What about positions and foreplay after a spinal cord injury? - Diane M. Rowles, MS, NP

Positions and foreplay. One of the things I always counsel people is to experiment and have fun. A lot of partners say to me, “Oh it’s kind of like having sex for the first time, we get to re-experiment.” And very definitely it can be like that. I always encourage people to use what they liked before though. Foreplay is wonderful in that it allows the sensation, it allows the touching, it allows all of that to occur. It just, sets the mood if you will. Positions. If you read the books, the positions say that the person with a disability is probably going to be on the bottom, because it preserves their energy, because it takes a lot of energy to hold your body weight up if there’s paralysis, and it also frees up any hand function. And all of that is true—you do want to preserve energy, you want to be able to last the full episode, and you do want to free up any upper extremity, hand movement, arm movement to help stimulate yourself, to help stimulate your partner. But I have some people who say to me, “Diane, I am not going to be on the bottom, I’m going to be on the top.” So that’s fine, I’ve sent people to therapy to learn to be able to be on their knees, balance on their knees obviously if their injury is higher, they’re not going to be able to balance on their knees. So other ways to do it is take pillows, take a wedge, prop yourself up in the bed, have the partner sit on the lap. That way you’re at least face-to-face, no body’s in the superior or inferior position. Other positions that work —experiment. A lot of it is going to depend on if it’s the male with the disability, whether they get a full erection or not, they may have to put pillows under their hips to help with the pelvic tilt, to help if the erection is not full, to help with penetration. For women with a spinal cord injury, the pillows under the hips is again a great idea, it helps with that pelvic tilt, it helps maintain the position. The important thing to know is no pillows if you’re still in your spine brace. So you can’t prop pillows, or do anything until you’re out of your spine brace. The other thing is if you’re still in your spinal brace, you have to have your spinal brace on while you’re having sex, until you’re released from that brace by your surgeon. Other positions—thing to consider are the person’s spasticity, what areas on their body they have sensation, and their ability to position. If they don’t have great balance, and they have really bad spasms, then where’s their best balance and where their spasms the least—it’ is in their wheelchair. For men, take the armrest off, straddle, have sex in the wheelchair. For women, usually slide the hips forward, wrap one leg around a partner’s waist, one leg over the partners shoulder, but again in the wheelchair is a great position. So if a woman’s in her wheelchair, it’s going to give her balance, and it’s going to help with management of spasticity. Other things to consider for women particularly, if they have really tight adduction spasms, which is pulling their legs together, some women have horrible adduction spasms, and they can’t get their legs apart to have intercourse. Then you’re going to want to position where you have best control over that spasticity. The other things to consider is, where can stimulation happen the best? If a person doesn’t have a lot of sensation, stimulating their face or their shoulders, what position are they going to have access to that the most. Another very popular place to have sex is in the shower, because if somebody has limited sensation, the water and the temperature of the water coming down can be very erogenous. So, having sex in the shower is wonderful. Now all the therapists always shaking their hands at me, and most shower chairs have a 250-pound weight limit, so that needs to be taken into consideration.