Here’s a collection of wide-ranging questions and answers from Mitch Tepper and Lizzi McNeff’s Love Bites columns over the past several years, re-edited for brevity.

On Sexual Positions
Sexuality Reborn: Sexuality Following Spinal Cord Injury by Craig J. Alexander and Marca Sipski, depicts many creative positions for couples with one disabled partner, and also some for two disabled partners. One segment demonstrates mutual mastubation as an option. This video contains sexually explicit scenes. To order, call the Kessler Medical Rehabilitation Research and Education Corp. at 800/435-6812.

Sex and Back Pain,by Lauren Andrew Hebert, is not intended specifically for people with paralysis, but does an excellent job of showing spooning, side-lying and cross-lying positions for intercourse. The scenes are sensitively acted out by a man and woman in leotards, and a book version is available. To order, call IMPACCUSA at 800/762-7720.

Both videos demonstrate the use of pillows, chairs and other furniture for supports. Positioning for sexual activities is a matter of problem solving, based on both partners’ physical function and the props and supports at hand.

Woman, T10-11 para, wants info on how to reach orgasm and how to know she has done it.
Many people with disabilities can achieve a physical orgasm. Others lack physical sensation but, because the brain can work independently of the genitals in generating an erotic experience, they do have feelings of sexual fulfillment.

For example, some people don’t feel physical touch while making love, yet say they feel a “rush” or flushed feeling. People who have never experienced orgasm are often able to fantasize one that can be intense and enjoyable.

Experiment, with and without your partner. Make love with the light on or use mirrors. Talk about what you like and what feels good. Use fabrics, textures or leathers. Try mutual massage. Many women have orgasmic sensations when their breasts are stimulated. I know of one woman who is orgasmic when her partner nibbles on her ear!

Remember, orgasm can be experienced many different ways. It is important to be flexible and liberal in your views of how it should feel. And remember that the ability to love and be loved and be sexually expressive is what’s most important.

Male quad, 24, has never had sex but gets reflex erections, sometimes long and painful, around nurses, and is embarrassed.
It is quite normal for a young quad to experience frequent and prolonged reflex erections–resulting from direct or indirect stimulation to the penis or surrounding area. Putting on a catheter, having your legs ranged or being turned in bed might all result in an erection. It’s called a reflex erection because it happens without thought.

Psychogenic erections, on the other hand, result from sexual thoughts or fantasies. While quads are likely to get reflex erections, they’re not likely to have psychogenic erections, unless the injury is incomplete. Either way, I think you’ll find that your nurses understand. Not every erection is sexually stimulated or needs to be “relieved.” And if by relief you mean ejaculation, it is not likely you would get that type of relief even if the nurse did give you a hand, so to speak. More often than not, spinal cord injury interferes with the ability to ejaculate without the help of a vibrator or electrical stimulation of the nerves.

So what’s a man to do? First, ask your doctor. Say, “Listen doc, I’ve been getting more frequent reflex erections that are lasting longer and longer. What can I do? And while we’re talking about it, I was wondering if I will still be able to ejaculate.”

Ask for a referral to a fertility evaluation, preferably to a doctor or clinic that uses vibratory stimulation as the first method for sperm retrieval. Your doctor may be able to help–there are medications that can impede erections, but benefits will have to be weighed against potential side-effects. Now, none of this is a solution for feeling sexually frustrated. Sexual desire is not directly affected by spinal cord injury and we all have a need to love and be loved.

How often are you in contact with people other than health professionals? Most licensed health professionals are ethically prohibited from having sex with you, so you need to work to increase your contacts with others who might eventually become sexual partners.

Woman has a new, intimate online relationship with T5-6 man she has known a long time but fears it may not last because of distance.
You have three things in your favor: You’ve known each other for years, you’re comfortable with his disability and you’re serious about the relationship.

Clear, honest communication and maintaining regular contact will be key in the eventual success of the relationship. If you have a chat room where you can talk online, great; if not, e-mail each other frequently. Start a daily journal of your thoughts, feelings and activities and urge him do the same. Exchange the journals weekly and share your experiences over the phone. Talk about your work, dreams and expectations for the future. Don’t be afraid to discuss your failures, too–they’re just as important as your successes. Many times, success is built upon a foundation of previous failures, real or perceived. Even when living apart, you can become part of each other’s life.

Let him know you are serious. But first ask yourself if you’re ready to commit to making the relationship fulfilling, intimate and permanent. Are you willing to open yourself up and be vulnerable?

Have the two of you discussed compatibility? It’s the key to lasting love and the mutual understanding and affirmation that keep love and a strong relationship alive. If you’re not very compatible, the relationship may merely survive; if you’re extremely compatible, the relationship has the potential to thrive and be emotionally, psychosexually and intrinsically rewarding.

Man seeks advice on how to please wife whose pain makes sex uncomfortable.
Pain takes a toll on desire and can even make one feel asexual. If pain is aggravated by sexual activity, it’s easy to come to fear and avoid it. Worse, having sex despite pain–out of guilt or a sense of duty–can harm a relationship.

Dr. Naomi McCormick, author of When Pleasure Causes Pain: Living with Interstitial Cystitis, makes the following suggestions that apply to anyone experiencing pain: Schedule sexual activities when symptoms are least problematic; take pain-control or antispasmodic meds prior to sexual activity; experiment with positions and activities that minimize pain; have your partner stimulate your genitals orally; tell your partner exactly what feels good and what is painful; and try other sexual, erotic and intimate activities that do not involve intercourse or orgasm.

Hot tubs, saunas, steam rooms and even tanning beds can ease stiff, sore muscles and loosen up joints prior to engaging in sexual activities. If floating in warm water relieves your wife’s pain, you can rent a hot tub and experiment in the privacy of your home. If overheating is a concern–it often is for people with multiple sclerosis or who are subject to autonomic dysreflexia–consult with your physician first. Alternatively, try relaxing your wife with a whole body massage using warm oil. Incorporate gentle manual stimulation to her breasts, nipples, labia and clitoris. Focus on making her feel good, not bringing her to orgasm. Let your wife be your guide.

Communication is critical when pain is involved. McCormick urges women to tell their partners when they want sex, when they don’t want it, and how they want it.

Disabled man wants to know why the topic of sexuality for people with disabilities is so hush-hush, and where info is available.
Many professionals and lay persons are uncomfortable dealing with anyone’s sexuality, let alone people with disabilities. There are many myths and stereotypes–we’re asexual, not capable of conception, not capable of erection or ejaculation, etc. Six weeks of rehab is barely enough time to learn how to deal with one’s personal care, let alone sexuality.

You can locate a counselor/therapist in your area at the American Association of Sexuality Educators, Counselors, and Therapists (www.aa sect.org/directory2.cfm). They have a membership directory, an online discussion group, books and articles by members, a newsletter and a section of products and conferences.

Sexualhealth.com (www.sex ualhealth.com) is an excellent site–hosted by Mitch Tepper–where you’ll find info on sex therapy, gender, pleasure, love and intimacy, orgasm, sexual activities, sexual dysfunction and sexual orientation. Enter “medication” in the search box–you’ll see a list of 20-25 articles on medication and related issues. Enter “sex toys”–you’ll find a list of articles about sex toys (“Sex Toys and Where to Purchase Them” is an article I wrote some time ago that is informative).

 Good luck and have fun!