After the trailers for Me before you started to be broadcast on television, some disability rights activists began to speak in protest. One of the many issues people have pointed out about the film is that the lead character Will, who became quadriplegic after a motorcycle accident, assumes that a great sex life is not possible for someone with his type of disability. physical.

This is a very common misconception, Mitchell Tepper, Ph.D., MPH, sexologist specializing in helping people with chronic illnesses and disabilities and author of Rediscovering that feeling: the secrets of sexual self-discovery, SELF says. But while experiencing sexual pleasure again after a spinal cord injury isn't easy, and for some takes years (or decades), it is indeed possible for many quadriplegics.

Tepper speaks from a place of both clinical and personal experience - he broke his neck over 30 years ago and has since been paralyzed from the neck down (although he still has sensations and is considered as an “incomplete quad”). "When I woke up in the hospital I was still in intensive care and as soon as they took out my breathing apparatus the first thing I asked was if I could still have children," he said. "I was 20, kids weren't on my mind yet, but instinctively when you're in that position, [you think] What is my sexual future? "

For many people who become paralyzed, the first attempt at sex again is masturbation in the hospital, Tepper says. After trying and realizing that you can't experience pleasure or orgasm, it's easy to conclude that sex is pointless. It doesn't have to be reality, however. "These are the people who go beyond 'why bother'" who are able to rediscover their sexuality and find satisfaction, he says.

For both men and women, the mechanics of sex can usually occur after paralysis with some assistance.

“Usually we have erections, and sometimes more erections than we want,” says Tepper. Many quadriplegic men, with all types of injuries, have reflex erections when the penis is touched. “Someone like Will (in the movie) would have strong reflex erections,” he adds. For those who don't, Tepper says drugs like Viagra generally work quite well. Ejaculation is usually possible with mechanical assistance, such as a vibrator, although “not many people will [ejaculate] inside a vagina,” Tepper explains. There are medical risks associated with premature ejaculation, such as heart palpitations, and some men have severe headaches. For women, physiological changes like lubrication and clitoral engorgement are usually directly affected by injury, Tepper says. Using a lubricant, however, can make intercourse possible. Whether or not there is pleasure associated with it, elusive G-spot stimulation may actually help reduce pain. “Stimulation of the anterior wall of the vagina has an analgesic effect, so it blocks the pain but not the pleasure,” says Tepper. He adds that some studies suggest it can reduce spasticity for hours in quadriplegic women.

But a great sex life isn't all about mechanics. Everyone wants sex to feel good, but this part is a little more complicated.

"With a complete spinal cord injury, the traditional definition of an orgasm becomes impossible, because it depends on the brain at the top communicating with the nerves below," says Tepper. But orgasm for quadriplegics, and even quadriplegic women, is possible. “The response of the genitals regarding erection and ejaculation and clitoral lubrication and engorgement have a direct correlation with the level of injury. Orgasm did not. ”

An orgasm, however, may not be what you think of as a traditional orgasm. This is where open-mindedness is the key. “Our mind is so powerful that cognitive processes, attitudes, and beliefs can really block a pleasurable sexual response,” Tepper says. On the contrary, being open to new sexual experiences and finding pleasure in different ways can help a person have - and enjoy - sex after injury. For example, it tells the story of a man who learned to orgasm when his girlfriend sucks his thumb. Tepper himself learned to experience orgasmic sensations through full body massages. “We have shown in lab studies with women that orgasm is largely a brain-mediated response” and that for some women, focusing and using the imagination can provide strong orgasmic responses.

Feeling sexual pleasure is more likely if a person is open to trying new things and redefining what an orgasm means.

For those who aren't ready to re-explore and redefine their sexuality, Tepper says it can be easy to label science and personal testimony as bogus. But exploring the possibilities and believing that it might work can increase a person's chances of experiencing sexual pleasure again sooner, instead of years later. “It doesn't necessarily take 17 years, and my mission in life is to help people regain that feeling sooner,” says Tepper. He recommends that people touch themselves regularly, through things like professional massage or adaptive yoga. Mindfulness and tantric yoga can also help you understand and enjoy sex in new ways. Having a partner you feel safe with also makes all the difference. “Context is important,” Tepper says. For many, feeling physically secure and having a sense of connection with their partner contributes more to sexual pleasure than any physical factor.

Photo credit: Valerie Fischel

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