Q: Now that I have a disability, I’m really concerned about having sexual intercourse. Can I do it? And what kind of sex life can I have if I can’t?
A: To the question “Can I do it?,” the answer is usually, “Yes.” The obstacle most often faced by women is an inability to lubricate, which is easily solved with a non-petroleum-based product such as K-Y Jelly or Astroglide.

For men, of course, the issue is being able to achieve and/or maintain erection. In most cases, use of either Viagra or an injectible drug will produce a reliable erection, but some men with higher spinal cord lesions find that these don’t work for them. A urologist would need to prescribe the drugs, and the man, his partner or attendant would need to be trained on how to use it.

For both men and women, spasticity can interfere with intercourse. People have found that certain positions are less likely to evoke spasms, so you should experiment to find out what works for you. There are drugs which you might take before sex – or already be taking – to help reduce spasticity. Be sure to ask your physician if there would be any impact on sexual interest or your energy level. You’re not going to feel very sexy if you’re sedated!

Some disabilities make intercourse painful for women, or someone who is small might find it uncomfortable. In most cases, women with disabilities can have intercourse. There might be loss of contraction in their vaginal muscles, but concern for this can be exaggerated. In fact, with less friction, intercourse can last longer.

For men with disabilites, intercourse might not be their forte, either due to limitations with erection, or inability to achieve positions or move their bodies. The good news is that many women don’t consider genital intercourse the most effective means of satisfaction. It’s quite easy to jump to the conclusion that we have to be sexual athletes, but it isn’t always so. There ARE other ways to please a partner – and enjoy yourself doing it.

I’m more interested in the second part of your question, “What kind of a sex life can I have?.” You seem to assume that intercourse is mandatory for a successful sex life. Nothing could be further from the truth. Too many people have bought into a commercially- and culturally-fostered message in which athletic, animal-like intercourse equals sex, and nothing else will do.

In fact, intercourse can be an obstacle to real intimacy. It’s not unusual for a couple to get so lost in such powerful sensations that they almost forget about each other! Some people even use genital intercourse to avoid authentic intimacy.

The oft-listed alternatives are well known. Oral sex. Kissing. Touch. Fantasy. Playing with toys. Or simply finding all the ways you can get wrapped up in each other’s bodies and cuddle. Searching for alternatives – or additions – to intercourse invites you to get creative. Sex should be like a good symphony. There are slow, gentle passages, and there are loud aggressive ones. It works best when the whole range is there. Over-emphasizing intercourse is a way to miss out on the soft and subtle parts of sex that are still extremely powerful and satisfying.

It really is possible to have sex without intercourse at all. It takes the pressure off both of you and gives you a chance to be more attentive to each other, to take your time and to build more variety into your lovemaking. As politically correct as this might sound, it really can be more fun. And more intimate.

Able-bodied partners often are delightfully surprised by the different style that can flow naturally in the context of disability. Many people have never taken the time to really appreciate the power of kissing and touch. You just might end up enlightening someone and expanding their own notions of sexual gratification.

And nothing says that you have to attract an able-bodied partner. Couples with disabilities might have no interest in intercourse at all and find it a huge relief to just let it go and concentrate on other activities.

Does this mean that your desire to participate in intercourse with full sensation and physicality will simply disappear? Maybe, maybe not. But after an acquired disability, you can reach a point where it need not interfere with enjoying the huge world of sensuality that remains. The urge just gets parked aside. Think about it. Isn’t it a lot better to focus on what you can than what you can’t? Intercourse may or not be a part of it.

The last thing you need is to be under performance pressure for something that your body just doesn’t do. If you’re fixed on wanting to have intercourse as a primary sexual act beyond your ability – or desire – then your attention will be drawn away from your many remaining choices. Start with being realistic and accepting about your body, and then genital intercourse will find its natural place in your sexual repertoire depending on your capacity.

Gary Karp is the author of “Life On Wheels: For the Active Wheelchair User” http://www.lifeonwheels.net/, which includes a chapter on Sex, Intimacy, and Babies. Gary has a spinal cord injury from a fall in 1973. Contact him at sexuality@icanonline.net

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