While the patient is in the hospital a brief sex history should be taken. In a recent survey of 45 patients, only two reported that this had been done. The main reason for doing this is that patients have said that sexuality is one of their major concerns after a heart attack.

There are a very few absolute contraindications to resuming sexual activity. It has been demonstrated frequently to the patient that it is the physician's lack of knowledge or fears that inhibits their sexual behavior. An example is Mr. H., a 45 year old man, who was admitted to a psychiatric unit for severe depression.

Approximately once every generation a prominent American male dies of a heart attack, allegedly in the arms of a younger woman who is not his wife. Perhaps this has something to do with the universal fear of sudden death that occurs in patients following a heart attack. Perhaps as some patients report, it is the fear of losing control while having an orgasm.

The P LI 55 IT system developed by Annon (1976), is helpful in organizing professional assessment techniques. This schema helps many professionals work sensitively with the sexuality without becoming more involved than their training allows. The first level of the PLI55IT model (P) encourages professionals to provide an environment of permission within which the subject of sexuality can be discussed in a nonjudgmental way.

If a physical disability is acquired after psychosexual maturity has been achieved, other implications for sexual health and function should be considered. The individual nature of the person's sexuality has already been established. If the physical disability is acquired after puberty, then a sexual preference toward heterosexuality or homosexuality may already have been established.

Persons whose disabilities began during their childhoods often become isolated from peers during the crucial years of sexual development. During childhood most people gain social skills through informal contacts with friends. For example, language develops in the early years.

When we assess loss of physical function, we must also make psychological and spiritual assessments. It is important to understand the individual's sense of self esteem and relationship to the world in order to understand what role the disability will play in that person's own concerns how the disability will ultimately affect self esteem.

Any lessening, or perceived lessening, of an individual's ability to contribute to society can be illuminated by assessing the individual's response to the disability. Self esteem is always most vulnerable during illness, disease, or injury.

What emotional feeling do you experience when you think of the word sex?

What emotional feelings do you experience when you think of the words disabled, crippled, gimp?

What emotional experiences do you have when you combine these two concepts in your fantasies? Do the concepts of sex, sexuality, and intimacy;" become any less acceptable? Is there a paradox here?

The different sexual dysfunctions make sense when they are viewed as consisting of impairments of one of the three phases. When the orgasm phase is disrupted, the clinical syndromes of premature and retarded ejaculation of males and their analogue, orgastic inhibition of females, result.