- Dealing with Relationships and Sexuality -
Psychologist Scott Berman
May not reprint for commercial use without author's permission

Sexual problems can be a major cause of distress in patients with peripheral neuropathy, even when normal sexual response is possible. Furthermore, there are pervasive social beliefs that disabled people are not interested in or not capable of sexual function. Finally, finding a willing partner may be harder for someone with a chronic medical illness.

There are a number of key myths about sex and disability:

  1. Myth #1-Disabled people are unattractive.
    n Fact: Lots of fully abled people are unattractive, and they have sex. Lots of disabled people are attractive. As one of my supervisors used to say: "love is blind, or no one would ever get married." We tend to view ourselves as unattractive, and then perpetuate this view to others, and then blame them for not finding us attractive.

  2. Myth #2-People with neurological diseases lose sexual function.
    n Fact: Many people with sensory or motor neuropathy have intact autonomic function necessary for sexual performance.

  3. Myth #3-People with neuropathy lose interest in sex.
    Fact: While both illness and aging can decrease arousal and ability to have sex, loss of interest is not necessarily the case.

  4. Myth #4-Sex is the only way to feel close to your partner.
    n Fact: There are a lot of ways to feel intimate with others; you just never see them demonstrated on prime time TV.

  5. Myth #5-Sexual abstinence can be harmful to you.
    § Fact: Probably not harmful, but why take unnecessary chances?

  6. Myth #6-No one will ever love me if I am disabled.
    n Fact: No one will ever love you if you go around making up reasons for them not to love you. Otherwise, it's up to you. Remember, even Hitler had a girlfriend!

  7. Myth #7-People with neuropathy are more comfortable sleeping alone.
    n Fact: Many couples with a disabled partner end up in separate beds because of a breakdown in communication and mutual frustration. When I talk with a couple where one partner has a major illness, I always inquire about sleeping arrangements. Often taking separate beds or separate bedrooms is a negative way to cope with frustration and resentment in the relationship.

  8. Myth #8-What worked before will still work now.
    Fact: You may have to make a lot of changes to have a good sex life. The neuropathy may cause fatigue and limit your ability to be acrobatic in bed. More foreplay and fantasy may be needed; Helen Kaplan Singer, the grandmother of sex therapy, once said that "sex is friction plus fantasy."

If you are having problems with sex you should talk with a doctor who takes your concern seriously. Don't work with doctors who tell you that you have to give up sex or that your problem is "just part of your disease."

There are a number of causes of sexual dysfunction in peripheral neuropathy.
Sometimes it is a result of damaged nerves, such as in diabetic neuropathy. Sexual problems can also be the result of fatigue, anxiety, depression, or just not feeling very appealing.

Some medications you are taking may have sexual side effects. For example, the selective serotonin reuptake inhibitors (SSRIs) which include Prozac, Zoloft, Celexa, Lexapro, Paxil, and Luvox can all cause problems with sexual interest, arousal, and orgasm function-they can prevent orgasms in women and prevent ejaculation in men. Many other medications, both psychiatric and for other diseases, have sexual side effects.
Psychiatrists often deal with the sexual side effects of depression or drugs used to treat depression. Medications such as bupropion, buspirone, and sildenafil (Viagra) may reverse sexual side effects. Viagra may be effective in men with a broad range of diseases including neuropathy. Newer agents, such as sublingual (under the tongue) apomorphine are on the way. Certain hormones may end up being useful for men and women, although not standard therapy as yet. Arginine preparations both taken by mouth and applied topically have been reported to have some effect in sexual problems in women, although this is not proven. There is a prostaglandin in the medicine for men called "Muse" that may work for women.
Sex is important to people, and more medicines will be developed. Even simple things such as an adequate lubricant for women with vaginal dryness, may be very valuable. DO NOT GIVE UP - people have been able to have some kind of satisfying sex under every imaginable obstacle, including severe neurological problems such as spinal cord injury.

A good sexual history should include your past, your current sexual activity, your sexual preferences, and a good deal more. The history can provide a great deal of information that lead to proper diagnosis. For example, if a man still awakens with an erection, than physically he is capable of this. If a woman is only aroused by partners who are not her husband, this is a psychological and not a physical problem.

RESOURCE DIRECTORY

The Neuropathy Association; www.neuropthy.org (for patients), or www.neuropathy.com (the neuropathy store), and www.neuropathymd.org (for doctors).
You can contact them by email at info@neuropathy.org, by telephone at 1-800-247-6968 or 212-692-0662, or by mail by writing to: The Neuropathy Association
The Lincoln Building
60 E. 42nd Street
Suite 942
New York City, NY 10165-0999

Medline Plus Information: http://www.nlm.nih.gov/medlineplus/peripheralnervedisorders.html
(put in Keywords such as neuropathy and drug therapy; there is a tutorial for new users)
The Jack Miller Center at University of Chicago: millercenter.uchicago.edu

Neuromuscular Web Site of the University of Washington, St. Louis: at http://www.neuro.wustl.edu/neuromuscular
http://www.gimpsex.org- Lots of resources by Ken Kroll, author of "Enabling Romance: A Guide to Love, Sex, and Relationships for People with Disabilities http://www.newmobility.com--home Good Vibrations 1-800-289-8423, www.goodvibes.com (well known sex product catalog-adult but not sleazy)

Enabling Romance: A Guide to Love, Sex, and Relationships for People with Disabilities (and the People who Care About Them) by Ken Kroll and Erica Levy Klein, 1992, No Limits Communications

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