Disabled with major sexual frustration

Dear R,

Take heart! While your situation may feel challenging right now, there are ways to call upon the abilities you do have to develop a sex life that feels good for you. Depending on what led to your paralysis, and what sensation you currently have (your body has different spinal cord tracts for motor movement and for sensing things like touch, vibration, and pain), there are a variety of ways you can find support in your quest for sexual satisfaction. You mention that the nursing staff isn’t available to help you address your sexual urges, but it may be worth finding a health care provider who you can speak with regarding your concerns. A lot of health care providers will be more than willing to talk with you about your feelings and desires, and work with you to find some tools that can help you (1) maintain an erection, (2) ejaculate, and (3) have sex with a partner in a satisfying way. It might take some work to find a provider who you feel is right for you, but it's definitely worth the search to find someone who can help! It might also be helpful to shift your perspective on sex to one that focuses on the process and exploratory side of sex, as opposed to orgasm and ejaculation as outcomes.

First, a bit about erections: erections are controlled by spinal cord levels S2-S4 (down at the base of your back in the sacral region). Broadly speaking, erections can be grouped into two categories — psychogenic erections are the kind that result from hearing or seeing something provocative, and reflex erections are a result of physical stimuli (like a full bladder, or being caressed or touched either on the penis or at another erogenous zone). While full body paralysis might make psychogenic erections more difficult, reflex erections are often still possible. Treatments like implants, pills (such as sildenafil), shots (with drugs such as papavarine or alprostadil), and pellets may help you maintain an erection when you get one. A vacuum pump is a non-drug and non-invasive way to get hard: a pump pulls blood into the penis and a band at the base holds it there for up to 30 minutes.

Now, onto ejaculation: because this action requires muscle activity and not just the filling of the penis with blood, many people who are quadriplegic cannot ejaculate. While reaching orgasm doesn't require ejaculation, it can become a concern when individuals want to have children. Rest assured, though, there are options for retrieving viable sperm, but getting a bit of medical advice first is recommended. When you are able to chat with your provider, some questions you might want to ask include:

• What are the medical options for me to maintain an erection?
• Given my injury, will I be able to ejaculate when having sex? Is there any supportive medicine or device that can help me ejaculate?
• Do you have other patients who have difficulty with maintaining an erection and ejaculating? What tools have worked for them in order to have a satisfying sex life?

In a larger sense, a healthy and fulfilling sex life includes many different activities, regardless of physical abilities or disabilities. A great first step can be to shift from a perspective of outcomes — for example, having sex with a partner, or ejaculating — to a perspective of physical exploration. Again, depending on what physical sensations you do have, and the source of your paralysis (e.g., traumatic accident, an infection, or a genetic process) you may come to adopt a more specific definition of having sex. Replacing a model of “outcomes” or a focus on an end result with one of “process” and exploration (i.e., the journey, not the destination) could not only be fulfilling, it may also end up helping you connect with a great partner out there who will be excited to join you on a journey of sexual discovery! To that end, the Disabilities Health Research Network of Canada published an informative guide for sex and disability called “pleasureABLE: Sexual Device Manual for Persons with Disabilities.” You may want to check that out for some initial suggestions and ideas.

Here’s to helping you get your Marvin Gaye-style “Sexual Healing” on,