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Sexuality and Reproductive Health--Sexual Functioning

Sexuality and Reproductive Health Table of Contents

Some of the problems women with disabilities experience with sexual functioning are specifically related to their disability.

  • While a wide range of treatments have been developed to help men with erectile failure, little has been done to help disabled women who have problems with sexual functioning.
  • The most common barriers to sexual functioning reported by women with physical disabilities in our national study were weakness, vaginal dryness, lack of balance, hip or knee pain, and leg spasticity.
  • Studies of women with spinal cord injury found bowel and bladder accidents, spasticity, positioning problems, and lack of spontaneity interfered the most with sexual activity with a partner.
  • In our national study, sexual response was lowest in women with spinal cord injury and stroke.
  • In women with stroke and other brain injury (e.g., TBI), sexual dysfunction depends on the severity of the neurologic impairment and the site of the damage to brain structures, but women with TBI in one study had more positive feelings about their sexuality than did men with TBI.
  • Extensive research has been done on physiology of sexual response in women with spinal cord injury and multiple sclerosis, but sex partners in surveys reported that emotional closeness and willingness to try a variety of sexual activities were more important for sexual fulfillment than physical ability.
    • Capacity for reflex lubrication, orgasm, and satisfaction depend on the completeness and level of the spinal cord injury, but psychogenic response may still be possible with some incomplete injuries, and non-genital body parts often play a greater role in activating sexual response.
    • Skin can become hypersensitive in spinal cord injury, making touch painful; conversely, increased sensitivity of body parts above the level of injury can increase sexual response.
    • Participation in sexual activity was found to be related more to activity before injury than to extent of injury.
    • Women with disabilities report being more upset by bladder accidents than their partners.
    • There may be differences in sources of sex partners for men and women with spinal cord injury; nurses and other health professionals as a source of sex partners was not used at all by women in one study.
    • Neurologic changes related to multiple sclerosis (MS) such as decreased desire, changes in genital sensation, decreased vaginal lubrication, and decreased frequency or intensity of orgasm directly affect sexual functioning.
    • Non-genital numbness, pain, burning, discomfort, weakness, spasm, fatigue, incoordination, medication side effects, and cognitive impairments can also impair sexual function in persons with MS.
    • Studies also indicate that nonphysical factors can affect sexual functioning in persons with MS, such as negative self-image, mood, or body image; depression and anger; feeling less attractive; fear of rejection; worry about satisfying the partner; and difficulty communicating.
  • Few studies have been done of sexual functioning in women with progressive neuromuscular disorders, such as muscular dystrophy, spinal muscular atrophy, poliomyelitis, or Charcot-Marie-Tooth disease.
    • The neuromuscular disease process does not affect sexual response capability, sexual arousal, vaginal lubrication, or orgasmic capacity.
    • The main factors affecting sexual practices and problems are age at onset of the neuromuscular disorder and its rate of progression, which imposes physical limitations.
    • Nearly all men, but only one-third of women, report masturbating in surveys of sexual function of people with neuromuscular disorders.
    • In a study of ventilator users with neuromuscular disorders, mainly polio, sex life was the only quality of life issue for which participants expressed dissatisfaction.
  • Factors that most commonly affect sexual functioning of women with arthritis and other connective tissue diseases include pain, joint stiffness, fatigue, decreased desire or other side effects resulting from use of steroids and other drugs, loss of mobility, inadequate vaginal lubrication, and disturbed body image. Pain is the most limiting symptom in most studies.
    • Loss of range of motion in the hips can interfere significantly with intercourse, and arthritis in the hands can interfere with masturbation alone or with a partner.
    • Some women report worse arthritis symptoms the day after intercourse.
    • Disabilities, such as scleroderma, and medications can produce acid reflux and heartburn that increases while lying down during sexual activity.
    • Scleroderma can also tighten skin around the vaginal opening, and lupus can produce skin ulcers and rashes on the vaginal lining, making intercourse difficult.
    • More than half of couples report mutual dissatisfaction with their sexual relationship, with dissatisfaction directly related to the degree of functional disability and with women reporting greater dissatisfaction than men.
  • The partner's unfounded fear of hurting the woman with a disability is found to interfere with engaging in sexual activity across disabilities.

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