HisandHerHealth: Information About Sexuality, Prostate, Incontinence

Questions and Answers

for Persons with Disabilities 

by Mitchell Tepper, Ph.D. Founder of the Sexual Health Network Reprinted with permission

Q  Sex has become close to non-existent due to my wife's chronic pain associated with fibromyalgia. What suggestions do you have for us?

Dr. Naomi McCormick, author of When Pleasure Causes Pain: Living with Interstitial Cystitis, makes the following suggestions that have application for anyone experiencing pain: Schedule sexual activities when your symptoms are least problematic; take pain-controlling or antispasmodic medications prior to sexual activity; experiment with sexual positions and activities that minimize painful intercourse; have your partner stimulate your genitals orally; tell your partner exactly what feels good and what is painful; and spend time engaged in other sexual, erotic and intimate activities that do not involve intercourse or orgasm. Hot tubs, saunas, steam rooms and even tanning beds can ease stiff, sore muscles and loosen up joints. Try one of these options prior to engaging in sexual activities. If floating in warm water relieves your wife's pain, you can rent a hot tub and experiment in the privacy of your home. If overheating is a concern--it often is for people with multiple sclerosis or are subject to autonomic dysreflexia --consult with your physician first .

Focus on making her feel good, not bringing her to orgasm. Let your wife be your guide. At another time, your wife can focus on pleasuring you in a way that doesn't aggravate her pain. With regard to intercourse, take time to find positions that are comfortable for both of you and do not put too much pressure on any one part of her body. If she becomes uncomfortable, switch positions. And talk. Communication is critical when pain is involved, especially for women who have been taught to be sexually passive. McCormick urges women to tell their partners when they want sex, when they don't want it, and how they want it. Reducing painful sexual activities and increasing pleasurable ones should help to revitalize your sexual life.

Q  I am a 52-year-old woman with multiple sclerosis. Before the onset of MS five years ago, my husband and I made love about once a week and I always had an orgasm. But the more disabled I get the less I want to have sex with my husband. I want to, I dream about it, but I can't do it. I've rejected him for four years now and I am afraid I am going to lose him. How can I go about rekindling my desire for sex?

A  Low sexual desire may be caused by a general medical condition like MS, psychological factors or a combination of both. Fatigue, medications, disturbed body image and past negative family or sexual experience can all contribute to sexual dysfunction. Based on the information you provide, I would speculate that fear of rejection and self-loathing because of your disability may be two contributing factors. Opening yourself to your husband raises the possibility that he might reject you. This outcome would only confirm your unexpressed feelings about your attractiveness and ability to fulfill your role as a wife.

Loss of physical function or the ability to perform household tasks does not necessarily translate into loss of attractiveness. Your husband may still love you for the life you share and may still be eager to have sex with you. You'll only find out if you give him a chance. It may be time to take the risk of sharing your fears with your husband. If the communication goes well, you can start with sexual activity that might be less threatening than intercourse. Taking small steps to build positive sexual experiences is the best way to overcome fear and regain desire.

Q  I am a C6-7 incomplete quad with pretty good sensation and no trouble getting erections. The problem is, I can only ejaculate for about two days in a row, sometimes three. Then I must "save up" for two or three weeks before I can ejaculate again, even though I have good erections during this period. Is this normal? If not, is there anything I can do or take (vitamins?) that would charge me up faster?

A  The range of normal human sexuality is very large, with or without spinal cord injury. For those of us with SCI who can ejaculate, frequency is often inconsistent and may vary greatly over time. But from what I understand, frequency of ejaculation in men with SCI has nothing to do with "saving up" seminal fluid. Semen is made of sperm from the testicles and fluid from the seminal vesicles and prostate. The seminal vesicles produce about 70 percent of the seminal fluid, which activates the sperm and supplies sugar--energy--for the long journey to follow. The prostate gland produces a thin, milky, alkaline fluid that accounts for most of the balance of the fluid. Together, the sperm, seminal fluid and prostatic fluid equal only about one teaspoon. The production of semen does not seem to be affected by SCI. The problem seems to lie in the two-stage process of ejaculation--emission and propulsion. Emission is controlled primarily by nerves exiting the spine at T11 and Tl2 and propulsion is primarily controlled by nerves exiting the lower spine at S2 to S4. The combined process of emission and propulsion is a exneurological reflex causing the seminal vesicles and prostate gland to contract and squeeze their fluids into the urethra (this point is experienced as ejaculatory inevitability) which in turn triggers rhythmic contractions of muscles along the penis. Ejaculation then occurs. After ejaculation there is a so-called refractory period during which most men cannot respond to additional sexual stimulation. The length of this period increases with age. For men with SCI, the complex reflex responsible for ejaculation seems to become exhausted and needs much more time to recuperate. I've searched for a more complete answer to this problem, and this is the only explanation I've found. There are no nutritional supplements or special diets that will help you recharge any faster.