Sex with someone who has spina bifida

Dear Alice,

I have been friends with a guy who has spina bifida for a while now, and recently, things took a turn for the better — we are just starting a relationship. I know that he has sensation below his waist, and can get an erection, but I wondered if there is anything about how his disability will affect our sex life. I am anxious for it to be pleasing for both of us, and although we are open enough for me to ask him questions, I would like to go in prepared so to speak! Is there anything that will be able to help me in making sure that the first time for us won't be awkward, uncomfortable or downright crap?!

Planning for Sex

Dear Planning for Sex,

You deserve to be commended for taking such a mature approach to your budding relationship! Spina bifida (SB) or no SB, responsible and caring sexual partners take time to talk through difficult issues, such as preferences and expectations. 

Rest assured that it is totally possible to create a mutually enjoyable sex life with a partner with SB. You are correct in recognizing that there may be special ways to prepare for sexual intimacy. Most of the following suggestions are based on knowledge that SB is a type of birth defect in which lasting nerve damage often leads to decreased sensation and response to touch and internal cues.

  • Many people with SB experience incontinence. To prevent potentially embarrassing mishaps, you may want to encourage your partner to empty his bladder and bowel just before and just after sexual intercourse.
  • People with SB are more prone to urinary tract infections (UTIs). One way to prevent UTIs is for both of you to wash well before and after sex. Urinating before and after sex will also help to prevent UTIs.
  • Some people with SB are less able to experience orgasms. In preparation for this possibility, it might be a good idea to talk this through with your partner. If this is an issue, you could both try to hone in on other bodily sensations instead of focusing only on the elusive "big bang."
  • People with SB are more likely to have latex allergies. As such, you may want to look for latex-free condoms if you chose to use condoms to protect against pregnancy and transmission of many sexually transmitted infections (STIs).
  • You specified your partner has sensation below his waist and can get an erection. If, in the future, you ever find that he has difficulty getting and sustaining an erection, there are many options available to help, such as medication, vacuum devices, and internal prostheses. 
  • It is a good idea to use lots of water-soluble lube to prevent sores and irritated skin.
Your sensitivity to your partner and sexual awareness exude sexual self-confidence, which should lay the foundation for mutual enjoyment and pleasure. With all of this know-how and planning, the stage should be set for good times.
Last updated Apr 24, 2015
Originally published Jul 28, 2006

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