What advice do you offer about sex and dating after a spinal cord injury?

The same things that made you attractive before your injury are just as important now. That some people will only see the wheelchair at first, and so you do need to kind of broach the subject, that you’re actually available. You want to do that in a kind of very brief and not too blunt way. But, your appearance is important, your personality is important, finding common interests is important—all those things are just as important. So people need to get to know you, and then the chair will fade away.

Those things are still important in your life and you should go for it. You might need some assistance in some specific issues regarding sex, whether it’s through education, through some equipment or assistance, but go for it. There’s nothing that says you can’t go ahead and have the love of your life, the romance of your life and have a very high-quality intimate relationship. Intimacy maybe different than what you think about, but let’s be honest, most of us have some pretty screwed up ideas about sex anyway.

The question of sex, sexuality, dating—sometimes for a lot of people, dating is hard to start with, and it speaks to how you feel about yourself but also opportunities, access. So we talk your readiness in terms of what you want, also what your knowledge is, and then whatever knowledge you had and experience you had. You also need to know where things are at in terms of function, but function isn’t necessarily functioning that’s taken away, so you also want to talk about function that you can bring back. And through all of this, we always spend time talking about bringing back, not just what we lost, what we’ve lost and get back. One of the things, in terms of dating, is to go out there and participate. And one of the things we’ve learned about is that you can’t live if you don’t participate. If you don’t give a person a chance to say “yes” because you’re always afraid that they’re going to say “no,” you don’t hear the “yes.” That’s a guarantee.

I tell them to take it slow and make sure they don’t necessarily feel that they need to overcome all those obstacles all at once. Just like before their injury, it takes time to develop relationships. I sort of emphasize that communication is the most important of part of any relationship especially after you have a disability. Being able to let the other person know what you’re condition might be, and trying to feel out from them how they feel about somebody in a wheelchair, and trying to help bridge that gap between maybe a lack of understanding. And slowly trying to build on that relationship where there’s mutual communication and trust.

It’s possible; things work in different ways. There was always the explore—figuring out what you enjoy. But, I think the main thing is to feel comfortable with yourself. And when you do connect, honor what you are feeling, trying to really work on the communication. Think about, “is this someone I feel comfortable talking with,” so that when you have sex you can problem-solve, you can use it to enhance the experience.  But, it’s really about the comfort of the individual, the couple and their ability to communicate on all levels.

The spinal cord injury does not dictate to you the nature of your intimacy. I think it’s absolutely imperative for you not to throw that area, important domain out of your life. There are many ways to be close, there are many ways to be intimate, there are many ways to communicate, and you need not give that up.

When individuals come to me asking about sex and dating, I'm actually very thrilled. We're moving to a point where they recognize-you know, individuals with spinal cord injury date, they have sex, they definitely want to be involved in that. For women they need to know, "Yes, I can get pregnant"; that certainly was a misconception for many years that women thought they couldn't get pregnant, but they definitely can and will. So it's very exciting to talk about dating and what that means, and to be involved with others to encourage them to reach out to other people with spinal cord injury as well to talk about dating and any barriers to that. One thing that's really important for men and women is what we call "sexual self-esteem." It's key for people without disabilities, without spinal cord injuries, for everyone, their sexual-self esteem-what we think of ourselves sexually, what we think of our bodies, that still is there. For someone with a spinal cord injury, you definitely have that coming forward, so now your body's changed, and now you're different, and what does that mean--"Do I still see myself as a sexual being?" Do I still feel sexy? Do I feel still loveable?" And yes, you are and how do we recognize that in that process. And some people embrace it much more quickly, and have a rich sex life and a very rich dating life, and others struggle more. It's a lot of our own self-esteem that plays into that.

Nothing is off limits in rehab. Fairly quickly, people’s modesty goes because we’re talking about bowel function, bladder function. We talk about sexual function, sexuality, dating, intimacy as a key component in life, and something to be addressed and educated about while people are in rehab. I often times tell people, “I’m going to give you a lot of information about this, and I’m going to give you introductory information about sexual function, dating, intimacy. Some of this maybe something you really want to hear right now, and some of this maybe something you put on a back shelf. A couple of months from now give me a call and we can talk more about it.” We like to make sure that we’re addressing it up front and meet people where they are if they have concerns or worries about that.