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Many of the sexual problems confronted by individuals with disabilities are related less to physical impairment than to the negative attitudes accompanying them. Family and friends may complicate these difficulties by suggesting that sex with a disabled person is pitiful or disgusting. In some couples, the onset of a disability may be used as a convenient excuse to give up sex.
Most readers here and probably all therapists are familiar with Jack Annon’s suggested formula of sex education, the PLISSIT model.
P is for giving Permission to feel or be sexual
LI is for giving Limited Information
SS is for giving Specific Suggestions
IT is for giving Intensive Therapy as needed.
Since the 1970s when Annon first put this forth, it has been the model for good sex therapy adjusted to the client’s needs.
When Julie G. Botvin Madorsky, M.D. (now retired) was Medical Director of the Spinal Cord Injury Program for Casa Colina Hospital for Rehabilitative Medicine in Pomona, California she found that the PLISSIT method of sex therapy provide the best method of involvement for all staff and patients according to their interest and level of comfort. She believed that in the area of sexuality, just as in the area of mobility, early intervention would maximize function and minimize secondary complications.
For patients, as well as the public at large, it was important for her and her staff to address negative stereotypes about the sexuality of the disabled such as if the disabled person is sexual at all or has a sexual problem it must be a result of the disability.
Although a sexual problem may be related to a disabling condition, it frequently has other causes. These causes are also apparent in the general population such as the presence of performance anxiety, absent or faulty information about sexual anatomy and physiology, concerns about not living up to idealized standards of masculinity and femininity, and difficulty communicating about sex with a partner. In able-bodied couples, almost half of the men report erectile or ejaculatory dysfunctions at least occasionally and almost three-quarters of women report arousal or orgasmic difficulties.
Whether in a comprehensive rehabilitation team setting or in solo office practice Madorsky says that the principles of treating sexual dysfunction accompanying disability are the same:
- Emphasize a broad concept of sexuality.
- Emphasize that part or all genital response does not mean the end of sexual life.
- Focus on potentials rather than on what is impaired.
- Adjust medication dosage and timing to provide optimum control of symptoms at the time of sexual activity.
- Provide accurate information to allow realistic expectations and to address specific fears.
- Give preventive counseling when making a diagnosis or advising treatment.
As always, keeping an optimistic and open mind is often the best medicine.
