This article was written by Dr. Justin Lehmiller and scientifically reviewed by Human Sexuality expert Dr. Laurie Mintz. She is a professor, researcher, private practitioner and Fellow of the American Psychological Association.
Physical disabilities can have an important impact on many different aspects of daily life, including sex. Unfortunately, however, sex and disability is a taboo topic of discussion that is rarely addressed, even by healthcare providers.
It is important to break down the barriers to discussing sex and disability because everyone—regardless of their ability status—is deserving of pleasure and sex education. Plus, sex plays a vital role in maintaining physical and psychological health and promoting healthy relationships, so why should anyone be denied these opportunities?
In this article, we are going to explore sex and disability in the context of persons with spinal cord injuries who have either paraplegia (paralysis of the legs) or quadriplegia (paralysis of the arms and legs). We will explore the answers to common questions people have on this subject and tips on having better sex.
Can paralysed people have sex?
It’s not uncommon for people to ask, “Can paraplegics have sex?” or “Can quadriplegics have sex?” The answer to both questions is a resounding yes.
Just because you have a loss of movement or sensation in some parts of the body doesn’t necessarily mean that you can’t have sex. It doesn’t mean that you don’t desire it, either.
People who are paralyzed are often incorrectly assumed to be asexual, but this is inaccurate. According to Andrew Gurza, a disability awareness consultant and host of the Disability After Dark podcast, “There are disabled people who are indeed asexual, but to assume people are asexual because of disability is ableist and says more about you than them.”
So don’t make assumptions about someone’s sexuality based on the fact that they have a disability. Don’t make assumptions about a disabled person’s genital function, either.
Among persons with spinal cord injuries, there is wide variability in genital function depending on where the injury occurred and whether the injury was complete or incomplete. For example, research has found that many men and women with such injuries (including those who are quadriplegics) can still experience reflexive arousal, which is genital arousal that occurs in response to physical stimulation, such as the penis becoming erect or the vagina lubricating.
Spinal cord injuries don’t necessarily impair orgasm, either. For example, in one study of quadriplegic men, 38% reported the ability to orgasm with ejaculation.
However, even if genital functioning is impacted to some extent, this doesn’t necessarily mean that sex is no longer pleasurable. “Even if their genitalia doesn’t work in conventional ways, that doesn’t mean they aren’t enjoying themselves,” Gurza says.
For this reason, if you—or your partner—have a spinal cord injury, it’s important to communicate and avoid making assumptions. It is essential for the disabled partner(s) to have space to communicate what they want and what works for their body.
Paraplegic sex
When one or both partners have a disability, sex might not look exactly like the sex you’re used to seeing or that you might see in the world of porn. It’s therefore important to be open-minded and to be willing to explore and experiment a little based on each partner’s accessibility needs.
For someone with paraplegia (impaired mobility and sensation in the legs), the fact that they still have upper body movement opens the door to a lot of different options for exploring sexual activity. For example, they may be able to perform modified versions of a number of traditional sex positions, including face-to-face intercourse and doggystyle sex while seated in a wheelchair (see here for a more detailed description of potential wheelchair sex positions).
Oral sex, anal sex, kinky sex—it’s all potentially still on the table. The key is being creative and adaptable and figuring out ways of making it work for each partner. This may mean relying more heavily on sex toys or using pillows, wedges, or other tools to provide the necessary level of assistance and comfort.
Quadriplegic sex
For someone with quadriplegia (impaired mobility and sensation in both the arms and legs), creativity and adaptability are again the key because fewer of the traditional positions may be feasible, even with modifications. However, some of the considerations might be a little different.
For example, there may be more issues with genital function that might need to be addressed first, in which case various sexual aides can potentially be pursued if desired, such as erectile dysfunction medication, penile injections, vacuum pumps, cock rings, or potentially even penile implants. Alternatively, if vaginal lubrication is impaired, use of artificial lubes can help with this.
However, keep in mind that sex—and even orgasm for that matter—doesn’t have to be all about a focus on the genitals. In fact, it doesn’t necessarily have to have a genital component at all. For instance, some people with spinal cord injuries learn to create new erogenous zones. Also, when genital sensation is completely lost, some parts of the body where sensation still exists may become even more sensitive, such as the ears or the neck.
It may even be possible to learn to orgasm from stimulation of these other body areas, because we know that—even in able-bodied people—genital stimulation is not essential for orgasm. What we’re talking about here are non-genital orgasms, and they’ve been known to occur from stimulation of the nipples, lips, and other parts of the body.
Masturbation and/or body exploration with a partner is therefore often the best starting point for someone with a disability. It may take some time and patience to figure out what works best for your body and is most pleasurable, so take your time and, above all, communicate with your partner.
What it’s like to have sex with a paraplegic or quadriplegic partner
If your partner develops a spinal cord injury or you otherwise become intimate with someone who has such an injury, the truth of the matter is that sex itself probably won’t feel all that different for you, but it may look different from the sex you’re used to having.
Consent and communication are key when it comes to having great sex—and this is true whether your partner is able-bodied or disabled. However, open-mindedness is really crucial in the context of sex and disability. You need to be willing to explore new positions, new activities, and new toys—and you need to be willing to take a more expansive view of what sex is.
It’s important to toss the old sexual scripts aside and work with your partner to come up with a new script that takes their wants and needs into account.
A broader change in mindset is important, too. Don’t think of sex and disability as inherently limiting—think of it instead as liberating. Sex doesn’t have to look a certain way or follow the standard narrative. You and your partner(s) have the opportunity to customize it and define pleasure on your own terms.
Conclusions
Spinal cord injuries do not have to be the end of your sex life—and they don’t have to be the end of great sex, either. However, the key to navigating sex post-injury is to discard unfounded stereotypes and assumptions about sex and disability, dismantle traditional sexual scripts, and bring some creativity into the bedroom.
