In another column in this issue, Mary Mwaniki, recently disabled through a motor vehicle accident, says, “many people think people confined to wheelchairs do not have sexual feelings.” How absolutely true? Her statement has inspired this column to look at sex for those with disabilities.Disabled people have sexual urges and needs, just like everyone else. Sex is possible and desirable for people with disabilities but it becomes difficult because of people’s attitudes. Perhaps the most difficult part of sexuality for many people with disabilities is finding a partner.

When there is disability and it does not matter at what stage in life this happens, having a sexual partner is perhaps the most difficult, but achievable, especially when the disabled person discovers the inner self and allows their inner being to shine through. This is not easy, as often people with disabilities tend to hide themselves in shame or to cover their weakness with anger. Although these two common responses are quite understandable, you must let people see the real you, the happy you, the sensitive you, and the sexy you.

The disabled, regardless of other physical attractiveness or personal charm, are too often written off as non-sexual beings by society. And sadly too, many disabled people adopt the same outlook of those around them and hold this negative view of themselves, although their sexual capability may be equal to those of other people.

Some people, who were once physicallyfit and had a partner, may have lost their partner after the disability happened. For example, when, without warning, marriage that included so many activities including lovemaking, becomes one full of obstacles, it is not only frustrating to the disabled partner, but also to the physically fit one who still has his health, hopes, dreams, aspirations and fantasies as damaged as those of their disabled lovers.

Sadly, many partners leave the marriage refusing to accept the limitations put on their lives by living with a disabled person. Even when the physically fit partner may have sworn after the disability happened to stay together and work things out, it sometimes becomes difficult to keep that promise. Many people leave relationships with disability mostly out of sexual frustration and this need not be the case if there was understanding and knowledge that sex is still possible even when one partner or both have a disability.

It is true that sexual problems often do arise for those with disabilities, but the first obstacle people with disabilities must overcome is prejudice. Once past this obstacle, their problems can usually be solved, or at least reduced. Sex on a wheelchair, for example, is by no means an impossibility.

The poor view of themselves held by some disabled people – and it can sometimes be extreme – may get in the way of sexual relationships. Since sexual ignorance and inhibitions are still fairly widespread in this country, many disabled people are prevented from finding their own solutions to the problems they meet. Advice and counsel on sexuality for the disabled is not widely available. Little attention is paid by doctors to the sexual aspects of disability, or to solutions, which exist in sexual problems that may arise for the handicapped.

The general attitude to people on wheelchairs and the physically handicapped or disabled is that all sexual possibilities are ruled out. This is not correct. For many couples, sex can be better than ever after a stroke or a disabling injury. People in this situation have no lack of sexual urge. What they lack is privacy and most people around them neglecting to consider that they may feel like having sex in a perfectly normal way.

As sex is never only genital, a disabled person can always enjoy it. The inability to move, for instance, does not mean the inability to please. The absence of sensations does not mean the absence of feelings. A disabled person still feels desire; there is no loss of sexuality just because the genital organs do not function. The ability to enjoy persists even though the ability to perform may not. Loving, satisfying and fulfilling sex is there for every couple to enjoy; they simply have to find it for discovering themselves by simply findingnew ways to make love and to please each other.

Most importantly, communication must be open and plentiful so that partners can find out what needs to be done to achieve sexual satisfaction for both. The need to be more open and experimental can lead couples to discover a range of touching, positions and pleasures that able-bodied couples may never discover.

Many people with disabilities have great sex, doing the best they can with what God has left to them after the disability and many are enjoying happy healthy marriages. A disability does not have to put an end to a couple’s sex life, although it will almost definitely mean that they will have to put more effort into seeing that their fires do keep burning brightly.

You should also remember that, besides sex, many other things form the glue that keeps a loving relationship together. You have to tell your partner how much you love them; you have to thank them for putting in the extra effort that your disability may cause, in short, you must nurture your entire relationship if you are going to have a successful marriage.

To understand how disabled people can continue to enjoy sex, it is important to know how the body’s sexual functioning gets affected when disability occurs. Our brain and nervous system control our sexual feelings. The front part of the brain and the central nervous system (the brain itself and the cord of nerves which runs from it down through the spine), control the physical changes which take place immediately before and during sexual activity. These include erection in the man and enlargement of the clitoris and vagina in the woman, among others.

Messages are carried from the base of the spine through the nerve fibres that run to the sexual organs. Thus, interruption of the spinal cord – if it is damaged, as with paraplegics, or does not develop properly, as in spina bifida, will prevent the messages getting through. Depending on the completeness and position of the nerve-break, function and/or feelings in the sexual organs, among other parts, of the body, may be lost, reduced or interfered with. A similar complete or partial effect may result from damage of the nerves leading from the spinal cord to the sexual parts.

The ideal should be for disabled people to automatically receive information and advice on sexual elements of their disorders in the course of treatment and rehabilitation. However, there are many handicapped people in this country who have never received such advice. But this should not be the case if the social outlook to disability was different.

It is important for disabled people to speak to their doctor about sexual functioning because today medical help is available for people with disabilities. For example, if a man cannot achieve an erection there all kinds of support – Viagra, penile implants or injections. In cases of spinal injuries, the man may not feel an orgasm the same away he used to, but he may be able to have an erection, ejaculate and feel pleasure from the experience.

It is also important for a couple who have experienced a disabling injury or illness in one partner to see a sex therapist who has experience working with disability issues. Both you and your partner may have worries and fears that play a role in your sexual functioning – may be even a bigger role than the actual disability. You both need to talk these problems out, and rarely can a couple accomplish this communication without professional help. Undergoing trials of a disability is never easy; so do not be ashamed to seek help in overcoming the issues surrounding it.

No matter how difficult having a disability is, a person with physical challenges must be willing to give his or her partner a hand. You may have lost certain faculties, but you have to be willing to exercise the ones you still have to your fullest.

If a man has an accident and, as a result, loses his ability to have erections, his wife does not have to spend the rest of her life sexually frustrated. If he can still move his fingers, if he can still use his tongue, if he can hold a vibrator, he owes his wife sexual fulfillment.

If the man abandons his wife sexually while at the same time asking her for all sorts of other help, then she may not be able to bear all those burdens. The same holds true for a disabled woman who withholds sexual favours from her husband. She too can use parts of her body still functional such as hands, mouth and tongue to give her husband sexual pleasure.

Some people who are handicapped can enjoy a nearly normal sex life with some variations of positioning for genital intercourse. For others, altered forms of sexual activity, or those of non-coital in nature such as touching, kissing, petting, or oral-genital stimulation, will be needed depending on the degree to which a partner or partners can move, how much pain there is, whether there are spasms and so on.

Paralysis may have little effect on the sexual organs, but can make certain sexual positions or movement impossible. It is seldom that postural difficult or bodily deformity totally prevents sex in one position or another. Intercourse is possible while lying, sitting, standing or kneeling with a man in front of or behind the woman or above or below her. Sex techniques also exist, which some disabled people may be unaware of and a sex therapist can help you discover them. Methods of intercourse when the penis is not fully rigid and means for extra stimulation of both the penis and clitoris are examples. Such knowledge could be significant for many disabled people.

Artificial aids such as use of pillows or cushions to adjust body positions or restrain a recalcitrant limb, or manufactured aids such as vibrators can be immensely useful. Such aids vary from small devices for maintaining or hardening erection to artificial penis or vaginas.

Where intercourse is impossible, caressing of the genitals of one partner by the other, or both together can be almost equally pleasurable. This can be done either with hands or orally. There are many techniques of this kind of lovemaking, which can easily be learned and put into practice.

Many people whose disability has caused a total loss of feeling in the main sexual areas find that their sensitivity in other parts of body – even those not usually recognised as erogenous zones, increases. It is important for the disabled person to understand his or her own body and communicate which areas are still sensitive to sexual arousal when stimulated.

Caressing and stroking of these parts can give intense pleasure. Even people who are virtually incapable of movement and have little feeling in their body report far more than usual sexual pleasure and satisfaction simply from being held close to their partner. Orgasm can still be achieved even when a significant part of the body is without sensation or motion. Sexual satisfaction may even be completely non-physical and may manifest itself as an emotion or spiritual release.

People with disabilities should engage in any sexual activity that is physiologically possible, pleasurable and acceptable to them. A priority is to find a comfortable position, and here using pillows and cushions may help to lend support or to take pressure off various areas. Using KY Jelly can help problems with lubrication, for example, when a woman has lost feelings in her genitals. Do not use petroleum jelly, which can cause vaginal infections.

Even the possibility of urinary or bowel incontinence should not preclude sex. A catheter that cannot be removed can be taped to the stomach or inner thigh to help keep it out of the way. An ileostomy bag (for holding feaces), if it is firmly in place, can be left as is. However, it should be emptied before intercourse to avoid accidents and then taped back in place. Paraplegics, too, can be taught to stimulate their partner using hands, mouth, toes, towel or anything else that does not harm, and to gain as much pleasure as possible from being touched.