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Sex and physical disability

Here are some physical impairments and strategies for managing them in relation to sexuality:

Weakness/paralysis on one side (hemiparesis, hemiplegia)

• lying on affected side with pillow support if not painful can allow movement of unaffected arm or hand to caress partner and vaginal entry from side
• male alternative is lying on back, although many men do not find this as enjoyable
• women who have difficulty spreading their legs due to tight hip muscles, may find if they bend their knees and bring their feet up close to their body that this may help
• firm mattress or larger mattress
• consider alternatives to sexual intercourse
• partner may take a more active role in love making
• see material on positioning (see ‘back pain or other chronic pain’, below).

Muscle spasms

• relaxing to try and avoid increasing spasms
• try and ride the spasm out and incorporate it into the lovemaking
• antispasticity medications such as Baclofen taken one hour before sexual activity can be helpful in alleviating spasms
• positioning can help to reduce spasming.

Incoordination, restricted range of movement in hands, arms or legs due to spasticity or contractures

• experiment with sex positions that incorporate the contractures
• partner is encouraged to take an active role in helping the person
• if hands weak or uncoordinated, use a vibrator to caress partner. If have trouble grasping objects, strap to hand.
• use sexual positions that do not require strong supporting movements by weakened muscles

Tremor in arms or legs

• if parts of the body tremble when movement is tried, allow partner to take more active role in love-making
• find positions that support the part of the body affected by tremor
• if parts of the body tremble when they are not active, then try and take a more active role in love making: trembling may decrease when you move that part of the body
• look at whether mild restraint such as interlocking arms of partner may help control the trembling
• check whether tremor is a side-effect of medication.

Back pain or other chronic pain

• think of positions that are comfortable when doing other activities – this can help in finding positions for sex
• use body positions during sex that place minimal strain on the person in pain
• use body conservation exercises (BCE) learned for kneeling, sitting down and getting up to reduce stress on body. BCE aim to train people to move in ways that put least amount of stress on their bodies
• avoid jarring movements or being too forceful – remember that smooth, flowing, gentle movements are less painful
• let partner know when you are in pain and what increases pain
• take gradual approach to rebuilding sexual activity
• are there times of the day when pain is less, more relaxed, more interested in sexual contact
• reduce your pain prior to sexual activity if possible by a hot shower, massage or stretches
• if sex has been used for other things (eg. reconciliation after fights) – can these needs be met through other ways, to help reduce pressure on sexual performance
• practice relaxation exercises 3 to 4 times daily to keep muscles/nervous system relaxed
• back pain and sexual positioning – try extension positions for sex; flexion positions for sex, giving people options whether greater comfort arching back, inwards or outwards.

Changes to sensation

• be aware of which body parts have new or reduced sensation and to what degree
• make partner aware of the change to sensation
• emphasise stimulation to other parts of the body where sensation is intact through experimentation, many people have found new parts of their body which can be sexually arousing (body mapping)
• loss of sensation – more vigorous stimulation of penis
• sensory disturbance – burning, tingling or pain. Sometimes symptom relief with prescription medication (Carbamazepine; phenytoin).

Oral and communication problems

• use non-verbal communication such as touching and gesturing
• use of Speech Therapy to improve communication or oral motor skills
• for people with aphasia, lack of expression of emotions and sexual communication is a potential problem, however, keep in mind, research has shown that the physically intact person with aphasia, who had relatively good auditory comprehension and non-verbal communication ability, exhibited the least problems in sexual adjustment, irrespective of expressive language ability.

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