SCI Forum Reports
Sexuality and Dating
October 1, 1997
After his C6 injury at the age of 16, Nick worried that women wouldn't be interested in him because of his disability. Before he resumed dating, he went out with groups of friends. He learned that becoming comfortable with himself and projecting that to others was vitally important in developing relationships. "Once I was comfortable with who I was, it gave me the confidence to approach Susan," he said. Nick and Susan have been in a relationship for five years. They were both panelists at this evening's forum.
"I'm a little different," said Della, who got polio at five months. "I grew up with a disability. I always had boyfriends around." When her fiance broke off their engagement after meeting another woman, "it never crossed my mind that he might have dumped me because I have a disability," she said.
Bob, a man with C6 tetraplegia, was injured right out of college. "I was a physical guy, and had been very sexually active in college," he said. After a number of dating experiences and sexual relationships, "I took a few years off and looked at myself." Eventually he realized that his preference for physically active women--a holdover from his pre-injury days--was limiting his options, so he became more open to different people. He also got help with sexual function problems through a urologist.
All the panelists agreed that open communication is the key to satisfying relationships and good sexual experiences. Susan said, "Nick is really open with his feelings. He lets you know what he needs and wants, what he can and can't feel. He made me feel really comfortable when he told me, 'this isn't going to hurt me,' or 'I can't feel this.' He was honest and forthcoming from the very beginning."
"You need to tell the other person, 'This is the package and this is what I need,'" Nick said. "If you're with someone who looks for more from you than you can give, then you need to move on."
The panelists also agreed that it is important to be creative with sex and try different things to find out what works best and to keep sex exciting. Experimenting with your body's sensations while alone is also helpful, Nick said. "Masturbation is very healthy especially with a disability because you have to know what works."
Talking about what you're going to do sexually can help build sexual excitement, said Nick. "It adds a whole dimension to sex and to the relationship as a whole. It's flattering and arousing."
Steve was a pre-med student when he had surgery intended to correct a blood vessel malformation. But complications during surgery resulted in paraplegia at the T2 level. When Steve resumed his sexual relationship with his girlfriend, they kept the lights on and used mirrors during sex. "It helped me to know where the heck I was. Also, it was more exciting," he said.
"Having gone through rehab gives you an edge," Steve added. "It teaches you to be in charge of your own body. You're more literate about your body. People I've dated were always kind of impressed by that."
A woman in the audience whose boyfriend was recently injured had heard that the chances a relationship will survive after SCI are one in ten. "I think it's better than that, but it does put stress on a relationship," said Steve, who is also a physiatrist (a physician specilaizing in rehabilitation). "I've seen short-lived relationships make it and long-standing ones end. Going through the rehab process together is in the very least a tremendous learning experience, whether you stay together or not."
A short movie about sex and disability profiled several individuals with SCI who are in sexually satisfying long-term relationships. One man with tetraplegia remarked that he now maintains erections longer than before his injury. The stimulation of the penile skin helps maintain the erection reflex. The film explained that although thoughts or visual stimuli can no longer cause erection after SCI, tactile stimulation can produce an erection if the nerves in the genital area are intact. Erection, ejaculation, and orgasm are different phenomena. While erection and ejaculation are reflex responses, orgasms are mental. After SCI, people may discover they have new erogenous zones in areas where there is still sensation, such as the chin, or the area where sensation starts right above the level of the injury.
At the end of the evening, Steve showed some devices available to assist with erections. One uses a vacuum pump to pull blood into the penis to produce an erection. A ring is then placed around the bottom of the penis to maintain the erection. The rings are sized so that blood flow isn't restricted, but they should not be left on more than a half hour. The devices are prescribed by physicians and are to be used after proper instruction.
Another option is an implant that is surgically placed inside the penis by a urologist. Some of these have pumps that fill the device with water to produce an erection. Implants are also sometimes used to keep a condom catheter on. Because erectile tissue is destroyed during implantation, less invasive methods are usually tried first.
Another method for producing erection is to inject prostaglandin substances directly into the penis, which causes the blood vessels to fill. Dosages must be determined with the help of a urologist or urological nurse. For those who are squeamish about injections, there is a prostaglandin-filled mini-suppository that slides onto the tip of the penis. As the suppository melts, the penis becomes erect. Erections produced using prostaglandin usually last 60 - 90 minutes.
Steve also mentioned that intercourse is possible without an erection by "stuffing" the flaccid penis into the vagina. "Moving around will produce friction that can give a lot of stimulation to a partner because the clitoris is right there on the surface," he explained.