristics of the individual and those of their environment (Eisenberg et al., 2015). Using this definition, the importance of adaptation in efforts to diminish disability is realized. It highlights that the interaction between the individual and their environment is the causal factor for disability and not the person’s impairment itself. Some may believe that those who rely on a wheelchair for mobility as a result of paralysis, stroke, cerebral palsy, etc., do not engage in the act of sexual intercourse at all. However, this is not true! The sex lives of those in wheelchairs are often quite active. As described by Eisenberg et al. (2015) disability shapes a person’s physical, emotional, mental, and social experience and expression of their own sexual nature. I hope to address a need to spark discussion about disability-relevant variations of intimate relationships and sexual activity.
Factors affecting sexual health in those with disability can stem from direct consequences of the injury or disease, and also from indirect consequences associated with the condition that interfere with sexual experience. According to Eisenberg et al. (2015), direct factors include any disruptions to the physiological sexual response cycle that are a direct consequence of the injury or disease (i.e. erectile dysfunction after spinal cord injury). Conversely, indirect factors refer to issues associated with the condition (i.e. mobility, bowel and bladder function, cognitive functioning, etc.), as well as psychosocial elements associated with living with a disability (i.e. negative body image) that interfere with the overall sexual experience. Too often the development of sexual rehabilitation plans seeks to restore what would be considered “normal” sexual functioning by focusing on only the direct factors impeding on one’s sexual health. Unfortunately, such a narrow focus discriminates in favour of able-bodied individuals, neglects the psychosocial factors such as body image, sexual self-esteem, internalized negative stereotypes about disability, and cognitive issues that are just as important to address during therapy. These indirect consequences appear to be particularly important predictors of the quality of one’s subjective sexual functioning. Eisenberg et al. (2015) describes a sex-positive, adaptation-focused approach to assessment and treatment that draws on strengths as opposed to focusing on the limitations of people with disability. Sexual assessment is the first step in communicating to a person with disability that the health care provider understands the value of sexual health as part of whole health and is open to discussing sexual issues according to Eisenberg et al. (2015). Assessing the needs of persons with disability seeking medical, and/or mental health care for issues related to sexuality requires an integrated biopsychosocial approach.
How do people in wheelchairs even have sex, you may ask? Well, just like any other person, usually in bed! However, many of the direct consequences of disability can be addressed using aids to help adapt sexual activity. Current aids available on the market include equipment such as vibrators, sex swings, sex wedges, sex chairs (i.e. IntimateRider), and restraints. The partners of wheelchair users have admitted that the wheelchair itself becomes a sexual aid at times. Most modern wheelchairs have removable armrests, swing away footplates, folding backrests, locking brakes, and power tilt, all of which can be used easily to accommodate wheelchair sex and greater sexual freedom. Just as you would for sex in any chair, sliding the male or female’s bottom to the front edge of the wheelchair seat gives greater access for sex. It is important to experiment with your partner, and encourage open dialogue with them. The process of re-learning about your body, or your partner’s body, new likes, and dislikes, can be a pleasurable one. There are many blogs and online forums that allow people with disabilities to ask questions, share their experiences, and provide great suggestions to others. For example, Graham Streets, founder of the Mad Spaz Club Blog, shares a few tips on how to better enjoy sex as a person with disability. He advises that some sex positions are easier to do than others in bed. With that, he cautions when limited sensation below the level of spinal cord injury exists, sensitivity above the level of injury often increases and can become hypersensitive and encourages partners to explore and pleasure these new sensitive spots. He also highlights a new appreciation for scented candles, rose petals, lingerie, nudity, enticement, and foreplay for all sexes as a reminder that sexual intimacy is more than just penetrative intercourse.
Those who were born with, or have acquired a disability of some sort are not damaged goods unable to participate in sexual intimacy, sex is an activity for everyone. Prioritizing the sexual rights of people with disabilities, as well as abolishing stereotypes, and taboos will ensure that people with disabilities, have greater education and access to positive subjective and physiological sexual functioning. Adjustment to disability is an active, ongoing process. Whether it be a medical or a psychological intervention, effective treatment requires a sex-positive, biopsychosocial approach. We must adapt the sexual script to emphasize the strengths of persons with disability putting the patient first, and not the desire to restore normalcy.
Brittany McBeath, BAH, Psychology.
Eisenberg, N. W., Andreski, S-R., & Mona, L. R. (2015). Sexuality and physical disability: A disability affirmative approach to assessment and intervention within health care. Current Sexual Health Reports, 7(1): 19-29.
Streets, G. (2011, October 15). Wheelchair sex after spinal cord injury. [Mad Spaz Club Web Blog]. Retrieved from http://www.streetsie.com/spinal-injury-wheelchair-sex/comment-page-1/#comments