[VIDEO] Sex and Intimacy After TBI – 1

The Brain Injury Alliance of New Jersey (BIANJ) is a statewide nonprofit organization dedicated to improving the quality of life people experience after brain injury, and bringing the promise of a better tomorrow. Our mission is to support and advocate for individuals affected by brain injury and raise public awareness through education and prevention. Our vision is a world where all individuals with brain injury and their caregivers maximize their quality of life, the consequences of all unavoidable brain injuries are minimized and all preventable brain injuries are prevented.

Learn more at http://www.bianj.org

[BLOG POST] What is intimacy?

by mpgarcia

According to the Merriam-Webster Dictionary, intimacy is a “state of being intimate or familiar” and “something of a personal or private nature”. To be intimate, according to the Merriam-Webster dictionary, means to be “marked by a warm friendship developing through long association”, suggests “informal warmth or privacy”, or “being engaged in, involving, or marked by sex or sexual relations” between consenting adults. People with disabilities have the right to be intimate relationships with their friends, siblings, lovers, and spouses, among others. However, they may face barriers in finding and nurturing intimacy – from social and attitudinal barriers to physical and communication barriers. People with disabilities do find intimacy in their relationships. Easter Seals shares stories and advice from people with disabilities related to intimacy. These stories cover intimacy-related topics such as dating, love and marriage, siblings, friendships, parents and children, and more.

Research has examined many facets of intimacy among people with disabilities and their relationships, both familiar and romantic. This research includes the NIDILRR-funded project iManage Sexual Wellness: Development of a Symptom-monitoring/Self-Management Program to Enhance Sexual Wellness After Spinal Cord Injury (SCI) and Traumatic Brain Injury (TBI), which develops new assessment item banks to measure sexual functioning in people with SCI and TBI. The NIDILRR-funded Model Systems Knowledge Translation Center (MSKTC) shares factsheets, modules, and other resources on intimacy for people with TBI, SCI, and burn injuries. NARIC’s collection includes over 160 documents on intimacy and people with disabilities from the NIDILRR community and elsewhere, including the international research community. NARIC’s Research In Focus series includes reader-friendly summaries of NIDILRR-funded research on this topic, including:

• New Findings May Offer Insight for Interventions to Strengthen Long-Term Marriage Stability for People with Traumatic Brain Injury.
• A Brief Couples Therapy Program May Provide Needed Supports for Partners of People with Brain Injuries.
• A Helpful Bug In Your Ear: Covert Audio Coaching Shows Promise to Help Young Adults with ASD to Navigate Peer Conversations.

Contact NARIC’s information specialists to learn more about intimacy and people with disabilities.

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[WEB] Providing survivors of stroke with guidance about sex and intimacy after stroke

by Stroke Foundation

Credit: Unsplash/CC0 Public Domain

Survivors of stroke have told researchers that they want information about resuming intimate relationships as part of their recovery, but rarely receive it, while only a quarter of stroke clinicians say they feel well equipped to give the right guidance.

The research was conducted by Auckland City Hospital occupational therapist Sian McGee and asked 41 patients between the ages of 36 and 90 about their preference for receiving information about sex and intimacy.

Ms McGee’s findings are being shared in Christchurch this week at the 31st Annual Scientific Meeting of the Stroke Society of Australasia 2022, which is being attended by international stroke experts.

The study is the first of its kind in New Zealand.

It found that clinicians need support in broaching the subject with patients, and that most of the patients surveyed expected to their doctors to speak to them about the subject of sex.

Ms. McGee says the study highlights how an important part of stroke recovery may be missed due to the discomfort around the subject of sex.

“Patients of all ages want this information but are almost never given it,” she said.

“We need to remember that stroke recovery is not just about physical therapy. Recovery needs to be considered holistically—survivors are intent on resuming their normal lives as quickly and as best they can, we need to ensure they are given opportunities throughout their journey to receive all of the advice and support to do that.”

Stroke is a leading cause of disability in both New Zealand and Australia, impacting almost 40,000 people each year. It is the leading cause of adult disability in both countries.

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[WEB] Disabled people want sexual lives, but face stereotypes

In 2021, sex and disability are still taboo. What are we so afraid of?

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When Kelly Gordon was 18 years old, she was having sex on the floor of a car with a person she didn’t particularly know. This might not sound especially risky, but somewhere in the middle of it, Gordon thought to herself, “what if he just left me here?” which was a terrifying prospect since Gordon can’t use her legs.

“We were in a remote location. What would I have done? I can look back on it now and I’m horrified to think that I ever was in that headspace. … My phone wasn’t near me. It was probably in the car somewhere but not within reach since I was on the floor and unable to move,” she said. “I was putting a lot of trust in someone I didn’t know.”

Gordon has spinal muscular atrophy type three, a progressive condition in which she loses ability throughout her life. Any changes to the body – growth, puberty, pregnancy – accelerate the loss. In Gordon’s youth, she engaged in risky sexual behaviors in an effort to explore a sexuality that society denies she possesses. She met people she barely knew in places that were often unsafe to sate a desire no one believed could belong to a girl in a wheelchair. 

“A lot of disabled people have personal assistants and because conversations aren’t had around the sexual desire of people with disabilities PAs are often shocked … Show more   HANDOUT

“Disability and sex are seldom mentioned in the same sentence,” she said. “As a disabled person you can often be viewed as asexual and completely left out of the conversation when it comes to sex and intimacy.”

People living with disabilities are frequently denied fundamental elements of well-being – visibility, agency, dignity. The cultural denial of their sexuality, disability activists say, is another feature of their dehumanization. Many people living with disabilities masturbate, experience sexual attraction and engage in sexual activity. But these facts do not align with stereotypes of disabled people that those living without disabilities confuse for reality.

“For nondisabled people, the idea of disabled people having sex doesn’t fit with their mental model of how they understand disabled people. We are perpetually infantilized so there’s that conundrum. They also largely don’t see us as lovers, parents, partners, one-night stands,” said Kara Ayers, associate director of the University of Cincinnati Center for Excellence in Developmental Disabilities. “Superficial ideals and misogyny also play a role here in people being fairly inflexible with what (or) who they consider sexually attractive.”

‘I felt like … I’m not attractive because of my disability’

Early in her life, when she could still walk, Gordon had “boyfriends” in the way children do. But by the time she was 12, she was in an electric wheelchair most of the time. People didn’t pursue her, they avoided her. At 14, like most adolescents, she had the urge to explore her burgeoning sexuality but quickly learned her disability complicated not only how others saw her but also how she saw herself. 

‘Sex drive’: Have we been thinking about it all wrong?

“I had those feelings where I felt like, ‘Wow, I’m not attractive because of my disability,'” she said. “I went on a journey where I was putting myself out there … to make myself seem like a sexual person from the off. So they’d know, ‘OK, this person’s interested in sex.'”

For Gordon that meant more elaborate makeup, more explicit sexual conversations and an expressed interest in casual hook-ups.

“I’d meet people online, people from out of school, not really disclosing my disability until either the last minute or sometimes not at all, because I was genuinely scared,” she said. “People made me feel like I wasn’t sexually attractive or good enough. I had a belief deep in me then that nobody would date me because I was disabled.”

Lack of understanding about disability and sex has harmful consequences

Approximately 15% of the world’s population experience some form of disability, and there’s a long history of denying them sexual agency and reproductive rights.

Some of the biggest myths about disabled people are that they don’t want or value pleasure, that they don’t have sex or one-night stands, and that they only date other disabled people. 

“Society objectifies and dehumanizes people with disabilities,” said Ayers, who has Osteogenesis Imperfecta. “We don’t think that a disabled person has the same desires, wants, needs.”

These misbeliefs have harmful consequences. People with disabilities are often not seen as sexually desirable, children with disabilities learn less about sex than their non-disabled peers and there’s a dearth of research on the sexual health of people with disabilities.

Some people with disabilities require caregivers, many of whom are uncomfortable assisting with sexual needs, whether that’s helping someone get onto a bed to engage in sexual activity with a partner or purchasing a sex toy.

A 2011 paper in the Canadian Medical Association Journal found “the sexuality of people with disabilities, many of whom require varying degrees of assistance to lead fulfilling sex lives, continues to be overlooked, avoided or even dismissed as a component of holistic care.”

There’s also a myth that people with disabilities don’t want or can’t have children. Ayers said many people with disabilities want families, but their choices are often curtailed.

According to the American Psychological Association, thousands of people living with disabilities in the last century were sterilized without their consent to keep them from reproducing. The legacy of reproductive violence continues today, said Ayers, who also says she sees parents of people with disabilities dictating their reproductive choices.

‘I had to lose my virginity in a brothel’

Asta Philpot had sex for the first time in a brothel in Spain. It felt good, though he admits he would have preferred a less transactional entre into his sexual life. While most people’s first sexual experience is awkward, he would have enjoyed less bumbling.

“The lady I was with couldn’t speak a word of English, and just asking her to remove my seatbelt was like launching a NASA rocket,” he said.

Philpot is an activist, a filmmaker, a romantic. He also has arthrogryposis, which impairs his movement. He needs assistance from the moment he opens his eyes until the moment he goes to bed. But Philpot feels less limited by his body than by a world that refuses to see the possibility it contains: to give and receive pleasure, to love and be loved. 

“I’m not living in denial, but I don’t even see myself as being in a wheelchair. I see myself going through life as just a … Show more   PERSONAL PHOTO

“I had to lose my virginity in a brothel with a sex worker because everyone thought I was switched off below,” he said. “Society looks at me as some kind of institutionalized being that has no sexual desire. … We’re in 2021 now, and I can’t actually believe that we’re still having to talk about the taboo of disability and sex.”

Philpot’s sexual experiences inspired a BBC documentary and two feature films, “Hasta La Vista” and the dramedy “Come as You Are.” But while the films focused on sexual pursuit, it’s no longer Philopt’s dominant storyline. Finding sexual partners has been a challenge, but finding love has proven the most formidable one. Philpot, now on the eve of 40, wants sex, but also connection, intimacy, longevity. He wants someone who will accept his body, who doesn’t see it as calamity and confinement. 

‘Am I actually going to meet someone?’

Gordon feared her disability made her undatable, but dates happened. Sex happened. What took more work was demanding the relationship she deserved. She needed to find acceptance outside the bedroom before she could ask for what she needed inside it.

Sexism diminishes female pleasure: What women need to know

Gordon, now 32 and married with two children, has a life tothat 15 years ago felt elusive. 

Philpot is still looking for it.

“I’m 39 now and I’m single,” he said. “I’ve often thought to myself, especially this year, ‘Jesus, am I actually going to meet someone?'” 

Nondisabled people, he said, don’t appreciate how difficult it is for those living with disabilities to pursue physical and emotional intimacy. As a disabled man, Philpot said his fears of isolation are amplified. But his desires – for connection, purpose, bliss –  are no different than someone who can move through the world autonomously. 

“I’m looking for intimacy and someone to share my life with, and to see me as Asta, and not as a person with a disability in a wheelchair. It’s something that we all long for, someone to love and who will love us back,” he said. “It wasn’t my fault that I was born this way, but this is what I’ve got. I’m happy in my own skin, and I’d just like to attract someone who sees me for who I am. That’s all I want.”

You may also be interested in:

• Disability advocates, experts implore you to stop saying ‘special needs’
• ‘Best Summer Ever’ is a feel-good musical and a big win for disability inclusion
• Brilliant ‘CODA’ is a moving, must-see movie that will inspire you

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[Editorial] Sex and gender in physiotherapy research

Evidence from preclinical and clinical research demonstrates that sex and gender can impact disease presentation, prognosis and response to treatment.¹ Sex refers to the biological attributes that define humans as male, female, or intersex, including chromosomes, gene expression, hormone levels and reproductive anatomy.² Gender refers to the socially constructed norms, behaviours and roles of girls, women, boys, men and gender-diverse people.² Gender is a continuum and not a static concept; gender can change over time. The mechanisms by which sex and gender impact health are complex and not yet fully understood, but include an interaction between epigenetic, genetic, environmental, social and behavioural factors, among others.³

Disaggregation of data by sex and/or gender helps to unpack the complex biological and psychosocial interactions that might influence disease presentation and progression. In a clinical setting, unpacking this interaction helps us to screen for disease more effectively, and choose the best evidence-based treatment course for patients. Differences between females/women and males/men have already been identified across several disciplines of physiotherapy, including neurology,⁴ musculoskeletal⁵ and cardiopulmonary.⁶

In clinical research, recruiting sex-diverse and gender-diverse populations is essential to enable disaggregation of data. Historically, health data have been collected on males and generalised to females.⁷ Such patterns are still observed in certain health fields such as pain research,⁸ exercise science⁹ and pharmaceutical trials.¹⁰ To remedy this, the governmental funding bodies of many countries have mandated equality in the collection, analysis and reporting of sex-specific and gender-specific health. It is still debateable whether or not these policies translate into research, so that the complex biological and psychosocial interactions of sex and gender with health can be unpacked.⁹ However, the first step in this process for clinical research must be the recruitment of sex-diverse and gender-diverse populations.

It is currently unknown whether physiotherapy research trials recruit sex-diverse and gender-diverse populations, or whether data are reported as sex and/or gender disaggregated. To gauge the current but pre-pandemic status of sex and gender reporting in physiotherapy trials, the reports of 250 randomised trials published in 2019 were randomly sampled from among those on the Physiotherapy Evidence Database (PEDro). Among these, four trial reports provided no information or conflicting information on sex and gender; these were not analysed further. Fifty-five trials studied females only or males only, and the remaining 191 trials included some degree of sex or gender diversity among the participants.

In the 55 trials that studied females only or males only, the minority were related to conditions that are female-specific (breast cancer n = 6, menopause n = 5, pregnancy n = 2, puberty n = 1) or male-specific (prostatitis n = 1). The other 39 trials involved participants with female sex only (n = 27), male sex only (n = 11) or female gender only (n = 1), even though the condition being investigated affects both females and males. Of these 39 trials, only 17 studies provided a rationale as to why they were investigating a single sex or gender; the remaining 22 studies failed to provide a rationale. Interestingly, the high proportion of female-only trials is in contrast to what has been seen in other health disciplines, where trials are more likely to be male-only⁹ or have a higher proportion of male participant inclusion.^11,12

Sex and gender diversity in physiotherapy research

The 191 trials with sex/gender diversity among participants included data on 19,390 participants. Nineteen trials, involving 1,049 participants, failed to specify the male/female split and so could not be included in the analysis of sex or gender ratio. For the remaining trials, the percentage of female participants was calculated. Among trials reporting the sex of participants, the mean percentage of female participants was 50% (SD 9), indicating that these trials typically had roughly equal participation of males and females. Among trials reporting the gender of participants, the mean percentage of female participants was 55% (SD 22). While this result again indicates roughly equal participation of males and females overall, the larger SD indicates that more trials would have had substantial imbalance. Also, no trials reported including any gender-diverse participants beyond binary males or females. Population-based studies estimate the prevalence of gender nonconformity to occur in up to 4.6% of the general population.¹³ That no trials included gender-nonconforming participants highlights a gap in current physiotherapy research. Previous research has identified that LGBTIQ+ individuals often have uncomfortable experiences with physiotherapists and physiotherapists lack knowledge specific to the needs of these individuals.¹⁴ These findings may reflect: poor physiotherapist training on gender diversity and inclusion; poor participation or recruitment of gender-diverse participants; and/or poor data collection and reporting regarding gender in research. It also indicates some deficiency in the evidence that physiotherapists have with which to tailor their clinical decision making to individual patients.

When describing demographic data, sex was used as a descriptor in 132 trials and gender as a descriptor in 59 trials. Eleven trials conflated sex and gender, using the terms interchangeably throughout the manuscript. Twenty-seven trials did not use either term, but instead provided a number or percentage of males and/or females (n/% of males/females n = 14, n/% of males n = 7, n/% of females n = 6). No trial included a definition of either sex or gender, or stated why one variable was chosen over the other to be collected from participants.

Sex and gender disaggregation in physiotherapy research

None of the 191 trials disaggregated their data by sex or gender. Some trials used statistical methods to account for potential sex or gender differences. Twenty trials used statistical adjustments for sex differences (18% of trials reporting the sex of participants) and five trials used statistical adjustments for gender differences (9% of trials reporting the gender of participants). While statistical adjustment for demographic variables is helpful, adjusting for sex and gender is insufficient in health research. Statistical adjustments do not show where specific differences between sex and gender exist, and understanding these differences is vital for clinical decision making.

Recommendations for future research

This analysis of physiotherapy trials has highlighted strengths and weaknesses in that research. The equal recruitment of males and females by sex and gender is encouraging and is something our profession should continue to strive to do in research. However, there was a lack of inclusion of gender non-conforming participants. Future physiotherapy research should look to recruit even or representative numbers of women and men (by gender), and also include gender-nonconforming participants.

Sex and gender were often used interchangeably, and no studies provided definitions of sex or gender, or a description of why either sex or gender was chosen over the other as a demographic characteristic. Researchers are encouraged to consider sex and gender variables in the planning stage of trials, and determine which characteristic may be more important to the primary research aim. Recruitment of participants by either sex or gender, or even both, should relate to any hypotheses around whether these characteristics may influence the outcomes of the trial. Gendered Innovations in Science, Health & Medicine, Engineering, and Environment¹⁵ provides comprehensive resources for health researchers to plan for analysing sex and gender differences, and the Canadian Institutes of Health Research offer free online training courses to assist researchers in appreciating the differences between and across sexes and genders.¹⁶

While some of the included trials statistically adjusted for sex or gender variables, no trials disaggregated their data according to sex or gender. Disaggregating data in this way ensures that differences in outcomes can be observed between and across sexes and genders, which is vital information for clinicians to more effectively screen for disease and choose the best evidence-based treatment options for presenting patients. However, we recognise that analysis of subgroups by sex or gender results in a loss of statistical power, which is an important consideration in clinical trials. Therefore, we encourage researchers to run analyses to determine possible interaction effects due to sex and/or gender, preserving statistical power, and present disaggregated data where such an interaction effect exists.

If a sex or gender effect is identified, it is important to determine whether it is a consistent finding. This could be assessed in future replications of the study. It could also be assessed easily in existing similar trials if they publish the individual participant data with sex/gender data. See, for example, Table 4 in the eAddenda of the trial by Scheer et al in this issue.¹⁷

The Journal of Physiotherapy encourages researchers to consider whether sex and/or gender may moderate the effects of the intervention. Where it is plausible that sex and/or gender may be treatment effect moderators, researchers should plan, a priori, to investigate this using appropriate analyses (eg, test for an interaction effect based on sex and/or gender). If a significant interaction is found, disaggregated data should be reported. We also encourage authors to adopt this approach when submitting research to other journals.

References

1 A.J. McGregor, et al.Biol Sex Differ, 7 (2016), pp. 61-72

2 Canadian Institutes of Health ResearchWhat is gender? What is sex?https://cihr-irsc.gc.ca/e/48642.html, Accessed 28th Jul 2021Google Scholar

3 Z. Wainer, et al.Med J Aust, 212 (2020), pp. 57-62 Download PDFView Record in Scopus

4 R.A. Haast, et al.J Cereb Blood Flow Metab, 32 (2012), pp. 2100-2107 Download PDFCrossRefView Record in Scopus

5 S.Z. George, et al.J Orthop Sports Phys Ther, 36 (2006), pp. 354-363 Download PDFCrossRefView Record in Scopus

6 J.A. Krishnan, et al.Arch Intern Med, 161 (2001), pp. 1660-1668 Download PDFView Record in Scopus

7 C.C. PerezInvisible women: Exposing data bias in a world designed for menRandom House (2019)Google Scholar

8 J.S. MogilNat Rev Neurosci, 21 (2020), pp. 353-365CrossRefView Record in Scopus

9 J.T. Costello, et al.Eur J Sport Sci, 14 (2014), pp. 847-851CrossRefView Record in Scopus

10 S.S. Richardson, et al.Proc Natl Acad Sci, 112 (2015), pp. 13419-13420 Download PDFCrossRefView Record in Scopus

11 V.S. Prakash, et al.J Womens Health, 27 (2018), pp. 1342-1348CrossRefView Record in Scopus

12 S. Feldman, et al.JAMA Netw Open, 2 (2019), Article e196700 Download PDFCrossRefView Record in Scopus

13 L. Kuyper, et al.Arch Sex Behav, 43 (2014), pp. 377-385CrossRefView Record in Scopus

14 M.H. Ross, et al.J Physiother, 65 (2019), pp. 99-105ArticleDownload PDFView Record in Scopus

15 Gendered Innovations http://genderedinnovations.stanford.edu/index.html, Accessed 9th Aug 2021Google Scholar

16 Canadian Institutes of HealthSex and Gender Training Moduleshttps://www.cihr-irsc-igh-isfh.ca/, Accessed 9th Aug 2021Google Scholar17A. Scheer, et al.J Physiother, 67 (2021)XXX–XXX

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[BLOG POST] Let’s talk about sex… – Headway

Let’s talk about sex…

“Sex after a stroke is tricky, but you don’t have to just do the missionary position.”

Let’s talk about sex…

It’s one of the most natural things in the world, yet intimacy and sex are still seen as taboo subjects that many of us don’t feel comfortable talking about.

Throw disability into the mix and there seems to be a stony silence pervading the scene. There also appears to be an implicit reluctance, including among the professional world, to acknowledge and address the fact that having a disability does not stop feelings of wanting romance, intimacy and sex.

Brain injury, as we well know, affects people both physically and in ‘hidden’ ways such as cognitively, psychologically, emotionally and behaviourally. All of these effects can have an impact on the brain injury survivor and their sexual partner’s feelings towards sex.

Here, we discuss the challenges that having a brain injury can pose when it comes to having a healthy sex life, as well as how to address the issues head-on and work towards ending the myths around brain injury and sex.

Okay, so we all know that sex is the rumpy-pumpy hanky-panky business that typically takes place between the bed sheets. But sex isn’t just about the physical act.

Sex has different elements that make it a much more intimate and psychologically fulfilling process, while also having a basic reproductive purpose that comes down to pure biology. So all in all, what is sex?

Sex is sometimes divided into two aspects of sexual functioning: the physical aspect of sex (such as sexual arousal, intercourse and orgasm…the ‘rumpy-pumpy’ stuff, if you will), and sexual well-being, which relates to the emotional and psychological aspect of sex such as sexual satisfaction. It also includes acts of intimacy such as touching and kissing.

But sex refers to more than just physicality. Complex emotional, psychological and social customs, such as forming romantic relationships in the first instance, are often involved in both initiating and having sex. The act of sexual intercourse itself is both physical and emotional.

Finally, there is no single definition of the word sex – it can mean different things to different people, depending on personal experience, values, personality and preferences.

Sex and the brain

So what does the brain have to do with sex? Actually, a lot! The brain is responsible for processing the feelings and sensations that are a core part of a sexual experience.

Different parts of the brain are involved in things such as the behaviour and social skills we use to meet and interact with a sexual partner, and our personality and overall interest in sex. These aspects can all be affected by a brain injury.

Sexual relationships after brain injury

Anna Smith-Higgs

Couples who already shared a sex life before the occurrence of a brain injury commonly find that the injury affects one or both party’s interest or ability to have sex.

This in turn can cause difficulties in the relationship such as feelings of loss and a lack of fulfilment. But in some circumstances, can fear play a part?

Anna Smith-Higgs suffered a life changing stroke aged 24, just one month after her son was born. She was left partially paralysed down her right-hand side, has mobility issues and is partially sighted.

Anna, now 38, said following her stroke sex was the last thing on her mind.

“I couldn’t accept what I’d become,” said Anna. “I’d gone from being a fit 24 year old with everything to look forward to, to struggling to change my child’s nappy.

“Before my stroke I had a very active sex life, but afterwards I spent months in bed and was scared to move, terrified that I’d have another stroke. At that point I was battling depression and I didn’t want to know or partake in sex at all.”

‘Communication is the key’

Anna said sex after having a stroke can be extremely scary and fill you full of doubts.

“My stroke was due to hormones from child birth so I was scared of sex as getting pregnant again was my biggest fear.

“I would also worry in case an orgasm increased my blood pressure. I worried that with only half of my body working to its full capacity, the sex wouldn’t be the same as it was before. I doubted that I wouldn’t be able to perform the way I once did.

“These fears got so bad that my partner and I just didn’t do it. This left both of us frustrated. It just wasn’t a very nice way to live.

“But with time I realised that all these worries were not worth thinking about. I realised that no, my blood pressure won’t increase; no, I won’t be able to perform like I did before. But that doesn’t mean my sex life is over.”

Anna said communicating with her partner about how she was feeling was the key.

“You have to try and not feel self conscious, you need talk to your partner, no matter how uncomfortable you may be feeling,” said Anna.

“It not only helps bring you closer as a couple but you will probably find your partner is feeling the same. A strong relationship can survive anything. It turned out my partner was just as scared as me the first time we had sex after my stroke.”

Anna said sex after a brain injury can still be fulfilling.

“Sex after a stroke is tricky but you don’t have to just do the missionary position. Why would I just lay there and get no pleasure at all. You need to experiment and find positions that work for the both of you.”

Taking up burlesque dancing was a massive help to build up Anna’s confidence

Anna said taking up burlesque dancing was also a massive help to build up her confidence and feel sexy again.

She said: “I found my confidence through burlesque. I now perform as a disabled performer. I don’t care that I am disabled and overweight – I embrace it.

Anna said her biggest advice about sex after brain injury is not to be put off.

“Talk to your partner and try to keep things relaxed. Things are going to fail but that shouldn’t put you off, try again. Oh and most importantly, have fun.”

Top tips for managing sexual relationships after brain injury

• Try to identify if a particular effect of brain injury is causing the sexual issues, such as fatigue, pain or psychological effects. Read up on ways of coping with these effects and seeking professional support for them, for instance from Headway’s booklets and factsheets at www.headway.org.uk/information-library 
  
• Both your body and your brain need time to prepare for sexual activity, so don’t rush into having sex. Instead, set time aside and make sure there are no distractions in the environment, and start off by engaging in activity such as touching and kissing to create a sense of intimacy.
  
• Seek support from professionals, such as your GP, a sex and relationship therapist, a neuropsychologist or the Headway helpline.
  
• Be adventurous! Having a disability, physical or otherwise, does not mean that you cannot try out new things and explore other ways of having sex.

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[WEB PAGE] Disabled People Have Sex – It Happens! | Disability And Sex Drive

Disabled people have sex – it happens!

Zec Richardson 08/02/2021 FacebookTwitterLinkedInTumblrPinterestRedditPocketSkypeShare via EmailPrintListenReadSpeaker webReader: ListenFocus

Here at Disability Horizons, we’re always trying to change society’s negative perceptions of disability and bust misconceptions. This is particularly true when it comes to sex and disability.

We’ve been looking at what people search online, and this includes the phrases ‘disability and sex drive’ and ‘sex when disabled’. Is this people believing that disabled people are asexual, with no wants, desires or needs? Or is this disabled people themselves unsure whether they can have sex with their condition?

Either way, ahead of Valentine’s Day, we’re sharing disabled people’s sex stories to prove what’s possible and break down the taboo. Here, our resident shop reviewer Zec talks openly about his sex life as a married disabled man.

The first thing I want to get straight with this article and for anyone searching those terms – disabled people have sex. We do it to the best of our ability and, it may come as a big surprise to people, but many of us do it very well!

Before I go on, I should just warn you that I am going to talk very frankly about sex – I am not the type to hold back. I will speak from my experience and point of view and speak candidly!

So don’t say that I didn’t warn you. But at least you have a choice – the poor editors at Disability Horizons don’t and I apologise for that (except I don’t really ).

Disability and sex drive

I haven’t always been disabled. In 1997, I was also diagnosed with myalgic encephalomyelitis, more commonly known as ME or chronic fatigue syndrome (CFS) – you can read more about how I became disabled in my first article on Disability Horizons. One of the first things I was worried about wasn’t losing the ability to walk, it was saying goodbye to my sex life.

When my pain levels started to grow, my mobility became increasingly problematic. I also had multiple knee surgeries, and too many years on crutches damaged my shoulders and wrists, so I started to use a wheelchair. I suddenly had this feeling of impending doom, that my sex life would never be the same again.

Happily, I now look back at that and laugh because, shock horror, my sex life is now better than it ever was.

Despite the fact that disabled people and those with health conditions have many varying physical and mental impairments, just like an able-bodied person, we still have those same desires, wants and the need for sex.

When people are aroused, their brain releases the chemicals oxytocin and endorphins, and it’s no different if you’re disabled. It just means that we have to approach sex differently.

My sex life as a disabled married man

I am very fortunate, I haven’t had to date or find a partner as a disabled person. No, I lured the girl of my dreams in my early 20s, married her and had children before becoming disabled.

For me when it comes to sex, I not only have the problem of a physical disability but also constant pain to varying levels and periods of extreme physical and mental fatigue.

But my brain does not seem to understand this and even on the worst of days, it suddenly nudges me and says, “By the way, you are feeling horny, have some chemicals.”

And so, there I am, laid in extreme pain and/or with fatigue and feeling aroused. Great!

Quite often in these circumstances, when I turn and look at my wife and she somehow knows what I am thinking, she says, “No, aren’t you in enough pain already?” She is right because even on the best of days, the act of sex will cause a big flare-up that can last for days.

But it’s worth it! I am willing to cause myself all manner of harm when I have an erection –  and I don’t mean that in a kinky, spank me, tie me up and hurt me kind of way. I mean that I don’t care if I have days of payback because I have had sex.

Adjusting our sex life

So how do we get around these issues? The first thing we needed to do was change our positions. We had to forget doggy style because of my knees and pain, which my wife actually tells me is a bonus of me being disabled.

We’ve also had to forget the missionary position too, and sometimes, when my hips are playing up, I can’t make any sort of thrusting movement. In addition, sometimes penetrative sex is just not possible.

If I had gone back in time and told a 20-year-old me that this would happen, I think I would have cried a little. But the truth is, it really isn’t a problem.

And yes, despite these changes, I still say that our sex life now is better than it was before! We’ve been together for 31 years, so we know each other well and we were able to work out my new limits together. Also, as we’ve had to rethink things and do them differently, we’ve also had to slow it down, which isn’t a bad thing.

So we take things as they come, depending on how I am feeling with my ever-changing condition.

On a good day, when fatigue is only a slight problem and my pain levels are down to a three (and yes, that is a good day), I can go mad and fill my boots (poor choice of words, but you get what I mean).

On days like that, I am able to have penetrative sex. That is usually done with my wife on top, me being the big spoon or with my wife on her back, me on my side next to her and her leg nearest me over my side (no idea what the name of that position is).

I know right, practically a gymnast – go me! Of course, that is after the introductory foreplay to get all right bits to the right level and ready.

Disabled sex aid equipment

So let’s skip to the complete opposite end of my disability and what happens when my pain levels are high and or my fatigue is more problematic (but not at a level where it is impossible to do anything).

In these circumstances, we use sex toys or aids – and it’s taken our sex life to the next level. We had used sex toys before, but only really a basic vibrator for my wife that was rarely used.

Now, we use loads, most of which I have reviewed a few on my website, www.satonmybutt.co.uk. So, on a bad day, we stick to foreplay and use sex toys for an orgasm rather than penetrative sex.

For some reason, people view sex toys as a bit naughty, a kink and something that we must not talk about. But the truth is that everyone should have at least one sex toy and, for disabled people, they are a game-changer.

I have to confess that when we received the first sex toy for men, I was a tad embarrassed and hesitant to use it. But after testing a few, I have found a very good one that we can use for me when I can’t physically manage to have sex. Everyone has the right to orgasm, even if they don’t have a partner.

There is a massive range of sex toys for either the penis or vagina (and other bits) and many sold online now come in very discreet packages. There are also some amazingly innovative and inclusive sex toys on the market. There are even hands-free toys and some that can be controlled via a remote or smartphone.

The Pulse from Hot Octopuss enables someone who can’t get an erection due to erectile dysfunction or spinal cord injury, to orgasm, that is amazing. There is also a Pulse Duo where a partner can get on top and an area of vibration will take care of their needs.

There is a lot of sex equipment available too!. These can range from simple, covered foam wedges to help with positioning, to large pieces of furniture. Some of these will even have the option to house a sex toy for hands-free pleasure. Check out Bedroom Adventures for products like these!

There still needs to be more sex toys designed for disabled people, but there is a lot out there to start with.

So, the answer to the questions on having sex when you’re disabled and sex drive is that where there is a will, there is a way! And I really believe that people shouldn’t be embarrassed about the topic, especially when it comes to disability.

Do not feel ashamed – the desire for sex is a basic and primal urge that every living creature has, and just because we are disabled, that does not mean that we should suppress those urges!

By Zec Richardson

You can catch up with Zec on his website, YouTube Channel, Facebook, Twitter & Instagram.

More on Disability Horizons…

• How to satisfy yourself as a single disabled person
• Disabled sex positions: how to enjoy explosive sex comfortably
• Spice up your sex life: top toys and positions for disabled people
• Thinking outside of the box if you’re disabled can make your sex life explosive

 TagsDisabilityDisability and sex drivedisableddisabled sex aid equipmentmarriageRelationships & Sexsexsex driveSex when disabled

Source: Disabled People Have Sex – It Happens! | Disability And Sex Drive

[WEB PAGE] How To Satisfy Yourself As A Single Disabled Person

We want to break the taboo around talking about sex and disability. Everyone, no matter what their disability or health condition, should be able to enjoy sex and pleasure. That’s why we’re publishing a series of sex stories from people with different disabilities talking openly about their experiences.

Having heard from a blind woman and a man who had a stroke, this week Tom, a wheelchair user with physical disabilities, talks about how he satisfies himself as a single man with erectile dysfunction.

My name is Tom Francis, and I was born 25 years ago with severe spina bifida and hydrocephalus. As a result of that, I am a wheelchair user and have assistance from carers four times a day. Without this, daily life would be a struggle.

I also need help getting into and out of my chair, and we all know how inaccessible the world outside can be. I am, therefore, also very grateful to have a good circle of able-bodied friends who are constantly watching out for me.

They regularly take me out to the pub (or at least, they did before coronavirus hit!) and we go to the cinema and to football matches together.

I have a pretty good social life, but there is one thing that bothers me. When the conversation turns to sex, as it inevitably does with a group of men in our mid-twenties, it’s awkward for me.

All of my friends are in couples, whether married, living together, gay, straight or bisexual – and I’m on my own.

Single and disabled

I have had girlfriends in the past (I’m definitely straight, by the way!), but none of the relationships has developed into anything serious or long-term.

That has had nothing to do with my disability, as such, but living with a disabled person can come with a degree of commitment in both time and effort. Many able-bodied girls in their 20s aren’t willing to give that – well, not the ones I have met, so far.

So, until I find someone who is right for me, how do I deal with this? It’s not just a case of saying: “Oh, forget about sex.” I still have the same sexual thoughts that any young man of my age would have.

But I also suffer from erectile dysfunction as a result of the damage to my brain at birth, so straightforward masturbation doesn’t provide a solution. So, what does?

Well, I learnt a while ago from a friend who works in the field of sex-therapy that sexual activity doesn’t have to involve the genitals. There are lots of ways to deal with my sexual urges – it just requires a little outside-the-box thinking.

Satisfying your urges

Firstly, there is erotica – both writing it and reading it. I loved English at school and with a little more drive from myself and encouragement from my family, I could have gone on to study it at university.

Nowadays, I keep myself occupied at home by writing short stories, and although most of them involve my other favourite subjects, sport and history, I sometimes venture into the world of erotica.

I don’t go too mad and I’m yet to write one about a disabled person. But I do have a pretty good imagination and the couples (it is usually couples) in my stories, do get up to quite a bit.

I’ve written about them having sex on the kitchen floor, sex in a shaded garden, mild bondage, playing with a wide variety of toys and discovering the various ways in which oral can enhance your sex life – my personal favourite.

I’m also a voracious reader and I have an extensive and varied collection of erotica. I’ll admit that some of it covers the things I can’t do (I really should publish something myself from the perspective of someone with a disability).

But a lot more doesn’t involve genital action. Instead, it involves the use of toys, touch, BDSM, smell (I love the smell of real leather underwear) and so on.

Outside of the written word, I have also learned to concentrate on what I can do, not on what I can’t. With that in mind, I have found a great way to pleasure myself…

I have a wet-room with a sit-down shower and nothing is more enjoyable than sitting in my wheelchair under the shower with the shower-head playing jets of warm water around my bits.

And yes, I’ll admit, I do watch porn. Nothing too strong, but I don’t see anything wrong with a disabled person using it to satisfy their desires if they wish. After all, disabled people are just as entitled to a fulfilling sex life if they wish as non-disabled people, aren’t we?

So, until I find someone who is willing to open their mind and look beyond the wheelchair, I’m keeping myself occupied – just like any other non-disabled person.

I’d be interested to get some feedback from what I’ve said here. Do people in my situation agree with me? What other ideas have people come up with?

By Tom Francis

Source

[BLOG POST] Accessible Sex Toys for People With Disabilities or Chronic Pain

By Renee Fabian 

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Sex is a basic human need, yet often people with mobility challenges or physical differences are left out of the conversation, from depictions in popular media to the design of sex toys. When considering the latter, most people view sex toys as a naughty bonus. For people with a disability or chronic illness, however, sex toys aren’t “just” for fun — they’re an empowering way to make sex accessible.

“Sex toys can not only give us pleasure but they are assistive technology just like a cane or a shower chair,” Eva Sweeney, sex educator and host of “Cripping Up Sex With Eva,” told The Mighty. “They allow us to explore and enjoy our bodies like everybody else. So many times toys are viewed as novelties or optional when they are necessary for many people with disabilities or chronic illness (and without).”

It’s easy to find enticing sex toys if you’re able-bodied, but it’s more of a challenge to find affordable options that people with mobility challenges or even chronic pain can use comfortably. “Most sex toys are very expensive and as we all know people with disabilities are more likely to live in poverty,” Sweeney said. “That’s the major barrier keeping people with disabilities from getting the toys they need.”

We gathered 15 accessible sex toys, wearables and devices that might just fast-track you to the big “O,” whether you’re looking for solo fun or a partnered encounter. And here’s a little extra advice from Sweeney: “Explore! Try different toys. Everybody is different.”

1. Tongue Star Pleasure Tongue by Hott Products ($5.65)

This toy lets your tongue do the talking during sexy times with this hands-free vibrator you can wear. It looks a little like a mouth guard, and that’s exactly how you’ll use it. The design reduces the vibrations you feel on your teeth when the vibrator is on. A small vibrator attached to the outside of the mouthpiece, meanwhile, lets you deliver what Hott Products calls “toe-curling thrills” to a partner.

2. Thigh Strap-On by SportSheets ($23.99; $15.36 on Amazon)

SportSheets’ thigh strap-on lets you give a partner an intimate experience with penetration even if your mobility restricts your pelvic movement. It’s hands-free for you, so while your partner grinds, you get to explore. The strap-on harness is sturdy and comfortable and can be a great solution for accessibility. “Harnesses can be really helpful for keeping toys in place,” Sweeney said. “There are harnesses for every body part and can be custom made,” so let your imagination run wild.

3. Mage Flexible Massager Vibrator by Intimate Melody ($29.95)

“I really like flexible toys because you can mold them in whatever shape you want and they usually stay like that so you don’t have to use your hands as much,” Sweeney told The Mighty. The Mage flexible massager vibrator delivers on this sex toy ideal. Made by Intimate Melody, this vibrator isn’t hands-free, but it’s completely flexible so you can customize the toy to what works best for you. That includes bending, twisting and folding the Mage and exploring its six massage modes at three strength levels.

4. Hollow Strap-On by Adam & Eve ($29.95)

A hollow strap-on can bring new energy into your sexual life if penetration is important to your routine. The hollowed dildo can accommodate an erect or resting penis, and if you live with erectile dysfunction, a hollow strap-on can provide the sensation of giving penetrative sex for you and a partner. The rippled shell will feel great for both parties. It’s a flexible investment because it can be used by any gender thanks to an adjustable, sturdy harness and an easy-to-clean dildo. You can also invest in a vibrating version of this hollow strap-on ($49.95).

5. Sex Stool by Kinkly ($60.99 on Amazon)

Sometimes, you just need a little extra support. Enter the sex stool, a sturdy metal frame with elastic straps to support your body weight that gives you amazing access to a partner or sex toy mount. With a sex stool, you’ll use less energy and be able to focus more on pleasure and less on strain. It’s easy on the knees, and some users have reported extra tingles thanks to increased compression in your glutes as you use the stool.

6. HelixSyn by Aneros ($69.95)

For those who like to enter through the back door, Aneros’ HelixSyn prostate stimulator is the hands-free option you may be looking for. Advertised as having “velvet touch” silicone, the toy is comfortable for both beginners and advanced users. Its shape fits comfortably inside your body and causes friction in all the right spots as you contract and relax your muscles (a version of anal kegel exercises). HelixSyn’s design pivots as you move, so you’re in good shape no matter what position you choose. Plus, the handle won’t cause any pain and a comfort tab is designed to increase your pleasure.

7. Door Jam Sex Sling by SportSheets ($69.99; $35.11 on Amazon)

To gain extra support and a lot of flexibility positioning with a partner, give this door jam sex sling by SportSheets a try. The sturdy sling has a seat, hand and foot straps, all of which are adjustable. At least one partner will need to stand. However, the sling can assist in bearing body weight as you try out new sex positions that might not otherwise be possible. Other sling options, like a simple sex sling ($35.99) or the Penetration Station that attaches to the mattress ($44.99), might also be worth checking out.

8. Fin Vibrator by Dame Products ($75)

With Fin, Dame Products has taken the grip challenge out of vibrators. “Fin is a finger vibrator…that’s much easier to hold than most bullets because it has little fins almost that goes between your two fingers,” Dame co-founder, Alexandra Fine, told The Mighty. “It also has a detachable tether that can really tie the product to your hand in a way that a lot of people either with disabilities or arthritis or any challenges gripping something really like….The way it works with your hand, it feels more like a natural extension of your body.” Introduced in 2016 by Fine and Dame co-founder Janet Lieberman, Fin offers dual sensations and three speeds all in the palm of your hand. Also check out Dame Products’ flagship hands-free vibrator you can wear during sex, Eva II ($135).

9. Wearable by Ohnut ($75)

The first intimate wearable, Ohnut’s creator and founder Emily Sauer wanted to address painful sex for people with a vagina. “I had been experiencing painful sex myself for my entire sexual life and when I had asked doctors for advice they really didn’t want to offer any help,” Sauer told The Mighty. “It finally got to a point where I had felt so isolated by my experience because I was too embarrassed to talk about it and [so I] came up with this crazy idea.”

Ohnut — comprised of four stackable, adjustable linking rings “that allow you to modulate penetration depth” — aims to reduce pain and bring fun back into the bedroom. The squishy, comfortable silicone Ohnut is worn by the penetrating partner or placed on a toy, and you can add or remove rings to personalize penetration depth. Orders placed on Ohnut’s website are scheduled to ship in early November.

10. BonBon Sex Toy Mount by Liberator ($85; $68 on Amazon)

A variety of pillows can make sex more comfortable and accessible. There are tons of pillow options out there, from wedges to ramps, lifts, sex toy mounts and center stages. From master sex-friendly pillow company Liberator, the BonBon sex toy mount pillow is a versatile investment. You can insert a toy into the mount for solo fun or you can use the BonBon on its own to find a comfortable sex position with a partner. It’s a two-in-one pillow combination for whatever you’re in the mood for.

11. Jive by We-Vibe ($119; $93.92 on Amazon)

For a wearable, hands-free vibrator that delivers maximum G-spot sensation, We-Vibe’s Jive has you covered. Easy to manage, the Jive’s design prioritizes user comfort. Once it’s in place, you can deliver 10 modes of self-pleasure. Kick your fun up a notch because the Jive connects to a controllable app via Bluetooth, so you or a partner can control the toy from anywhere, and you can create custom vibes. It’s on the expensive side, and for any toy in a higher price range, Sweeney advised finding a cheaper version for testing before investing in the higher quality version.

12. Pulse III Solo by Hot Octopuss ($119)

Vibrators aren’t just for people with vaginas. The Pulse III Solo by Hot Octopuss brings hands-free vibration to those of you with a penis. It’s expensive, but this “guybrator,” as they call it, delivers oscillating stimulation backed by science to give you an orgasm without lifting a finger. You can adjust the Solo’s speed, and the expandable silicone wings wrap around comfortably for maximum sensation. In addition, Hot Octopuss’ research found that an erection isn’t required to use the Solo: “Tests have shown that used static, Pulse can lead to orgasm even while the user remains flaccid.”

13. Bi-Stronic Fusion by Fun Factory ($220)

Check out Fun Factory’s Bi-Stronic Fusion for hands-free penetration. It’s a multidimensional tool, providing thrusting, pulsing and vibrating all in one. Once inserted, it does the work for you. The Fusion is shaped to reach the G-spot and provide clitoral stimulation all at the same time, though some reviewers have said the toy’s larger size makes full insertion (required for the external vibrator to reach the clit) uncomfortable for some people. You can also test-drive the Fusion through 64 pulsation and vibration options.

14. Sex Machine by Humpus ($258)

Humpus, a U.K.-based company working to revolutionize hands-free pleasure, is nearly ready to release their Humpus sex machine. Made for any gender (or couple), the compact machine is worn around the waist with either a penetrative or sleeve attachment. With the click of a button, Humpus will do the stroking or thrusting, and you have the ability to adjust the speed or the attachment. They’re on the pricey side, and, according to a recent press release, the Humpus won’t be available until the holidays this year at the earliest.

15. Sex Chair by IntimateRider ($329)

Designed by a person with C6-7 quadriplegia to add more choice to sexual movement, the IntimateRider chair smoothly glides to provide thrusting action. The seat of the chair is short so it doesn’t get in the way of the action, and its design makes it easy to transfer into and find the optimal position. IntimateRider swings into action with movement from your upper torso, or with assistance from your partner. You can also add a RiderMate ($169) or RiderMate Deluxe ($315) for additional positioning and support options for you and a partner.

Looking for some disability-inclusive sex positions? Check out our illustrated list. 

via Accessible Sex Toys for People With Disabilities or Chronic Pain | The Mighty

[Abstract + Similar articles] Interventions for Sexual Dysfunction Following Stroke

Abstract

Background: Sexual dysfunction following stroke is common but often is poorly managed. As awareness of sexual dysfunction following stroke increases as an important issue, a clearer evidence base for interventions for sexual dysfunction is needed to optimise management.

Objectives: To evaluate the effectiveness of interventions to reduce sexual dysfunction following stroke, and to assess adverse events associated with interventions for sexual dysfunction following stroke.

Search methods: We conducted the search on 27 November 2019. We searched the Cochrane Central Register of Controlled Trials (CENTRAL; from June 2014), in the Cochrane Library; MEDLINE (from 1950); Embase (from 1980); the Cumulative Index to Nursing and Allied Health Literature (CINAHL; from 1982); the Allied and Complementary Medicine Database (AMED; from 1985); PsycINFO (from 1806); the Physiotherapy Evidence Database (PEDro; from 1999); and 10 additional bibliographic databases and ongoing trial registers.

Selection criteria: We included randomised controlled trials (RCTs) that compared pharmacological treatments, mechanical devices, or complementary medicine interventions versus placebo. We also included other non-pharmacological interventions (such as education or therapy), which were compared against usual care or different forms of intervention (such as different intensities) for treating sexual dysfunction in stroke survivors.

Data collection and analysis: Two review authors independently selected eligible studies, extracted data, and assessed study quality. We determined the risk of bias for each study and performed a ‘best evidence’ synthesis using the GRADE approach.

Main results: We identified three RCTs with a total of 212 participants. We noted significant heterogeneity in interventions (one pharmacological, one physiotherapy-based, and one psycho-educational), and all RCTs were small and of ‘low’ or ‘very low’ quality. Based on these RCTs, data are insufficient to provide any reliable indication of benefit or risk to guide clinical practice in terms of the use of sertraline, specific pelvic floor muscle training, or individualised sexual rehabilitation.

Authors’ conclusions: Use of sertraline to treat premature ejaculation needs to be tested in further RCTs. The lack of benefit with structured sexual rehabilitation and pelvic floor physiotherapy should not be interpreted as proof of ineffectiveness. Well-designed, randomised, double-blinded, placebo-controlled trials of long-term duration are needed to determine the effectiveness of various types of interventions for sexual dysfunction. It should be noted, however, that it may not be possible to double-blind trials of complex interventions.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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via Interventions for Sexual Dysfunction Following Stroke – PubMed