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The earlier counselling starts the better the chances for sexual adjustment. It important to deal with problems of: poor body image and self-esteem, interpersonal communication and social problems. Physical changes which alter the patient’s perception of her/his body may make her/him feel damaged and unlovable, and make her/him assume that she/he cannot be sexually attractive. When she/he is most in need of assurance, the partner may withdraw from physical contact because of revulsion or fear of causing damage or pain, or of 'catching' the cancer, or effects of radiation, and patients interpret this as validation of their negative feelings about themselves. The patient may go further and make her/himself unpleasant in order to 'prove' how undesirable she/he is. This is called 'negative testing'. This may lead to hostility and a rift between them.
It is important to think of yourself as a sexual being so that you can expect others to do so, and to recognize that your value as a [sexual] person has not changed even if you have changed in appearance.
Touching is tremendously comforting and conveys acceptance that is difficult to convey in words. Your partner also goes through a period of mourning and distress, and should not be isolated. She/he takes on a new role in family and work situations, and assumes the role of nurse and lover. She/he may fear causing pain or embarrassment, and may find physical changes repugnant (e.g. stoma, incontinence), and may suffer depression and be concerned that their own sexual needs will not be fulfilled. You should therefore both be involved in counselling earlyin the relationship or after the accident or onset of the illness, and be given an opportunity discuss these issues alone and together, ask for explanations about the effects of and limitations imposed by the disease / injury/ surgery, drugs, or radiation/chemo therapy, pain control, and the potential for sexual function.
Specific treatments: men may be enabled to gain erections by: injections into the penis or oral medication, or a surgical procedure to insert a prosthesis [special kind of rod] into the penis.
Childbearing: the potential for and desirability of pregnancy must be discussed, and genetic counselling provided if there is a possibility of transmission of the disease.
You should consider the problems associated with parenting, and the need for artificial insemination, or adoption.
Contraception: should be provided if pregnancy is not desired or desirable.
Sensual assignments: are based on sensuality, tenderness and intimacy, rather than on performance and achievement [see: Sexual Assignments: Self Discovery, Sensate Focus and Genital Pleasuring Exercises]
Performance should be de-emphasized, as sexual expression is not synonymous with intercourse, and does not necessarily include penetration or even orgasm, but it is important to satisfy one's partner and to receive as much pleasure as possible.
Assertiveness: the patient should be helped to express how he/she likes things done, and to be assertive in every day matters as well as in intimacy.
Self-exploration exercises: the patient should spend time exploring her/his ‘new ‘ body, and concentrate on caressing and sensual pleasuring of the parts of the body she/he really likes, then gradually together they can extend to include those that are liked less, recognizing what feels pleasurable or hurts. Sexual activity may require modification, for example the patient may prefer to keep the lights off, or remain only partially nude.
Mutual stimulation: discovering the patient’s altered body together should increase intimacy. The entire skin surface is potentially sensitive and should be explored to provide pleasure. Caresses with lips and tongue and oral genital sex may be the prime options for a paralyzed person.
Sensory amplification: the couple should discover and maximize new erotic zones in order to achieve the most pleasure, because when feelings are diminished in one part of the body they may become greater in others. For example, an individual who has lost sensation in the genital area transfers sensation from an area of the body that has retained feeling, e.g. neck, breasts, buttocks or around the anal area. Transposing these sensations by imagination, magnifying them by fantasy, and recreating intense feelings can result in a "mental orgasm". Many disabled people find this satisfying, and that it leads to release of sexual tension. People who have previously experienced orgasms are usually able to recall the experience, and obtain release equivalent to orgasm.
Preparation: for intercourse: may include taking a bath, emptying the bladder and bowel, making a towel available in case of "accident", and allowing plenty of time and privacy to relax and enjoy intimacy. A catheter should be taped out of the way (to the groin in women, down the penis in men), and drapes can be applied over a stoma bag if desired.
Artificial aids: can improve sexual function. Therapy is aimed at ensuring that intimacy, and if possible that genital intercourse continues, and should provide practical suggestions for dealing with difficulties. Most people accept spectacles and hearing aids, and sexual aids should be considered in the same way, these may include oral sex or manual stimulation, the use of KY jelly, pillows for support, vibrator, erotica, fantasy, waterbed or a dildo.
Positions. may be advised that the couple had not considered "normal" before. The four basic positions (sitting, lying, kneeling or standing) have many variations and the couple should be encouraged to explore those that are comfortable/possible for both of them Permission should be given for both to be resourceful, but not to feel under compulsion to do anything that they find unacceptable.
In most cases, sexual activity can be resumed even in a limited fashion once the patient starts to recover.
Everyone, and no less disabled people, gain excitement and satisfaction from their partner's response to pleasure, and so residual function should be used to the utmost benefit.
Physical changes may alter your sexual activity but kissing, touching, oral stimulation, fantasy are alternatives not compromises, and you should both strive to attain the maximum pleasure and intimacy possible within the limitations of the condition. You should accept that no sexual practice is "wrong" provided that it is acceptable and enjoyed by both, and is not offensive, harmful or degrading to either partner.
Acceptance: people get stuck in their beliefs about the impact of a recent disability on their sexuality. These beliefs may unnecessarily extend the grieving process. If you are you wanting sex to be the same as before then it would just be a trap to try to resurrect the same style and acts of sex, and same kind of sensations. For example after a spinal cord injury or stroke, or in the case of multiple sclerosis, this would guarantee that you’re going to keep responding with a sense of loss and disappointment every time you engage in sexual activities rather than a spirit of exploration. It denies the possibility that there is another style of sex you can find together that will be intimate and fun and loving. This is possible if you can let go of what you think sex is supposed to be – or was-, and consider what it can be. Don’t allow yourselves to be fixed on ‘what it is to be a man – or a woman’ or performing in a particular way- the redefinition of yourself or your partner as a lover paves the road to success.
Enjoying what is possible far outweighs the disappointment around what is not possible and the disappointment becomes minimal if not irrelevant. Show each other that you love each other in any way that you can. [2]
