Anonymous on August 9, 2011

Is physical trauma the end of good sex?

I’ve survived a spinal cord injury. Now I’d like to know if I can learn to orgasm again. I’m a woman and I have a C4 injury with about 80% sensory below the shoulders. I can "feel" a lot, but the big bang eludes me. I have learned from my physical therapy that my body is very responsive to learning. What is it that would help me "re-educate” my intimate body?

answered by Annette Fuglsang Owens, MD, PhD on August 9, 2011

Thanks for sharing your story and question with us. It sounds like you’re already working with a physical therapist...I would encourage you to also share your question with your therapist who knows your body, or a doctor who specializes in spinal cord injuries. An expert who is familiar with your specific physical strengths and challenges will be able to offer you the best recommendations.

In the meantime, I’m pleased to provide you some thoughts for your consideration.

Don’t overthink it. Your situation as a spinal cord injury (SCI) survivor is, of course, unique. But many women have trouble reaching on your journey to relearning your body, I would tell you the same thing I’d tell any woman with this challenge: don’t think about it too much.

Why? Sometimes, the harder you try to orgasm (and the more you worry about it), the more elusive it is. Instead, I encourage you to try some techniques to help increase awareness about areas of your body where you have sensation, and where you may be able to experience sexual stimulation.

For example, here are three options for couples to increase sexual communication and sexual pleasure:
  • Sensate focus exercises that were developed by sex researchers Masters and Johnson in the 1960s are still relevant today. For the exercises to work, I tell couples to stop everything they are doing...most importantly, to stop having intercourse for a while. Instead, I ask them to create a relaxing atmosphere at home and to free up time for each other, touching each other’s bodies from head to toe...but avoiding touching the genitals or other arousing areas of the bodies, like the nipples. Why? Because the purpose of touching each other in this context isn’t a prelude to intercourse...but its own enjoyment and exploration of different strokes and caresses that are pleasurable in perhaps unexpected areas of the body.
  • Pleasure mapping or “somatic communication” are exercises that emphasize intimacy and pleasure, instead of orgasm. For example, you might lay on a bed while your partner caresses parts of your body. For each spot your partner touches, describe how pleasurable it is for you based on a rating. Zero is neutral, one means it feels nice, two means it feels really good and three means it’s great! You can use negative numbers to indicate areas that aren’t pleasurable. Through this process, some people with SCI discover or re-discover areas of the body that allow them to reach orgasm.
  • Charting your personal extra-genital matrix, described by Drs. Whipple and Ogden, is similar to pleasure mapping. This technique focuses on finding places on your body other than the genitals that may bring sexual pleasure.
In summary, through self-touch or with a partner, focus more on exploring which sensations give you pleasure, rather than focusing just on reaching orgasm. As you rightly observed, you’re in a process of re-educating your body....and the end result may very well be that you will once again experience orgasms. But allow yourself some time to get there, and to enjoy this period of rediscovery.

Related info:

Annette Fuglsang Owens, MD, PhD

Dr. Owens is an AASECT-certified sexuality counselor. Her areas of expertise include the medical aspects of human sexuality and sexual problems, as well as the impact of STDs ⎼ and other diseases, illnesses and disabilities ⎼ on sexuality. Dr. Owens was educated at the University of Copenhagen in Denmark.

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