Emedicine is an online source for the most up to date information on any medical problem. I reviewed the article on"sexual disability" and it includes the type where there is decreased sensation. There are also a lot of links to organizations, so there may be other recommendations that will help you, but as of yet besides the type of things I have mentioned to you, there is no drug that will bring back sensation any better than what is mentioned above, although if you have not tried viagra or cialis, you may find that through increasing the circulation that sensation is also improved by using these medications. It is mentioned in this article, as well as in other's I've read in the past about this subject, that a successful method is to prolong foreplay, and also that focusing intently on the partner may sometimes bring about better results for you (in a round about way). I would like to link you to this article. The problem is you will have to sign up on the web site to get it. In case you want to do that I will give you the link:
But I will also copy some of the treatment information or "solutions" for you here:
FROM EMEDICINE, (see above for link)
Physical examination and history
Before the patient resorts to using erectile aids or other interventions, perform a thorough physical examination and implement a coordinated team approach to assess for possible accompanying medical conditions.
Take a complete history of both partners and perform a complete physical examination, including a genitourinary examination. Order basic laboratory screening (eg, blood pressure, chemistry panels) to rule out hormonal or metabolic imbalances. Ask male patients whether they wake up with an erection. If so, some physiologic function is intact. Conduct medication review with the treating physician or pharmacist to rule out intolerable side effects or cross-reactions.
Sexual counseling can help the individual to learn how to communicate his/her needs and feelings concerning sexual issues. Implementation of strategic solutions may require assistance from the partner. The person who is disabled may find it difficult to admit to sexual dysfunction and to ask for assistance.
Annon describes a system known as PLISSIT, which includes the following12 :
- Limited information
- Specific suggestions
- Intensive therapy
Care providers can have a significant impact on a patient's recovery process. Inclusion of sexual history as part of the evaluation and treatment process validates or gives the patient permission to include healthy sexual functioning as part of overall functional goals.
When possible, ask both partners to share information regarding sexual functional status before and after the disability. They need to think in terms of physical and mental changes and to work together, possibly with a counselor, to devise solutions or optimal coping strategies for those problems. The level of information provided should be tailored to the couple's level of comprehension.
Couples are encouraged to use a desensitization approach, returning gradually through each stage of the sexual response cycle. Advise that they first get used to sleeping together again. After awhile, they should practice minimal intimacy, such as kissing, fondling, and hugging. Discuss how that went, and when they are ready, have them proceed through each subsequent step. This eliminates the goalpost mentality of having to reach orgasm each time, while permitting an enhancement of the quality of interaction that is comfortable for both participants.
For excellent patient education resources, visit eMedicine's Erectile Dysfunction Center. Also, see eMedicine's patient education articles, Impotence/Erectile Dysfunction, Causes of Erectile Dysfunction, and Erectile Dysfunction FAQs.
Addressing organic issues
Once specific areas of dysfunction are identified, make suggestions to address those dysfunctions. For example, pain and limitation of motion may limit interest or adversely affect performance.
Choosing more appropriate times, such as the morning or after a warm shower or bath, can minimize the factors that encourage one partner to avoid physical contact. Relaxing massage may be incorporated into foreplay to reduce pain, spasms, and anxiety. Side-lying positions sometimes are tolerated better. Strategic placement of cushions or pillows may enhance the experience for both partners.
Taking advantage of the best time of the day may lessen the effects of fatigue. The morning may be a better time than the evening. The beginning of the week may be better than the end of the week. A quiet day may be better than a busy day.
Strengthening and endurance training as part of the overall rehabilitation program also can help to improve physical function and endurance during sexual relations. The conditioning program designed for the patient also should address mental and physical stress reduction, as well as energy conservation during sexual relations.
Partners need to communicate about sensory changes. What previously was pleasurable may be irritating, and vice versa. Reduced sensation may be a problem in parts of the body; thus, advise that foreplay activities be directed to areas with better sensation. This adaptation could mean the difference between lying on one side or the other to optimize body contact and stimulation.
Longer foreplay may be needed to achieve sufficient stimulation, which could be frustrating for a person with traumatic brain injury (TBI) who has reduced attention or easy distractibility. Discussion between partners in a relaxed manner about what has changed and working together creatively to optimize remaining potential may lead to better physical relations.
Many males have erections; however, these erections may not be firm enough or last long enough for sexual activity. Several options are available for males to achieve erections, including penile injections, surgical implants, the vacuum pump, and oral medications.
Penile injection therapy involves injecting medications into the corpus cavernosum of the penis to relax smooth muscle and promote blood flow by inhibiting sympathetic tone. Such medications include papaverine, phentolamine, and prostaglandin E1. Use of these medications can produce a hard erection that can last for 1-2 hours. Severe adverse effects (eg, prolonged erection, priapism) may result if not used correctly. Pain and ischemic damage to the penile tissue can result from improper use. Administration of penile injections may be difficult for a patient with limited hand function secondary to spinal cord injury (SCI). He must have a partner who is willing to learn to give the injections.
Before introduction of penile injections, surgical implantation of a penile prosthesis was commonly used in individuals with SCI. The irreversible surgical procedure involves inserting an implant directly into the erectile tissues. The 3 types of implants available are semirigid or malleable rods, fully inflatable devices, and self-contained unit implants. Risks include skin breakdown in an insensate patient and infection.
The vacuum pump is the least invasive erection aid. In most individuals, this mechanical, nonsurgical device produces penile engorgement and rigidity sufficient for intercourse. The penis is placed in a vacuum cylinder. Air is pumped out of the cylinder, causing blood to be drawn into the erectile tissues. The erection can be maintained by placing a constriction ring around the base of the penis. This ring also can prevent the urinary leakage that can occur in an individual with SCI who has not emptied his bladder before sexual activity or in anyone who has a reflex bladder. Pumps are available in manual and battery-operated models.
Oral medications for erectile dysfunction, such as sildenafil citrate (Viagra), tadalafil (Cialis), and vardenafil (Levitra), are phosphodiesterase-5 (PDE5) inhibitors that relax smooth muscle by enhancing the nitric oxide effect, promoting effective erectile function.These oral medications are convenient to use and do not require any preparation, which may delay and detract from the enjoyment of sexual activity. Men who take nitrate medication for coronary artery disease should not take PDE5 inhibitors due to associated hypotension. Another reported adverse side effect is a sudden decrease or loss of vision in 1 or both eyes when taking these medications. Viagra and Levitra have been found to be effective for the management of erectile dysfunction in patients with SCI who have either a complete or an incomplete lesion, as reported in randomized, controlled studies. No adverse side effects, such as autonomic dysreflexia, have been reported.
In summary, people with disabling conditions are human beings, just like everyone else. They have human needs just like everyone else. Although they may have changed after their injuries, they have not been rendered asexual. Patients and their partners have a right to know about every aspect of their bodies, the changes that have taken place, and useful solutions to overcome those changes. Physicians need to ask open-ended questions and to be prepared to discuss some of the pathophysiology of sexual dysfunctions in order to educate and reassure the patient and his/her partner.
Case 1: JS was a healthy man in his late 30s who sustained a severe facial blow with frontal lobe dysfunction. He suffered from recurrent headaches, disinhibition/anger and impulse dyscontrol, and problems with memory and concentration. JS and his wife worked out a schedule for energy conservation to optimize his helping out around the house and with childcare.
JS and his wife included time-outs when things escalated, so that he could either work off frustration or collect himself in a quiet environment. He also found spiritual support and deep breathing helpful. Through regular, scheduled communication sessions with a mediator, JS and his wife were able to discuss their different concerns clearly and honestly. Through relaxation techniques, gradual return to sexual interaction, regular exercise, and use of anti-anxiety medication, they reestablished their relationship sufficiently to conceive a child. They report good rapport and a positive relationship at this time.
Case 2: IR was a man in his late 50s who sustained polytrauma in a motor vehicle accident and suffered orthopedic problems in the neck, back, leg, and head. Challenged by memory deficits, concentration problems, headaches, dizziness, circulatory problems, and spinal pain in the neck/back/leg, he and his wife were unable to bridge communication challenges and separated. IR's wife was unable to accept that his significantly changed behavior was not deliberate, and IR was unable to recover sufficiently enough to reach his previous level of function and so maintain the relationship.
Case 3: MM was a 50-year-old married female classified with a C-6 American Spinal Injury Association (ASIA) A (complete) spinal cord injury. She was injured in a diving accident at age 20 and met her husband at age 25. Postinjury, she required intensive education and counseling regarding SCI lifestyle and sexuality. Her partner was willing to accommodate her severe level of disability. They maintained a satisfying and successful relationship that resulted in a lasting marriage, because both partners were enlightened and willing to be flexible concerning each others needs and desires. MM became a counselor for female patients with SCI to help them resume lifestyle activities, including participation in sexual activities.
Information Center for Individuals with Disabilities - Fort Point Place, First Floor, 27-43 Wormwood Street, Boston, MANNN-NN-NNNN(NNN) NNN-NNNN TDD(NNN) NNN-NNNN/span>
Sexuality Information and Education Council of the United States (SIECUS) - 130 West 42nd Street, Suite 350, New York, NY 10036,(NNN) NNN-NNNN/span>
American Association on Intellectual and Developmental Disabilities, Special Interest Group on Social and Sexual Concerns - 444 North Capitol Street NW, Suite 846, Washington, DC 20001,(NNN) NNN-NNNN(NNN) NNN-NNNN/span>
Sexuality and Disability Training Center - University Hospital, 75 East Newton Street, Boston, MA 02118
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Edited by Susan Ivy on 12/12/2009 at 7:18 PM EST