How to be sexual when your body doesn’t work like it used to. This chapter reviews ways to express physical intimacy when there are challenges with movement or spasticity.
I will always have to depend on my partner to do all of the work during sex after SCI.
With help and the right tools, you can take an active role.
The body has a motor system (similar to the sensory system) that is connected to our brain and works together to coordinate and/ or activate our muscles and limbs to move how we want it to.
Mobility: the ability to move or be moved freely and easily.
In terms of sexuality, mobility can be defined as the way you move your body to express yourself sexually.
What’s Different Now?
Following spinal cord injury there is a change in the communication system between the nerves, muscles, spinal cord, and the brain. For certain people this can result in a loss of some or all movement below the level of injury. In some cases, the body can contract without your permission—these movements are called spasms.
Changes to movement can interfere with how you would like to move your body to express yourself. Hand holding, hugging, caressing, and positioning for sexual play may be affected.
What Can I Do About It?
Learn about the tools, aids, and/or devices that assist your ability to move (e.g. wheelchairs, braces, canes, sliding boards, lifts, grabbers, universal cuffs, straps etc). All of the things that you use in everyday life, can also be helpful in assisting you with being sexual.
Things are going to be different now; however, keeping an open mind is important. Trying new things can be helpful in discovering new ways to adapt to this change. Visit our Sensory Page for tips on how to explore your body and its new level of sensitivity.
What Do I Need To Know?
While pleasure and intimacy may be at the front of your mind, remaining safe is the priority here. Falls can be a reality when trying out new techniques. Just like when you were learning how to transfer. Understanding the limits to your mobility can help you avoid injury. Keep your mobility and its limits in mind as you go through this section.
There are many common concerns:
I am not strong enough to support myself anymore
The missionary position is the most common and comfortable sexual position for most people. After spinal cord injury, this position proves to be the most challenging for partners with SCI who are on top. There are lots of other fun, comfortable, and achievable positioning options to try. Download our positioning handout for suggestions and how-to information. Pillows, slings for mechanical lifts, and straps can be helpful too.
My spasms make it difficult to have sex
Sexual play can trigger spasms. Sometimes they can be helpful (i.e. for ejaculation) and other times they can be troublesome (i.e. when you kick your partner in the face…oops!).
What are you currently doing to manage your spasms? You can add some of these techniques to prepare for sex or foreplay (i.e. hot shower, stretching, medications etc). In addition, the use of straps, foam wedges, cushions etc. may increase your level of comfort, help you access different parts of your body, and increase safety.
I can’t balance myself sitting up
Consider your balance when looking at positioning options and devices. If you have to concentrate on not falling over, this will distract you from the fun that you are trying to have. Straps, pillows, wedges and slings can be useful here (are we repeating ourselves here?). You can also consult a health care professional about ways to improve your balance.
My pain makes it hard for me to move
What are you currently using to manage your pain? You can use these techniques to prepare for sex or foreplay. If pain limits your abilities completely, consult your doctor to explore pain management options.
Click here for a good resource on understanding pain and pain management.
Real sex is only when a penis penetrates a vagina.
There are as many ways to have sex—it can happen alone, between men, between women, and between men and women!
Be familiar with how your body moves, what you can do, and what options are out there to maximize your abilities! It’s a process of exploring how your body works now — try to approach this exploration process with a sense of humour and a willingness to be flexible with your expectations and it can be fun and sexy, too.
Who Can Help Me?
Your physiotherapist or occupational therapist, can help you discuss and brainstorm options for positioning in bed or using devices. A sexual health clinician and/or your rehab physician can help you problem solve some of your biggest obstacles to sexual health, and identify medical complications of SCI that might need attention in order to help you have a safe and healthy sex life.
Peers with SCI are an excellent source of ideas and experiences – not everyone will be open to discussing it but it’s something almost everyone has been thinking about! In B.C., contact SCI BC to get involved with peer program activities and events, or contact your local SCI organization.
Despite changes to your mobility, physically intimacy is still possible. Exploring how your body can move and what you might find enjoyable or possible with sex can be both a frustrating and fulfilling process. The more you try, the more you know……the more you know, the more confident you can become!
PleasureAble: Sexual Device Manual for Persons with Disabilities (2010) - Krassioukov et al. This booklet was created by rehabilitation, sexual health clinicians and OT students, and contains pictures, descriptions and information on how to find sexual devices that work for a variety of disabilities. Available in .PDF format above, or email the SCI-BC Infoline to request a copy.
Accessible Sex Toys for People with Disabilities - My Sex Toy Guide
5 Disability-Inclusive Sex Positions to Spice up the Bedroom - Jordan Davidson, The Mighty.
Sex Positions Guide - Sex Info 101.
Contact the Sexual Health Rehabilitation Service (SHRS) or consult your rehab doctor for information on a sexual health clinician in your area.
Facilitated Sex - Sexuality After SCI
Adaptive Devices - Sexuality After SCI
Positioning with Partners - Sexuality After SCI
Check out the Video Playlist for this chapter.