Major disabilities, such as spinal cord injury, cerebral palsy, blindness, and deafness, have widely varying effects on sexual responsiveness. Some people with these disabilities can maintain or restore satisfying sex lives; others find that their sexual expression is perma­nently reduced or impaired by their difficulties. In the following sections, we look at some of these problems and discuss sexual adjustments that people with disabilities can make.

Spinal Cord Injury People with spinal cord injuries (SCIs) have reduced motor control and sensation because the damage to the spinal cord obstructs the neural pathways

between body and brain. Although the SCI does not necessarily impair sexual desire and psychological arousal, a person with an SCI may have impaired physical ability for arousal and orgasm; this impairment varies greatly accord­ing to the specific injury (Alexander & Rosen, 2008). Research indicates that 86% of men and women with SCIs feel sexual desire, more than half experience arousal from physical stimulation, about 30% become aroused from psycho­logical stimulation, and 33% experience orgasm or ejaculation (Mathieu et al., 2006). Research has found that Viagra can increase arousal and erection for some men with SCIs (DeForge & Blackmer, 2005).

Cutting-edge research on women with complete spinal cord injuries has found that vaginal/cervical self-stimulation can cause orgasm. Brain imaging techniques that have identified brain activity occurring during orgasm in uninjured women have identified similar activity from vaginal/cervical self-stimulation in women with complete spinal injuries (Pappas, 2012). The physiological data indicate that the vagus nerve provides an alternate pathway from the vagina/cervix to the brain, bypassing the spinal cord (Whipple & Komisaruk, 2006).

Much of the sex counseling for individuals and couples faced with SCIs con­sists of redefining and expanding sexual expression. Thus, sensory amplification— developing heightened sexual responsiveness in the inner arm, breasts, neck, or some other area that has retained some feeling—can enhance pleasure and ^ arousal (Rosengarten, 2007).

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Cerebral Palsy Cerebral palsy (CP) is caused by damage to the brain that can occur before or during birth or during early childhood. It is characterized by mild to severe lack of muscular control. Involuntary muscle movements can dis­rupt speech, facial expressions, balance, and body movement. Severe involuntary muscle contractions can cause limbs to jerk or assume awkward positions. A person’s intel­ligence may or may not be affected. Unfortunately, it is often mistakenly assumed that peo­ple with CP have low intelligence because of their physical difficulty in communicating.

Genital sensation is unaffected by CP. However, spasticity and deformity of arms and hands can make masturbation difficult or impossible without assistance, and the same problems in the hips and knees can make certain intercourse positions painful or difficult. For women with CP, chronic contraction of the muscles surrounding the vaginal opening can create pain during intercourse. Options that can help individuals with CP include try­ing different positions, propping legs up on pillows to ease spasms, and exploring nongeni­tal lovemaking. Partners can help with positions, and focusing on genital pleasure can help to distract from pain. The sexual adjustment of a person with CP depends not only on what is physically possible but also on environmental support for social contacts and privacy. People with CP and SCIs may require the help of someone who can assist in preparation and positioning for sexual relations (Joseph, 1991; Renshaw, 1987).

Blindness and Deafness The sensory losses of blindness and deafness can affect a person’s sexuality primarily when the visual or hearing deficits interfere with learning the subtleties of social interaction skills and with a persons independence (Mona & Gardos, 2000). Sexu­ally, other senses can play an expanded role, as a man who was born blind explained:

During lovemaking, my other senses—touch, smell, hearing, and taste—serve as the primary way I become aroused. The caress of my partner, and the way she touches me, is tremendously exciting, perhaps even more so than for a sighted person. The feel of her breasts on my face, the hardness of her nipples pressing into my palms, the brush of her hair across my chest. . . these are just some of the ways I experience the incred­ible pleasures of sex. (Kroll & Klein, 1992, p. 136)