Sexuality and Spinal Cord Injury

1. Sexuality and Spinal Cord Injury Starting over...

2. Why I am involved… • Part of a poem that explains:I would touch you deep inside And join with you on love’s ride Tumbling through passion’s grace And watch the pleasure on your face

3. Anna Freud said... • Sex is something you do. • Sexuality is something you are!

4. Overview of human sexuality... • Human beings are curious creatures with an overwhelming need to learn about the world around them - this includes our bodies and our sexuality. • Sexuality is life-long learning - as I become more informed, I realize just how much I still don’t know! • “I don’t know all about sex, but I am willing to learn.”

5. What really is our “sexuality”?There are a number of ways of looking at it. Here goes... • a driving, fundamental and vital life force • our need to express our sexuality is as basic as our need for food, water and rest

6. Sexuality (continued): • central to our identity and self-concept • Sexuality is our personality - it’s what compels us to discover who we are and drives us to express our own uniqueness

7. Sexuality (continued): • Who you are as a total person, your… • abilities • individuality • libido (sex drive) • specific sex acts you enjoy • ability to love and be loved • ability to be loveable and capable

8. Sexuality (continued): • Sexuality is my honest relationship with you - • letting down the walls we hide behind • being “real” - this allows us to love others • no “playing games” • sharing personal experiences is exciting, satisfying and very life-affirming • being honest affirms your right to be you!

9. Sexuality (continued): • Is a celebration of life • our sexuality is an affirmation of life, of being alive • our gift of sexuality is our greatest gift from God • sexuality is love and giving of ourselves

10. BIOLOGY libido (hormone levels) procreation (making babies) LIFE EXPERIENCE what sexual acts you enjoy receiving what sexual acts you enjoy giving sex is the “glue” in a relationship - it’s helps bond a couple Sexuality has two components:

11. Sexuality…my latest... • Involves the timeless desire for both physical and emotional intimacy • to feel and give affection and pleasure • If you’re healthy, your interest in sex can last your entire life!!

12. Sexual Maturity: • A relaxed, natural attitude towards sex: • unhurried • unselfish - being able to delay gratification • being aware - “tuned in” to your partner • taking time to pleasure your partner (sensuality)

13. Men’s and women’s views on sex • We approach our sexuality so completely differently - • Men - more visually oriented • Women - more emotionally oriented • Only a generalization - a man uses love to get sex, a woman uses sex to get love • Women are looking for the right mood, men are only looking for the right place

14. Human sexual development over the life-span: Or- how did we ever get together?

16. Males - body centered Intense Physical love 90% + masturbation orgasm-centered sexuality “sexual peak” Females - person centered Romantic Sensuous and emotional love 70% masturbation difficulty transferring masturbation skills to intercourse Teenage and early 20’s -

17. Male sexual response slows - peaked at 18 some impotence frequency of sexual activity decreases emphasis changes from quantity to quality sex becomes more than intercourse Female sexual response quickens some become multi-orgasmic sexual peak in late 30’s or early 40’s increased frequency of masturbation conception (or not) a major concern 30’s and 40’s -

18. Males - sex and orgasm of less concern More emphasis on emotional closeness Men - more nurturing More complete person Sexual response slows Erection difficulties Females - initiates sex more and more consistent orgasms Women acknowledge their male aspects and enjoy sex more and initiate sex more often diminished vaginal lubrication 50’s and 60’s - becoming more complete persons!

19. 70’s and 80’s - • Male and female - • energy level decreases • sexual (physical) response slows further • FANTASY life still active • health and availability of partner a problem • may accept society’s expectations - no sex

20. Sexuality and Spinal Cord Injury • Some specifics - • 10% of the population has some form of disability • sexuality and libido not necessarily altered, they’re usually only altered as much as the SCI chooses - and that’s OK!

21. Sexuality Services for Disabled • Individual Counselling • Group Counselling • Couples Counselling • Sex therapy

22. Sexuality Services for Disabled • Sex & disability course • Access to reading materials • Audio-visual materials • Group Discussions

23. Sexuality Services for Disabled • Contraceptive/Genetic Counselling • Obstetrical/ Gynecological/ Urological Care

24. SCI sexuality - • We are mental, physical, spiritual and emotional people - what affects our physical side may affect all. • The desire for love, affection and intimacy usually doesn’t change, but the choice of sexual expression might - depending on the level of paralysis

25. SCI sexuality - • Sexual intercourse is often understood as the accepted means of sexual expression - but with the level of SCI and the physical condition, the SCI person might want to consider OTHER sexual options • Poor self-esteem may affect how SCI person feels sexually • Being paralyzed (stress) often causes changes in testosterone and progesterone

26. Sexual Options for Paraplegics and Quadriplegics - WHY SEX? • Sexual release • Emotional fulfillment • Couples intimacy and togetherness - especially after orgasm

27. Sex - • NOT just a source of physical and emotional pleasure, but • it bonds and validates a relationship

28. Healthy Sexuality and SCI A work in progress...

29. Accept personal responsibility - • Be honest - present yourself in a way you feel comfortable • You didn’t ask to become disabled - don’t apologize. “I didn’t ask to become disabled, but hey, this is who I am now”. • “My disability isn’t me - but I do have a disability that sets certain conditions for my life”.e.g.. Bladder infections

30. Be clean, hygienic and presentable - • It shows that you care about yourself and others • it’s an outward sign to those around you that you feel good about yourself

31. Communicate - • Be open and honest • Often you have to take the lead • Use “body language” if possible • Use facial expressions • Improve ability and style through practice • People generally want to know what happened - tell them! It’s a beginning.

32. Be assertive - • In general - Express what you want • In particular - Practice to express desires sensitively • Sometimes you think you have communicated and you haven’t at all

33. Social Skills training - • Initiate interactions or acquire the social skills to do so. Practice! • Make the first move - others often initially feel awkward around you. • “I often feel that it is my responsibility to help others feel comfortable around me”.

34. Accept life now! • Learn to like yourself and live. • Learn to live in the present moment - it’s all we have to work with. • Learn to accept “down” days - everyone has them! • Realistic expectations of yourself. • Spiritual books and videos helped me.

35. A satisfying sex life is possible - • Learn the basics - fertility - anatomy - sexual options • Get the anger out - “God, I’m mad as hell that this happened to me” • “God accepts you where you are at today.”

36. A satisfying sex life is possible - • Get comfortable with the new you. • Don’t deny the anger, fear, depression and anxiety - express them verbally and in writing - thus this talk for me!

37. A satisfying sex life is possible - • Fantasy and imagery • Use all the senses • Enjoy partner’s pleasure visually, mentally and emotionally.

38. Sexual Needs of any person - • Amount • Intensity • Frequency - differ for ALL people

39. Sexual Options - • MUTUAL willingness to explore new experiences - reciprocal loving • Use ALL the senses

40. Sexual Options • More sexuality in the brain than in the genitals • Especially true of spinal cord injured • Communication - of thoughts and feelings - is the key!

41. Sexual Options depend- Spinal Cord Injury level

42. Sexual Options - • Fantasy and daydreaming • Sensate Focus • Intercourse • Manual stimulation • Oral-Genital sex • Vibrators

43. Fantasy and Imagination • With or without a partner • Our brain is the largest sex organ - fantasy • Catharsis effect - removing something undesirable - esp. no physical orgasm • Aristotelian - purification or relief of the emotions through art - writing, drawing, photography etc. • Erotic books and videos (cathartic to me)

44. Sensate Focus - • Couples exercises developed to reduce performance anxiety, fear of failure • focus on touching - enjoyable, affirming, sensual and sexual • usually three-stage approach

45. Sensate Focus - stage one • Unhurried, set aside at least one hour • Undress • Explore partner’s whole body - do NOT touch each others genitals or female’s breasts • Sensual touching - learn to enjoy the process, what is happening NOW • Cuddle time

46. Sensate Focus - stage two • Now add genital touching and female’s breasts • Orgasm is not the intent now • light, teasing erotic touching - using fingers, tongue, vibrator or other sensual things • explore and develop orgasmic potential • overcome feelings of inadequacy which might accompany SCI

47. Sensate Focus - stage three • Partner’s orgasm is the main idea - through intercourse or any other sexual option • Watch partner masturbate so you learn what brings them to orgasm - communication and trust • Feelings of relaxation and assurance

48. Orgasm and SCI • Orgasm is more a cerebral event • Mingling of sensations and the senses • Comfortable resolution • Partner’s orgasm assimilated, shared

49. Orgasm and SCI • “fantasized” orgasms • still not the same as before • satisfaction doesn’t last as long as before, thus may want to make love more often??

50. Intercourse • Usually tried first (cultural expectations) • 25% “success” rate, (i.e. Reflex erection and sufficient penetration to please female partner) Reflex erections don’t last long • Sexual positions depend upon level of disability • Visually and emotionally important to SCI, usually no genital sensations