A few years ago, during a nationally televised tribute to actor-director Christopher Reeve, Reeve's wife, Dana, took the stage to sing a song. Before launching into her number, she spoke eloquently of her love for Reeve, paralyzed by a spinal cord injury received in a fall from a horse. And then she turned toward her husband, sitting in the audience, and smiled secretively at him. "Chris? You still do it for me, baby," she said.
In that "public-private" moment, Dana and Christopher Reeve told the world what scientists and sex therapists already know: Sexuality doesn't end when a person suffers a disability. There are quite literally hundreds of ways to experience sexuality and sexual pleasure. Even when someone apparently loses all the physical sensation in their genital regions, couples can still achieve sexual closeness, pleasure, and even orgasm.
Mitchell Tepper, PhD, president of the Sexual Health Network (www.sexualhealth.com), travels the country speaking about sexuality to conventions and groups of people with disabilities. Tepper, whose spinal cord was injured in a diving accident when he was working as a lifeguard some 20 years ago, tells listeners that television and movies often promote myths about sexuality and disability.
"For example, people with spinal cord injury are often portrayed in movies as sexually frustrated men and women who either have to rely on buying sex from a prostitute or have to go without," he says.
Nothing could be further from the truth, says Beverly Whipple, PhD, RN, FAAN, a professor emerita in the college of nursing in the neuroscience center at Rutgers University and a noted researcher on sexual health. "Sexuality encompasses the totality of our being," she says. "Think of a candy cane. The red is the peppermint flavor. But do you only taste peppermint in the red or throughout the candy cane? You taste it throughout, and similarly our sexuality goes through all of us."
Whipple advises people with disabilities -- particularly those with limited sensation in the "traditionally" sexual parts of the body -- to talk with partners about many of the ways to have erotic pleasure that do not involve the genital area. "Sensuality and sexuality are much more than the genitals."
From giving and receiving touch in areas of the body like the cheek, the neck, or the back of the hand to using scent -- candles and aromatherapy -- or music, Whipple suggests using all the senses for erotic pleasure.
"Different sounds, scents, and sights can bring us pleasure. For example, maybe you like peeling grapes and feeding them to your partner." She calls these alternative options -- paths to sexual pleasure that don't involve the exchange of bodily fluids -- "outercourse."
Outercourse isn't the only option. Many people who have, through spinal cord injury or other neurological disorders, lost all feeling or sensation in their genital areas can still experience orgasm as a result of genital stimulation, Whipple says. She's done a wide range of laboratory studies involving women with spinal cord injuries, and they report having orgasm from genital stimulation, feeling it above the level of their injury. "They report that it feels just like the orgasm they had before their injury, except they feel it only in part of their body," Whipple says.
Pleasure Bypasses Spinal Cord
In one study, 16 women with various levels of complete spinal cord injury (below vertebra T-6, meaning that they were paraplegic, not quadriplegic) were compared with five women who had no spinal cord injury. Each used a specially designed tool to stimulate themselves in vaginal and cervical areas as well as in other parts of their body above the level of their injuries where they felt especially sensitive.
"Only one of the non-spinal-cord-injury women had an orgasm, while three of the women with [spinal cord injury] had an orgasm in the laboratory," Whipple says. "One had six orgasms during the experiment. One had never had any sexual stimulation in the two years since her injury, and these were her first."
If there's no "feeling" below the waist, then what explains these sensations? Whipple notes that a nerve bundle called the sensory vagus bypasses the spinal cord, carrying nerve impulses directly from the genitals to the brain. So even if the spinal cord is damaged, "pleasure" messages can be carried through the sensory vagus from the genitals to the brain, triggering the experience of orgasm.
Whipple and her colleagues even confirmed this theory by doing PET scans of women with complete spinal cord injury. These tests showed that an area of their brains that is connected to the genitals through the sensory vagus was indeed receiving signals.
Lessons From Eastern Traditions
But even if you can't experience "traditional" orgasm, that doesn't mean your sex life is over. "Acceptance means letting go of all your old notions, like 'sex equals intercourse.' Comparison is something that really kills people in moving forward," Tepper says. "We're not tied to old ways of being, and that way we can allow pleasure to happen."
He advises people with disabilities to consider incorporating tantric approaches to sexuality into their relationships. "It's an eastern model, focused on sexuality as an altered state of consciousness, rather than the western model of sex as working toward a goal."
Originally published June 4, 2001.
Medically reviewed Jan. 20, 2003.