Sex after a disabling injury? Yes, it’s possible

Singapore — Mrs Janice Lim (not her real name), in her 30s, was on her honeymoon when she was involved in a horrific road accident. Her husband escaped unscathed but serious spinal cord injuries left Janice permanently paralysed from the waist down.

After recovering from her physical injuries and starting life anew, Mrs Lim, now wheelchair-bound, began doubting herself: Could she have sex with her husband again or start a family?

A patient at Tan Tock Seng Hospital (TTSH) at the time, she was referred to the hospital’s Sexual Wellness Service. There, principal occupational therapist Shirlene Toh addressed the couple’s concerns about maintaining sexual intimacy and worked on their communication techniques.

The couple now has a child and continue to maintain a healthy sexual relationship despite Mrs Lim’s physical challenges. After sustaining disabling injuries, patients typically undergo a rehabilitation process that focuses on helping them get back on their feet. But little emphasis is placed on regaining sexuality and intimacy with their partners, which remains a hushed topic among healthcare professionals.

SUPPORT FOR SEXUAL CONCERNS AFTER DISABLING INJURIES

TTSH, part of the National Healthcare Group, is one of the hospitals in Singapore with a designated Sexual Wellness Service catering to this group of patients.

Over the last six years, it has seen an increasing number of patients with disabilities seeking help and support for sexual intimacy issues. Ms Toh currently sees up to 12 patients a month, or at least double the one to two cases she saw per month back in 2010.

Ms Toh, who started the service in 2009, said the increase is due to greater awareness of sexual health and the availability of such an avenue to seek help. Mostly in their 30s to early 50s, the majority of patients suffer from stroke or spinal cord injuries; the rest are patients with brain injuries, an amputation or multiple fractures.

“The early weeks following a major illness or injury are a matter of life and death for these patients, who will be focused on maximising recovery. But once they are discharged and return home, issues and challenges on sexual relations and intimacy will start to kick in as they adjust to fulfil their family roles such as a spouse,” said Ms Toh, who dispenses advice ranging from communication techniques, expressing intimacy and setting expectations, to safe positioning for sexual relations.

TTSH also has a Complex Erectile Management Clinic where one in 30 cases seen are patients with disabilities due mainly to spinal cord injuries.

The National University Hospital (NUH) is another hospital here taking patients’ sexual concerns seriously.

Since last year, its occupational therapists have been initiating discussions on post-injury sexual intimacy with spinal cord injury patients at NUH Ward@Senja after undergoing training. The rehabilitation ward admits patients who have suffered conditions such as stroke, as well as spinal cord or traumatic brain injuries.

To date, eight patients, half of whom are married, have benefited from the sessions, which touch on avoiding and managing autonomic dysreflexia. This is a condition where excessively high blood pressure may occur during sexual relations and is more common among patients with spinal cord injuries, said Ms Phyllis Leong, senior occupational therapist at NUH Rehabilitation Centre.

Other topics covered include positioning, types of erection possible for male patients of different injury levels, as well as managing bladder and bowels in preparation for sexual relations.

“So far, the patients whom our occupational therapists have spoken to had many questions on their minds and they seemed relieved to have someone to talk to. They were concerned about whether sexual activity was even possible and safety of having sexual relations (after a spinal cord injury),” said Ms Leong.

PEOPLE WITH DISABILITIES ARE ALSO SEXUAL BEINGS

Although a disabling illness or injury can change a person physically, cognitively and emotionally, Ms Toh said it is a misconception that these individuals are “asexual or no longer require any forms of sexual intimacy”.

Another myth is that all patients who sustain spinal cord injuries, which can impact erection, can no longer have sexual relations, added Adjunct Assistant Professor Ronny Tan, consultant and director of Andrology at TTSH’s Department of Urology.

“Spinal cord injury patients experiencing erectile dysfunction can still remain sexually active with treatment such as medications, injections and vacuum erection device. If those treatments don’t work, there is also surgery to put in a penile prosthesis,” said Adj Asst Prof Tan.

Stressing that sexual intimacy is not just about the act of intercourse, Ms Toh said: “Every human being needs to feel that touch and love. Often, people forget that those with disabilities are still sexual beings who need intimacy even if it’s just hugging, kissing, holding hands and sleeping on the same bed. Yet it is not uncommon for us to see situations whereby the patient sleeps on the hospital bed while their spouse sleeps on the floor or in a separate room when we do home visits.”

When not addressed early, these issues can have a negative impact on relationships. According to Ms Toh, research has shown a high rate of separation in couples after a disability.

“The separation may be due to the patient’s fear of being a burden to his or her loved one, and not a lack of love between them. So providing that early engagement and support to both patients and their spouses is important,” she said.

While some support is now available for people with disabilities, there is still some way to go in Singapore, when it comes to frank discussion about sex. The majority of healthcare professionals are ill-equipped to address the sensitive topic.

Ms Leong said “it would be good if the healthcare service could start addressing sexuality and intimacy as it is an important part of our lives”, but added that without adequate training, few occupational therapists are comfortable addressing intimacy issues for disabled patients.

Ms Toh added: “The healthcare system is currently still very medicalised. Most healthcare professionals do not proactively ask patients if they have any sexual concerns. Even when patients do ask, some healthcare professionals will avoid answering questions about sex due to the lack of information or training. Patients may have to ask more than one person before they get an answer, but don’t give up.”