Sex for the Disabled
It may never have occurred to you but even people who are partially brain dead sometimes have the ability to become sexually aroused. Sexuality is such a strong characteristic that it often exists in individuals whose other physiologic systems are severely impaired. Even quadriplegics frequently desire to please a woman with their tongue despite being unable to be stimulated themselves.
We don't normally have contact, even in books or movies, with disabled people having sex. For example, when was the last time you thought of two people with Down syndrome having sex?
What about severe mental retardation? What about paraplegics? How about really old people...I mean like in their late 80s or even in their 90s?
We also tend to be unaware of differences in sexual activity in people who have common medical conditions that change sexual function. This can include guys with high blood pressure who take certain medications or people with multiple sclerosis who have reduced sensation or people with atherosclerosis who have reduced blood flow to the pelvis or people with diabetes, Parkinson's disease, Hypogonadism, Peyronie's disease or simply people with obesity. These individuals have more difficulty having sex but they probably still want to.
Due to the fact that we don't normally see or talk about disabled people having sex, when somebody finds themselves disabled they frequently have no idea how to have sex. Therefore, I was thinking that it's Levystien's job...neigh, I mean his duty...or even his moral obligation to inform them.
I want to begin by making sure we call it "change in sexual function" rather than "sexual dysfunction." It might surprise you to learn that all change is not bad change. For example, I knew this guy, who is definitely not me in any way shape or form or at any level, who had multiple sclerosis (MS). Again, this is not me. I know that Levystien has MS but this story is really not about me at all. There was this guy who had MS, remember that this is not me, and he had decreased feeling in his genital area. Therefore, he could last much longer and had much better control than most men. The only problem was that maintaining an erection was difficult. Then, along came Viagra®. Now, he can maintain an erection all night. In addition to that, his decreased sensitivity gives him total control!
This guy, who is not me, can satisfy one woman multiple times or multiple women multiple times. He is a sexual God! Do you see why I call it change in sexual function rather than sexual dysfunction?
Women who have MS may not be so lucky. They often have decreased sensation but this simply makes it more difficult for them to climax. In addition, they can experience fatigue and decreased libido. This can make it pretty frustrating for their spouse.
Another example is the antidepressant drug Prozac®. If you are a woman, then the delay to orgasm that this drug can cause might result in you failing to experience an orgasm during the first few months of taking it. You may not be happy about this side effect. If you are a man, then the increased time to ejaculation might improve your performance. This may be especially true if you are a young man who ejaculates too quickly.
A long time ago I dated a woman who had some incontinence secondary to childbirth. I am pretty sure that I remember her name but I won't say it here because I don't want to embarrass her. I am definitely not omitting her name simply because I have forgotten it...anyways...It is common for post child-bearing women to have incontinence. This can usually be repaired by a gynecologist. This particular woman that I knew, whatever her name was, had no incontinence when lifting or doing normal activities. However, when she had an orgasm…man…three feet of urine would stream out.
She was unaware of this condition because she had not been having orgasms with her previous lovers, something I encounter on a regular basis. She had no idea that she was producing such a glorious orgasmic flow. I'm not really into that sort of thing but some guys are. If I had been one of those guys, I would have thought that I had found a golden mine! Sorry about the pun.
Because I would not place my face in the line of fire, so to speak, she had it fixed.
Thus, there are changes in sexual function that can be good. There are also changes that are good for some but not so good for others. Then, there are changes that are not so good for anyone. The primary purpose of this chapter is to talk about how to have a wonderful sex life even if you are unfortunate enough to have a change that is not so good.
Let's begin with mental retardation (MR).
These are the kids on my Special Olympics baseball team. Emotionally, they are normal kids with all the usual feelings and desires. They can be enthusiastic and competitive. They can laugh and have fun. They can also get hurt and feel bad. The problem is that they are not very smart. I am sure that they will want to have sex when they grow up but they will not be allowed to marry or even to live independently.
In fact, in most group homes there will be a concerted effort to prevent any and all contact of a sexual nature. Even in the 45 year olds. Therefore, the contact will occur out of site of the staff. These kids will do it with inappropriate partners and without adequate protection. The fact is that sexually transmitted disease and unwanted pregnancy is not uncommon among this group of people despite 24-hour per day supervision.
Why can't we educate these kids about sex and set up structured times for them to do it? Some of them may become oppositional from time to time but most of them are pretty compliant. These kids usually respond well to structure and generally do what they are taught. I don't think that marriage in the usual way is OK but can't we provide some sort of structured relationship activity?
Some facilities do this, and a few do it quite well, but for the most part puritan attitudes tend to prevail.
One special case is kids with Down syndrome. Most people think that this condition is synonymous with MR. This is because there are a disproportionate number of kids that have both Down syndrome and MR. You might be surprised to learn that there are people with Down syndrome that are smarter than you are. For example, I went to medical school with a guy that had Down syndrome. Interestingly, he was one of a very few colleagues of mine that I truly thought would make a good doctor. Go figure.
In any case, even the Down syndrome kids that have low IQ are relatively normal in regards to sexuality. They are totally capable of having an intimate relationship. They are also capable of looking at pornography and pleasing themselves.
Down syndrome is the most common birth defect and there are numerous support groups. These kids have ample opportunity to have socialization. I have known a number of couples where both partners had Down syndrome. From the perspective of a cynical psychiatrist who deals with normal adult relationships all the time, the relationships I have witnessed between people with Down syndrome has impressed even me.
People with Down syndrome are usually honest and open and they tend to wear their feelings on their sleeves. It would be very unusual for one of them to be anti-social or distrustful. The couples I have known have deeply touched my heart.
Mr. and Mrs. Paul Annear
But isn't it dangerous for people with Down syndrome to have relationships?
My God, they might want to make babies?
Don't we check for this condition with amniocentesis so we can terminate these pregnancies?
We don't want to be burdened with these horrible little monsters...Do we?
In fact, men who have Down syndrome are infertile and 70-85% of women with Down syndrome are infertile. Babies ain't gonna happen.
Even if you get a kid with Down syndrome, it isn't that bad. Yes, it will take extra work. It will require you to be mature enough not to be embarrassed in public. But you will have a kid that is very loving and warm and happy. I might terminate a pregnancy because of a lot of serious conditions but I would never terminate one due to Down syndrome.
Despite what I just said, even some mother's of Down syndrome kids get the wrong idea. There is one British mum who thinks her 21 year old son is going to miss out on sex due to his condition. She is trying desperately to get him laid. She even takes out ads in the paper and on the internet. She certainly has her heart in the right place but I think she needs a little education.
She needs to have exposure to lots of kids with Down syndrome so she won't hold such misperceptions about it. Check her out: Mom on a Mission - British Mother Seeks Sex For Down's Syndrome Son
In another development, porn star Tabitha Stevens is graciously offering to have sex with the British mum's son. Tabitha Stevens volunteers for Down syndrome sex
Despite how ridiculous this is, the National Down Syndrome Society NDSS has clearly stated that they welcome and applaud the efforts of such wonderful people as Tabitha Stevens. They go on to state that caregivers and even NDSS executives could also benefit from such services.*
*If you are an NDSS employee and you just reached for the phone to have someone come over and kick my ass, don't worry, I will let everyone know that I made this up and that no one from the NDSS said anything like this.
What about old people?
I know that it is not particularly comfortable to think of grandma jumping into the sack with a lover. I also understand that this may not make the best movie going experience but…it happens. In fact, my experience in multiple nursing facilities is that a healthy older man sometimes has several lovers. Interestingly, a frequent problem among the residents of such facilities is too few men to go around.
Health issues are certainly more frequent in this age group and can make sexual activity more challenging. For the sake of this chapter, let's assume that we are talking about two healthy 85 year olds. If that is the case, then there is no reason they should be avoiding sex. Puritan values tend to soften as we age and old people tend to be less worried about behaving in a socially "proper" way.
The issues regarding sex for these two old love birds are centered more around changing physiology. For example, reduced natural lubrication could get in the way to some extent but that is easily resolved. Or, the increased amount of stimulation needed to become aroused may be confusing to an elderly woman who has not had sex in twenty years. Also, the men will likely last longer but will have a significantly longer refractory period.
My advice to an old man who is outnumbered 5 to 1 in his nursing home is, "You had better pace yourself. Nursing home women are outnumbered, their husbands are dead, they are lonesome, they aren't virgins, they haven't had sex in a while, they aren't concerned about their reputations, and you look pretty damn good to them...he...he."
You might think that this guy is going to have a heart attack pretty soon. You may be correct but I would suggest that if sexual activity causes a heart attack, it is a heart attack that was getting ready to happen pretty soon anyways. It was all those years of tobacco and chili dogs that actually caused the heart attack. I would also argue that dying in a woman's arms is probably the best way to go that there is.
A lot of older men have high blood pressure or coronary artery disease or diabetes and therefore have some difficulty maintaining an erection long enough to satisfy a woman. This problem has been totally resolved with the advent of phosphodiesterase inhibitors such as Sildenafil (Viagra®), Tadalafil (Cialis®), and Vardenafil (Levitra®). These medications are relatively contraindicated with certain coronary conditions, so be sure to consult your doctor first, but for the majority of men they are pretty safe and extremely effective.
One major issue with sex in this age group is that romance is still very important. Remember that my grand pappy used to say "Son, you gotta heat up the oven before you stick in the sausage." My grand pappy used to say that. So, I'm pretty sure that old guys should know this.
Perhaps, they have reason to forget this very important rule on occasion. Do you think that old women really require very much foreplay? They are after all...well...how shall I phrase this...they are old women. They may be a bit on the easy side but, dude, they still need some romance.
What about people who are crippled?
In my opinion, the biggest issue with paralysis is fear that no one will love you. Who would want a woman who is not fully functional? The same applies to people who have amputations.
This might surprise you but I would argue that if you have a disability you are actually likely to get a lover of higher quality. A selfish and egotistical man is not going to marry a woman who has a below the knee amputation but an unselfish and caring man might. In fact, I would argue that the loneliest people in the world are the Marilyn Monroe types who are physically perfect. Any man would want such a woman. Marylyn could have had any number of anti-social criminal types who were pretending to be respectable in front of her.
She could not stay with a really good guy like Joe DiMaggio. Instead, she allowed herself to be with a number of rich and good looking assholes who showered her with attention. She ended up not valuing the one good guy who cared enough to be there in the end.
Sir Paul, who is probably as good of a person as God ever created, could have married any woman he wanted but he chose an amputee. Unfortunately, just because you are an amputee does not mean that you are a good person. On the other hand, the person that wants to marry you probably is.
Of course, you won't have men beating down the door if you are disabled but you just need to be creative in the way that you make yourself available. As someone once said, "There is someone for everyone."
This is very true. No matter how disabled you are or how disfigured you are or even how unattractive you think you are there is probably someone who could love you.
What about people who have other medical conditions?
My brother is in his fifties and has had a very unusual auto immune illness for the past fifteen years called idiopathic polymyocytis. It has caused wasting of his proximal musculature. This means that he has intact calves but no hamstrings or quadriceps. He has intact forearms but no biceps or triceps. Oh, and he has been HIV+ since there was a test for HIV but has never had an AIDS related illness.
Several years ago, he lost his longtime partner. He went on a search for someone new and was open an honest about his condition. Low and behold, he is now living with a wonderful new lover. Oh, and this guy is a high caliber individual. He is honest, caring, and unselfish. If my brother can find someone like that, then so can you!
Having a communicable disease such as HIV or herpes can put a wrinkle in your romantic plans but there are plenty of ways to meet similar individuals. There are also plenty of ways to have sex without endangering each other. Remember, we live in the era of safe sex!
Untreated high blood pressure can eventually contribute to atherosclerosis and erectile dysfunction. Beta blocker therapy will help prevent atherosclerosis but can cause erectile dysfunction directly. Since high blood pressure is not an acute condition, you may be able to reduce the dose periodically for sexual activity. Alternatively, Viagra® frequently works well.
Diabetes, high blood pressure, tobacco use, and high cholesterol can lead to atherosclerosis or hardening of the arteries. This usually occurs in older men and is probably the main cause of erectile dysfunction. Viagra® to the rescue!
Peyronie's disease is most likely secondary to trauma although beta blockers may also contribute. Some men develop scar tissue or plaques in the soft tissue of their penis. This can cause divots, indentations, or curvature. Intercourse can be painful and erectile dysfunction may occur in the later stages. My advice is to go to a specialist as most physicians don't have a clue how to treat it.
Peyronie's disease
Hypogonadism is failure of the testes or ovaries to produce testosterone or estrogen. It causes secondary sexual characteristics to fail to develop. Replacement therapy is usually successful but it needs to be diagnosed and treated in a timely fashion.
Parkinson's disease is associated with reduced dopamine in the brain and frequently results in erectile dysfunction that is treatable with Viagra® or testosterone.
Morbid obesity may make sexual relations difficult. Obviously, losing weight is a good idea. Hey, what if you ejaculate 5 times per day. Do you think you might lose some weight?
Unfortunately, there are hormonal changes that often occur with morbid obesity that reduce energy and libido. If you are significantly over weight, I highly recommend medical care for a number of reasons the least of which is sexual activity. However, there are several treatments specifically for sex that you might find helpful.
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All of the diseases and conditions that I have mentioned so far have one thing in common. You can't just be silent and selfish with regards to sex.
If you have one of these conditions, then you are going to have to talk. You are going to have to care about pleasing your partner. You are going to have to learn about your condition in regards to sex and have an open mind about ways to do it that are not the norm. Alternatively, I can provide some internet resources where you can have sex by yourself. Oh, but you are way ahead of me on that.
In my case, I have found that having MS causes me to experience fatigue late in the day. I also find that even a single beer will put me to sleep, especially if it is consumed in the evening. I also have to take Viagra®, so there needs to be some rather non-romantic communication in advance about whether or not I need to take a pill. If we won't be having sex until late, then I may also need a stimulant such as Provigil®, coffee, or a nice cigar. I am capable of thoroughly satisfying my woman but I am a one shot wonder. I will be asleep while she is still climaxing and I won't be waking her up to do it again in the middle of the night.
We get around all of this by having sex before we go out or before we eat dinner. When I ask her if I should take a pill we both grin and take it with a grain of salt. Also, she allows me to smoke a cigar on occasion.
When we first met I was honest and up front about all this and guess what? I got a really good person to be my lover. She is not only the most beautiful and intelligent woman I have ever known but she is also honest, caring, and unselfish. I have total confidence that if I am infirmed in old age she will take care of me and enjoy doing it.
Oh, yeah, I mean...I'm talking about this guy I know...this isn't me I'm talking about.
Some people in our society seem to have an idea that they want to help disabled people have sex but they aren't very well educated and don't know how to do it correctly. For example, there is a Swiss welfare group that is making a misguided attempt at providing sexual services to the disabled. Check out this article: Disabled sex "assistants" tackle taboo
It isn't clear to me what they mean by "disabled" but I think they mean normal adults who were in an accident or something. If that is the case, then they are only offering prostitution. If they mean people with mental retardation, then Levystien thinks they have the right idea but are a bit off base.
Disabled people are usually capable of masturbating and don't need assistance for that. What I am suggesting is that they should be allowed to have real relationships with others whom they find attractive. I would not advise hiring "professionals" just to get them off. I think it would be very confusing to a mentally retarded person if Tabitha Stevens was coming around and jacking them off periodically.
Actually, maybe I'm missing the boat. Tabitha, if you are reading this, you need to know how horrible it is to have MS. I am 45 years old and I have never had sex. No one wants me. I can't even figure out how to masturbate.
Please, Ms. Stevens, can you come and help me?