Intervention

Intervention falls within the realm of sex education and counseling. Basic to understanding sexual function after traumatic paraplegia is comprehension of the normal human sexual response. It may be necessary to review the patient's understanding of healthy sexual function before beginning counseling.

Counseling is directed toward maximizing the patient's gratification as well as that of the partner. Conjoint counseling with both the man and woman is advisable if their relationship is a permanent one. It is especially important for future spouses, since adaptation in one's approach to achieving sexual gratification may have far-reaching implications for the sex partner.

Before proceeding with counseling, it is advisable to consult with the neurologist to determine the level of the cord lesion and its degree of completeness. Lack of this information could lead to fallacious explanations, dimming of the patient's hope, or inappropriate reassurance.

Response to sexual stimulation. Manual stimulation of the penis is usually an effective method of promoting erection when psychogenic stimulation may be ineffective. A condom stretched around the base of the penis and held with stretchable tape may be used to maintain engorgment and prevent detumescence before intromission. Of course, the condom should not be too constricting or be left in place more than a half hour. Commercial devices reported to induce erection by means of electrical stimulation are not usually recommended or necessary. Of course, some men will be unable to sustain an erection long enough for coitus. Sometimes stimulation of the inside surfaces or the thighs and of the lower abdomen can lead to reflex erections, and some men learn to trigger erections psychically.

The female response to sexual stimulation is not so readily observed. However, if neurologic control of vasocongestion is present, vaginal lubrication should ensue. Therefore, one can infer that artificial lubricants would be unnecessary under these circumstances.

The female paraplegic's sex organs lack sensation if the lesion is complete, but they do not lack function. A woman may choose to playa more passive role during coitus, thus fulfilling her husband's needs. Many women derive satisfaction by substituting their partner's gratification for their own or substituting pleasant stimuli in other erotogenic areas of their bodies.

Positions. Several positions are possible. Paraplegics are usually able to assume top, bottom, or side positions. Quadriplegics generally find it necessary to be supine, with the partner on top. The neurologic deficit to the upper and lower limbs will determine the extent to which the paraplegic person can initiate sexual activity. In some instances it may be necessary for the partner to control the rate of stimulation and to initiate nearly all the pelvic thrusting.

Methods of sexual stimulation. Alternate approaches to sexual stimulation are available. Oral-genital contact may be practiced if it is psychologically acceptable to both partners. Manual stimulation of the clitoris may be substituted for intromission for men incapable of erection. Other men prefer to use prosthetic devices, although some men regard them as a type of perversion. Often the paraplegic person is able to substitute the sexual gratification of the partner for his own.

Frequency of intercourse is, of course, individually determined. There appears to be no difference between the paraplegic and the nonparaplegic in regard to this variable.

Some male patients with upper motor neuron lesions report achieving reflex erections more easily when their bladders are empty. In both men and women, catheters may be left in place during intercourse. This sometimes causes difficulty for the man if traction is applied to the catheter. If he has a condom catheter, it is removed prior to intercourse. If the person is on an intermittent catheterization program, he or she will find it necessary to empty the bladder before intercourse. During orgasm the bladder may go into spasm and empty, causing embarrassment.

Since many paraplegics have chronic bladder infections, the potential for infecting the partner is ever present. For this reason, the male needs to take extra precautions, including careful cleansing of the penis and complete emptying of the bladder before intercourse.

Predischarge visits. Weekend passes and overnight visits home afford paraplegic patients an opportunity, in privacy, to attempt coitus, evaluate their abilities, and find answers to their most intimate questions.

Evaluation

To evaluate the effectiveness of teaching and counseling, the health practitioner can compare the goals of the general rehabilitation program with the client's progress. Evaluation of the person's knowledge can be accomplished on an informal basis, such as simply asking the patient to feed back what you have presented in his own words. Attitudes are more difficult to evaluate. However, overt behavior will provide clues as to the palatability of the counselor's suggestions.

Modification of the approach reinitiates the entire process. Constant data collection may reveal new and more appropriate approaches for each client. Finally, the clinician-client relationship never proceeds in a vacuum. It is essential that the team members be cognizant of one another's roles and progress while working with the client.

About The Author
David Crawford is the CEO and owner of a Penis Enlargement News company known as Penis Enlargement Group which is dedicated to researching and comparing penis enlargement products in order to determine which penis enlargement product is safer and more effective than other products on the market. Copyright 2011 David Crawford of What Penis Enlargement Really Works This article may be freely distributed if this resource box stays attached.