by Robert Lovering

Copyright (c) 1995 by Robert Lovering. Permission is granted to make copies for your individual use and to give copies to others. This manuscript may not be reproduced in whole or in part and sold to others nor included in a collection of documents which are sold.

Persons wishing to contact the original author to ask questions about sexuality, particularly dealing with the topics contained in this paper, may send e-mail to me ( Your message will be received by the author and you will receive an e-mail response.

This document is written by a psychological counsellor with over four decades of professional experience who specializes in problems facing persons with disabilities.

With all the volumes of current sex-enlightening information available today, what was your purpose in writing this?

Even with all the sex education available today, there are many persons foundering in the abyss of sexual understanding, especially relative to disability. However, these pages contain potentially valuable information for all adults. It has been very difficult for a moralistic person to write a non-moralistic approach to sex. Nonetheless, I felt it was necessary even knowing that some would be offended perhaps to the point of anger and backlash. Although I specialize in problems relating to disabilities, in my counseling sessions it seems that almost on a daily basis I am dealing with persons, with and without disabilities, regarding sex and their individual sexual complications. Please weave these facts into your own personal moral fabric.

If safe sex is a problem for the able-bodied, how much more difficult it is for those with disabilities that often prevent so-called normal sex. Most everyone has unique and secret sex desires, and all of us have a very secret compartment in our brain for sexual fantasies. We are afraid and embarrassed to express these to anyone, sometime even afraid to admit them to ourselves. Never lose sight of the fact that if our genitals are unhappy, we are unhappy. On this earth this fact is as absolute and immutable as the law of gravity.

How do I know you know what you are talking about?

You don't, and in some respects this subject is like handling dynamite. You don't want an inexperienced handler to be playing with such potentially explosive material. However, I can tell you that from the standpoint of education that I have spent eight years in post-high-school academic study with a number of courses being directly related to the sexual functioning of human beings, with one course specifically focused on sex and disability. Very early in my psychological education I learned the importance that our sexuality plays in all our behavior, and that to be a good counselor it was paramount that these facts of life be learned and understood in relationship to that behavior. My counseling experience now extends to forty-one years during which many hypotheses have been formed, and then an attempt made to prove to myself that these were either accurate or in error.

These hypotheses were in all areas of life, not just related to disability, and not just sex. Sometimes, later experience indicated that I was wrong and had to change my mind. However, what advice I now give is tempered with the years of experience and also with the realization that I could sometimes be in error. If my advice works, you will then know that I know what I am talking about in this area of sex as well as other areas of disability. "The proof of the pudding is in the eating."

Don't the words sexuality and sex mean the same thing?

No, sexuality and sex are not interchangeable words. Although sex is certainly a part of our sexuality, it is just that--a part. Sexuality is defined in the Random House College Dictionary: Sexual character; possession of the structural and functional differentia of sex. In the professional psychological dictionary by English and English it is defined: The sum of a person's behaviors and sexual tendencies. Apart from expressing gender such as a he or she, sex is an act, and for our discussion we will concentrate on the importance of that act.

Why do we need to have sex?

Within each of us is a dynamic drive for reproducing our species which our Creator put therefor the purpose of reproduction of His creation, for without it there would have been no twinkle in my father's eye, nor would there have been a father--or a son--or a human race. We were all conceived because of this drive. In most of us our sex drive is so intense that it rates second place only to oxygen requirement or other survival behavior. It cannot be ignored, and if this drive is not satiated or relieved, it builds up a dangerous head of steam. Animals and humans have a rutting season, whether it be once a year or once a month. However, humans do more than just breed; they indulge in sex for biological relief and for pure emotional and physical enjoyment.

Many persons do not understand the command that this drive has over our behavior, sometimes masking itself as something else and confusing the issue. Although Sigmund Freud's postulate has been discredited to some degree, it must be recognized that sex is the undercurrent in motivating much of our behavior, but not all of it. Then there are some who realize the control sex drive has in their own lives, but are unwilling to admit it to themselves or allow this understanding to temper their criticism of others who are sexually driven in a somewhat different direction. We learned in Psychology 101 that drives in any organism must be satisfied as illustrated in the salmon's drive to return to its birthplace to spawn. Sex is a drive and it must be satisfied!

Do we all have the same degree of sex drive?

Although there is an element of society who wants us all to be the same--have the same intelligence and the same skills, etc.--this universal drive is not the same in each person. To believe we are all the same, one must then believe that each of us possesses the same demand and the same production of hormones. Rubbish! They attribute female frigidity to bad sexual experiences, and impotence or low sex drive in men to psychological hang-ups. A lifetime ago the French were reputed for having a saying, "There is no such thing as frigid women, only inept men." If a man cannot arouse his sex partner, that notion leaves 100% of the arousal responsibility with him. Not only is this unfair, it is untrue. However, keep in mind that there is a little more truth to that French premise than most of us men would like to believe.

Using the bell curve, your own good sense, and a host of studies of animals, about 80% of us have what is considered a normal sex drive; 10% of us have a zero-to-low sex drive; and 10% of us have a high-to-insatiable (not able to be satisfied) drive. Keep in mind that only a small fraction of persons have zero drive, as there is only a small fraction of persons who cannot get enough. It is also important to know that there is a normal low and a normal high. In the bell curve used in IQ, normal IQ is stated as anyone testing between 90 and 110 IQ, and 80% of us fall into this bracket. However, let me warn you that although persons with an IQ of between 90 and 110 are considered normal, there is one huge difference in performance between those at the bottom of the normal scale and those at the top of the normal scale. In times past the bottom normals were termed dull normal, and those at the top, bright normal, but nonetheless considered normal but not the same.

In our understanding of sexual behavior, then, it is important to realize that all persons do not have the same degree of drive, even those in the normal range. Whatever degree of sex drive each of us possesses, it cannot be ignored. However, it sometimes can be rechanneled or redirected (sublimated) in some cases, but sublimation is a poor substitute for sex. You really can't and should not try to fool Mother Nature, and there might be some very unhappy consequences in trying.

We must understand that our bodies cannot differentiate between a wild, intense and satisfying orgasm to one of minimal intensity and satisfaction. To the body, an orgasm is an orgasm is an orgasm. However, the mind comprehends it differently. Long after an emotionally-intense and satisfying orgasm, the memory of the pleasure keeps alive the emotional satisfaction. The body forgot about the release and drive satisfaction a few minutes after the last cervical or prostatic contraction. Sex drive is related to the physical or biological aspect of reproduction. Sex pleasure, divorced from the biological sex drive, is emotionally pleasant and desirable. This is what most of us refer to when we discuss sex.

Is there anything new in the area of sexual understanding today?

Although it was published in 1969, Everything You Always Wanted To Know About Sex, by David Reuben, M.D., most of his sexual statements remain valid. The book deals in depth with concepts to which this writing may make only casual comments. The sexual revolution of the sixties through eighties seemingly increased no-commitment sexual activity without much increase in knowledge other than "who would and who wouldn't," some new approaches for the alignment of our sexual organs, and some new sex toys for genital stimulation.

In yesteryear's society it was taught that it was wrong or sinful for the woman to enjoy sex, and that she would be thought of as a wanton woman by God and her husband if she allowed herself the slightest tinge of enjoyment. How stupidly frustrating for both men and women. In today's society our sexuality is taken for granted. Our ability to perform the sex act is seemingly limited only by our ability to have a willing partner or to utilize our own imaginations. We have finally learned that sex is absolutely vital to our contentedness with life, at least for 95% of us.

If sex is so necessary for our emotional well being as well as procreation, shouldn't all those who need sex have the opportunity for satisfaction?

Yes, however there is a segment of our population that is deprived of an outlet for this physiological and psychological necessity. Some of these persons are celibate because of personal or religious choice. However, others are celibate by social decree. Society says that if you are incapable of finding or procuring a willing partner or incapable of self eroticism, you are out of luck. As a society we tend to the needs of our ailing members: children, elderly, sick, poor, and homeless. We provide, food, clothing, shelter, and all sorts of social services. However, can you imagine the howl of protest from Washington and a high percentage of our nation's population if we proposed surrogate sex for those who could not provide their own?

Society fidgets when it turns its attention to the sexual needs of any group in our population. It is just easier to look the other way and ignore it. Even in this enlightened era it is often customary to expel the sex-offending member from the nursing home or from the residence or program in which the person is involved. One director of nurses told me she instructed her nurses to just look the other way if they came upon consenting adults sexually fooling around. Looking the other way may solve the problem for those who have the option to be sexually active, but it does nothing for those who don't have that option. Often these are persons who are emotionally or physically incapable of behavior leading to the completion and satisfaction of the sex drive. It also includes those who could perform with a little help, which we will discuss later.

Aren't people with disabilities often sort of sexless?

No, they are just like everyone else even if our disability limits us in this area. Because we are discussing sexuality in the light of disability, we will primarily pursue the problems of sex drive satisfaction relative to the obstacles placed on us by a disability. So, let's move out of the clinic and into the bedroom. Over the years I have been involved with singles, couples, and group sessions dealing with the problems that disability places on our performance as a sexual being. The questions and answers that follow are those that have been asked and answered time and again both privately and in group sessions.

Is there such a thing as safe sex?

Yes and no, assuming you are talking about disease and not pregnancy. Let's talk about the NO first and later we will discuss the YES or truly overall safe sex. Prior to AIDS, there was not much talk about safe sex in the ranks of those caught up in the so-called sexual revolution. If it feels good, do it. The illusion was that modern drugs could cure all sexually-transmitted diseases; it is our right to have sex with anyone we please, whenever we please, and however we please. The "pill" removed the fear of pregnancy and it was a sexual free-for-all in the late fifties, sixties, seventies, and early eighties.

Then came the AIDS scare, and the value of the monogamous relationships among non-AIDS carriers emerging as the only sure way of protection against the sexually-transmitted aspect of AIDS as well as other diseases. Of course we understand there is also the possibility of blood-to-blood transmission of AIDS apart from sexual activity. Oral sex has been touted as a safe approach to venereal disease including AIDS. Absolutely not so! Condoms are being promoted as the way to safe sex, but if they are only about 95% effective against pregnancy, how could they be 100% effective against AIDS or other sexually transmitted diseases? They aren't! They break; they slide off; and they often do not cover 100% of the genital areas that are vulnerable to venereal diseases. They were crudely developed in the fifteenth century primarily to prevent the dreaded syphilis. The HIV-1 virus is .1 micron in diameter or 60 times smaller that the spirochete that causes syphilis. The Naval Research Laboratory has determined that the new latex used in manufacturing condoms has "maximum inherent flaws"--holes that are 700 times larger than the AIDS virus, and some tests suggest an HIV failure rate of more than 33%. Whoa, there! And you think there is such a thing as safe vaginal sex? As one researcher stated, we should stop urging people to practice safe sex and rather urge them to practice good science.

Now is the time for a qualified yes answer to disease-free sex. Apart from single-partner sex among two disease-free adults, there is no such thing as safe sex. Even in this disease-free, single partner business, all it takes to take the safe out of sex is for one of the partners to have intimate sexual activity just once with a person other than with his or her monogamous partner. However, when we began with this question I said there was such a thing as totally safe sex both from the standpoint of disease and pregnancy. This is self eroticism or masturbation with no sex-organ-to-sex-organ contact. We will discuss this later and in detail.

As long as pregnancy is mentioned, perhaps you would mention something of birth control.

We have a biblical record that over five thousand years ago coitus interruptus (pulling the penis out of the vagina just before ejaculation) was used as an attempt to control conception. However, it is a very poor method for either sexual gratification or contraception, does nothing to prevent disease, and interrupts the process at the worst possible time for pleasure. Contraceptively it has been estimated that even in the very first drop of male lubrication that oozes from the penis long before ejaculation (in the vernacular it is termed, pre-cum), that drop is loaded with about 50,000 sperm. This is 49,999 more than necessary to become pregnant. Surgery on either a man or woman is the only 100% effective birth control if penis/vaginal sexual intercourse is practiced. Spermacides are best used in conjunction with condoms and diaphragms, not by themselves. There are women who became pregnant who were "technical" virgins; no penis had ever entered them, but one little sperm managed to wiggle into the vagina, past the cervix, and do its duty. This came to be because the boyfriend ejaculated into his girlfriend's crotch. Can a sperm get through panties? You bet, and there are some testimonies to that effect. Conception can occur if the male cleans himself up after taking off a condom and his partner uses that same washcloth on her genitals after he does. After ejaculation, the condom should not be removed and the penis reinserted into the vagina because it is loaded with sperm, 50,000++++++. Those invisible little "polliwogs" have only one destination--the female egg.

What about group or open sex?

Those groups or societies who have advocated open sex are in trouble today whether in the U.S.A., Africa, or wherever. For whatever reason intended, humankind was not seemingly designed for open sex. Those patriarchs of the Bible often had more than one wife, but it was a closed circuit. Wise King Solomon (not too sure of his wisdom in this case) is reported to have had over 300 wives and at least as many additional concubines. It was the same group having sex however they did it. No outsiders were allowed. Eunuchs (castrated men who had no sex desire) were the watchdogs of the harem. Arab sheiks guarded their harems with ferocity, perhaps because they were jealous or perhaps more so because they were aware of the contamination or sicknesses that could come from outside. Perhaps you think me old fashioned, but in light of what we know today we will not bother to discuss open sex or open marriage. I am not going to be a part of encouraging anything I believe that might precipitate someone's signing his/her own or another's death warrant.

Apart from finding a willing partner for sex, what problems arise from a disability?

Our first approach relating to sex and disability is directed toward the married couple (or otherwise cohabiting single-partner relationship) where there has been normal sex activity. Along comes the presence or the diagnosis of a disabling disease or condition, and there is often gloom in the bedroom. The inability to perform in the same manner as before the disability or impending disability becomes a stumbling block to marital or relationship happiness as well as to a healthy ego.

Generally, ego is enhanced by the ability to create a sexual desire in the opposite sex. We tend to believe, and often rightly so, that initial sexual attraction often lies in the correct size and shape of our body parts--pure physical beauty, which of course is in the eye of the beholder. Very often a woman with a disability will express to me something like this: "Look at me! How can my husband or any man get excited over this mess I have for a body?" Men feel much the same way: "No woman in her right mind would want me as a sex partner." And in our present sexual culture that stresses the body beautiful, too often they are correct in their appraisal of their sexual attractiveness.

If I am sexually unattractive, does that mean I am sexually worthless?

Unfortunately, those who feel sexually unattractive often tend to feel sexually worthless, and it creates a misconception of their sexual worth. Women seem to be obsessed with the breast size as men are with penis size. Fifty years ago my father informed me it was not the size of the organ, but how it was played that was important. Only the first two inches of a woman's vagina responds to sexual stimulation so any penis longer than three or four inches is purely aesthetic. If anything can be said for size, the diameter or thickness of the penis is more important than its length. A short one just has to utilize more short movements to accomplish the same thing. It is much like a short-stroke piston that needs to make a complete stroke two or three times faster than a longer-stroked engine to arrive at the same outcome. Small breasts may not be as initially sexually attractive as larger ones, but when it comes down to business, most men are more concerned with how the breast responds to physical stimulation. Most often small, live breasts are preferable to large dead ones. Bodies are only sexual bait, not the meal. Bodies are the advertising, and most of us know how much deception can be found in advertising after we have purchased the product. Remember, in the end it's the product's performance that truly counts.

What are some of the problems persons with disabilities face in their sex life?

First of all, disability usually douses the flame of spontaneity. In our group sessions I often begin by saying that in most cases where disability is involved, a "quickie" is out of the question. This usually brings a giggle or a howl of laughter from those more physically limited. These physical limitations do present a problem for sexual activity, some making it difficult, or even preventing the usual positions, and in some unusual and very frustrating situations prevents any vaginal penetration. This requires some understanding and developing a new or different approach that is much more easily accomplished in the single-partner, long-term relationships because you learn step by step, repeat, and build upon what has been successful. Remember the old adage, "There is more than one way to skin a cat." (no pun intended)

Can persons with disabilities have an improved and satisfying sex life?

If both the body and mind need sex in these varying degrees, what are we to do with those who find sex physically impossible or have the biological and emotional drive limited, destroyed, or severely altered by necessary prescription drugs, brain damage, or other disabilities? How about those who are needy, but physically are unable to get into any usable position for sex? Should we just turn our faces and tell them that this is their problem? To whom does one turn when faced with these problems?

My experience with the professional world of medical doctors, counselors, social workers, and sex therapists on these questions has left much to be desired. Medical doctors often blush when we ask them a direct, pertinent question about sex. We leave the office wishing we had not asked. Doctors tend to look at our sex organs more in the light of their physical and reproductive functions and avoid the pleasurable emotional aspect of sexual behavior. Sex therapists can understand able-bodied sex, but come up short when comprehending sex in which a disability is present. Don't give up at this point. There are many problems, but also many solutions. I am convinced that most persons with even a severe disability can have a reasonably satisfying sex life.

What about male impotence?

Impotence is defined as the inability to "raise the flag and keep it waving until the sex act can be finished". For many years it was proposed that impotence was primarily a mind-over-matter situation--it was purely psychological. Many men spent much time and money searching for a cure for their so-called emotionally-caused inability. Some were treated effectively, while others were not. The poor fellow, who after much time and money could not function properly, was left with the guilt that his mind was the culprit and that he was unable to overpower it. Another failure!

In the arena of impotence the man is uniquely alone. No matter how big or well-proportioned his penis may be, if the starch is low or all gone (I dislike the word impotence), it is functionally useless in bringing the sex act to a climax for either him or his partner. All too often he reacts to his misfortune by becoming angry at his partner (misplaced aggression), and says and does mean and nasty things like, "If you are hungry for sex, why don't you go out and find yourself some?" He truly becomes one of the Grumpy Old Men. Too often he withdraws any loving or touching behavior. Most women can get along easier without sex than they can without love. They need those tender touches and tender words. Lest some give up at this point because he "cannot rise to the occasion," let me say that in paragraphs to come we will discuss some of the solutions.

Are there different types of impotence?

It has been postulated that there are three types of impotence: 1) an erection is possible but peters out before completion of the act, 2) an erection is possible but the man ejaculates prematurely and cannot satisfy his partner, and 3) little or no erection is possible. A generation ago the psychiatrists and psychologists made a wad of money treating men for so-called psychological impotence. The success rate was dismal, and those hoping for some form of miracle found none. There was denial in the medical camp that impotence may also be neurological, and that would mean it could not be treated. Today it is recognized that perhaps 75% or more of male impotency in the general population is physical or medical, but my guess that in men over 60, neurological impairment would be considerably higher, and perhaps 90% of those with any neurological diseases are impaired. Some men have been helped with testosterone shots, but to my knowledge this has not been effective with chronic neurological impotence.

Isn't there something to assist in erections for those men who are neurologically impotent?

Of course there is, and there are also solutions to any type or degree of impotence. New on the scene about in the eighties, was an implant in the penis. Like many other new products, there were failures. Today's implant prosthesis should not be compared with the early crude model which often had mechanical failure. However, even with improvements the implant poses a possible threat of infection. The implant can be inflated and deflated at will. Its most common use is among those men who have some sensation in the penis but who have only a partial or no erection. It is also useful to the man who has little or no sensation, no orgasm, or no interest, but whose partner and/or his ego thrives on this pseudo-erection. It would seem to me an implant procedure would be much more attractive to a man in younger years than when he is older. An implant at 30 or 40 would have more merit than one at 65 or 70. So isn't there something else for this problem?

Since rubber was invented, men have used bands of it around the base of an erect penis to keep the blood from vacating it, and thus sustain an erection. Going a step farther, the latest possible solution to harden the penis and sustain it is a kit which is gaining more and more acclaim. It consists of a large plastic tube, a vacuum pump, and some different size plastic rings to slip off onto the penis after the vacuum has sucked in enough blood to give the desired degree of erection. A plastic ring at the base of the penis holds the erection until the ring is removed. In the same vein as a tourniquet, in most cases the warning is to not leave it on for more than 30 minutes. Like any other part of the body deprived of new blood, it will die, rot, and fall off. That ought to frighten one into compliance. There are also self-injected shots directly into the penis. Because of the ever-changing scene, it may be best to consult with an understanding urologist for the most up-to-date and appropriate method of treatment for your particular problem.

Do some neurological diseases and/or dysfunctions actually cause impotence?

We have learned much in the last decade regarding the causes of impotence. Granted, the mind is the "great communicator" to the sex organ, but what seemed to go unanswered was that neurological as well as emotional dysfunction could affect performance. Multiple sclerosis is the best example I know. Here you have an emotionally-destabilizing condition that is unpredictable with no one knowing where it will take them. If the mind is overloaded with the weight and concern of the disease, the thought and performance of sex comes in a distant second for both men and women. Persons who are seriously depressed by a disability or circumstances surrounding it are often not sexually stimulated easily or at all. When the emotions heal, sex drive and performance often returns, but only to the level the newly-affected nervous system allows.

However, those affected by a neurological disorder, such as may be the case with multiple sclerosis, very often are impotent (or at least it is a contributing factor) because of nerve dysfunction. This means that no message, or only a whisper, manages to get through to and from the brain to the genitals of either men or women. (If a woman needed an erect penis for sex, she also would have this potential for impotence.) Defective nerve pathways can also be the case with those of us suffering from post-polio syndrome. There is no amount of psychiatric treatment that will make the organ play well again, or at all. If there are both neurological and emotional causes, treating the mind can only bring back the performance to the highest level of neurological functioning.

This can also be true in both men and women, not only in sexual performance, but in sexual enjoyment as well--their enjoyment can be brought back to the highest level of neurological transmission. The female can indulge in full sexual behavior without her sex organs being stimulated (don't forget the lubricant). However, for those women who have experienced even a slight loss in feeling in the sex organs because of neurological dysfunction, sex loses some of its previous allure and satisfaction. Having an apparently dead sex organ, male or female, is an emotionally-painful and humiliating feeling. For many it robs us of a part of our masculinity or femininity. Keep in mind that it might be playing possum, and that there might be a little delightful life there if sought after.

Particularly, persons with disabilities must learn to be creative in our approach to sex. There are a "million-and-one" books available. Somewhere within this booklet or other works there should be at least a partial solution to your problem. Caution! Do not accept everything you read as gospel truth. Some of these writers are more concerned with their own fantasies or their own pocketbooks to worry much about truth, and don't be taken in by those who promise the impossible. If it sounds too good to be true, it most likely is.

Why is it so difficult to talk openly about sex with so many professionals?

First of all, our personal sexual behavior is just that-- very personal--very, very personal. It seems as though we have a secret cavity in our brains that stores our sex desires and fantasies. We want no one to have the combination to the lock, and we guard it like it was Fort Knox. These desires and fantasies are too personal and sometimes too hurtful to discuss with anyone. Therefore, it is not unusual for either the patient/client or the serving professional to hide from any discussion of sex other than personal generalities. I was no different from anyone else in hiding from it in my early years as a counselor.

However, researchers have found that the one area in which persons are unwilling to answer is any question that probes their fantasies when they masturbate. When that question was asked, there was stone silence. I am sure most sex partners feel the same way even between themselves, but that is unfortunate because sometimes these fantasies can be made real if they are revealed. However, no one seems to want to risk the possibility that his or her partner will be shocked or turned off, worse yet there is the fear of being scorned or laughed at.

In 1971 I took a course offered by Theodore Cole, M.D., at the University of Minnesota. He had been working intensely with cord-injured persons who in most cases had apparently lost total sexual function. At his own admission, when his patients asked direct questions relating to sex, he would dodge them. After his retreat from these questions, he began thinking about his position as a medical doctor. Should he not be expected to not only know the answers and also to answer without personal embarrassment?

He worked over his attitude, delved into the questions and then designed a course for professional persons like himself who most likely would be faced with some of these questions. The first phase was to desensitize these professional students so that discussing sex was on par with discussing what we had for dinner last evening. He used sexually-explicit movies and discussion groups to accomplish this. Some of these professional counselors, social workers, and medical personnel were aghast at the movies and the low-key discussion groups that followed. Some just quit coming to the course while other stamped out of the classroom and slammed the door to indicated their disgust. Most were married and indulged themselves liberally in the sex act, but they could not think about it for others or bring themselves to talk to their patients or clients about bedroom behavior. It was just too personal and absolutely too private to discuss with anyone.

Although I survived the course, it was not without its problems. Sex became a topic on which I could discuss openly and freely with anyone just as I could state "what we had for dinner or breakfast"--and with about as much hesitancy. One particular meeting comes to my mind, one in which a vocational rehabilitation counselor, a county social worker, and I were discussing a client with whom all three of our agencies were involved. The client had expressed to me some deep and personal sex-related problems. Should not all of the professionals involved with the client's direction and planning be aware of the problems? So I brought this situation to their attention. To my surprise, both of them (both married and over thirty years of age) nearly dived under the conference table in embarrassment.

To this day I can discuss sex, any phase of it, with anyone who indicates a need or an interest. I have discussed all aspects of sex even with our children both as children and as adults. My thanks to Dr. Cole for the conditioning, even though my freedom of sexual speech is often met with looks of embarrassment and horror.

What sexual problems can be encountered in those with spinal-cord injuries?

One of the early questions Dr. Cole dealt with was the sexual performance of the spinal-cord injured. They had no feeling in their sex organs so it was assumed that an orgasm was impossible. And then, how does one concoct an erection with no connection between the brain and the organ? How about the reflex knee-jerk reaction the responds to the tap of a doctor's rubber mallet? Through experimentation it was learned that with many of these cord injured, the reflex nerve pulses from manipulation of the penis, breasts and vagina somehow managed to short circuit themselves and there was a glorious erection and/or sense of well being. The erection lasted as long as the physical caressing on the organ was maintained. The sex act was possible, but without orgasm. However, it was also learned that the body responded to this stimulation by giving a warm, contented feeling to the male or female owner of this reflex-action stimulation. Small amounts of semen were sometimes passed (oozed, not ejaculated) and therefore any fertile woman, another cord-injured person or not, could conceivably (no pun intended--well, maybe just a little one) become pregnant.

What about masturbation, or as you call it, self-eroticism?

Earlier when we discussed safe sex I mentioned there was such a thing as totally safe sex. Sex discussion cannot ignore the act of a sexual climax or orgasm by other means than penis-vaginal sexual intercourse. This is called masturbation, and to most people the word identifies an ugly, sinful practice--an attitude that can be credited to our early training that was inflicted upon us by teachers, parents, the pulpit, and other authority figures. The word is derived from the Latin, mastubari, meaning "to pollute oneself." This term and similar words such as self-abusers have not done much to erase the guilt of those evil and sensuous "polluters" who number in the billions at any given time.

Even with moderate-to-severe loss of sensation, most men and women can be physically stimulated to orgasm, and often by some form of external means. If you choose to use the term masturbation, fine; but there are other terms that carry with them less guilt and emotion for those who were taught it was sinful. How about using the term self-eroticism? Several years ago, parked in a large shopping mall lot, we found tucked under our car's windshield wiper a flyer on crimson paper telling the windshield that God was horrified by oral sex. God also abhorred any other position other than what was "according to nature." Whose nature? I don't know. Personally, my belief is that the Lord has a great sense of humor and is more apt to chuckle at some of our sexual creativity than to be angry. After all, He is the one who "in the beginning" created the sex drive with all its ramifications.

What any adult does, including a monogamous couple in a relationship, in their bedroom, bathroom, kitchen, living room, dining room, patio, hallway, garage, tent or automobile is their business, and their's only unless they are careless and display their activity where they might have an offended audience. However, if this conduct is irresponsible and there is the possibility of pregnancy, a child conceived out of passion that is unwanted and must be cared for by society, I believe society has a right to complain, and complain bitterly. And I will also complain bitterly over those who indulge in sexual behavior in which a venereal disease is transmitted that harms the fetus and/or that costs the responsible members of society tax money for medical assistance. There is such a thing as individual responsibility, and we had better get back to it. This is a financial judgement and not a moral one.

How, then, can a person or couple with a disability (or anyone else) be sexually active but yet totally responsible from the standpoint of conception?

There are pills, injections, surgery, and a host of contraceptive devices and procedures. The most careful and cautious of us have "accidents," but this should be the exception and not the rule---once-in-a-lifetime accident. There is no "safe" time (rhythm method), and there is nothing apart from surgical sterilization that is 100% effective. However, we can certainly prevent both disease and pregnancy by using our intellectual brain rather than our genital brain. Am I a bit testy on this subject? You bet I am because as a counselor I have seen the trauma, damage and misery in the lives of persons, both disabled and able-bodied, that an unwanted pregnancy caused. There is no provision for afterthought when having penis/vaginal sexual stimulation. Know what you are doing and be ready and able to accept the consequences. There will always be irresponsible persons in every area of life, but when irresponsibility (especially sexually) becomes an epidemic, society must either face up to it and do something about it, or just pass on into oblivion. Rome thought it was indestructible also. Well, let's get off the soapbox and back to the subject of self-eroticism.

Can self-eroticism be dangerous?

I'll give this a qualified no. Caution must be exercised when using any device other than the genitals themselves. With both men and women, soreness is usually the only result of over-indulgence, and the body takes care of that in a day or so. There are case histories in which no permanent damage was done even when some rather large objects were used as a substitute for a penis. Anything glass or otherwise sharp objects are always to be avoided. As early as the twenties, women were using Coke bottles as vaginal stimulators because the shape of the bottle and the raised lettering on the neck brought greater pleasure. Doctors have extracted some rather unusual objects that were broken or lost in women's vaginas, or from both men's and women's urethras.

What is a safe and good way to bring oneself to orgasm?

Most of us were born with eight fingers, two thumbs, and two palms that were always readily available for self satisfaction from Day-One of the human race. Fortunately, our genitals were placed where these ten digits on two hands had easy access to them. Babies and young children discover the pleasure of fondling themselves, but at this age many people do not consider this a sexual act. Many a child has spent extra time washing his or her genitals simply because it felt good, and many an adolescent discovered orgasms washing his or her genitals. So why abandon a good thing? One problem is that bacteria-laden fingers in a vagina, yours or another's, may cause infection. Wash you hands! Another problem with fingers in a vagina is that until puberty there is no lubrication. Lubrication is essential to keep from getting a sore spot. That's why the petroleum industry gave us Petrolatum marketed under a trade name Vaseline. It is also a great help in regular sex, but remember that it will destroy the condom or diaphragm because it is petroleum based. Use water based lubricants made for sex. These have no ingredients that will inflame the tissue of the genitals or dissolve the condom or diaphragm. Soap is not a lubricant; it is too harsh and soreness will result.

Is a vibrator really helpful in sexual stimulation?

Absolutely. Other than body-to-body stimulation, there is also the use of any device including a vibrator that stimulates the sensitive sexual nerves. Even if these nerves have lost much of their sensitivity, a hand-held vibrator can often bring on an orgasm to either a woman or man, and particularly if fatigue is a factor in completing the sex act. With some of the more disabled population, self-eroticism becomes impossible because their arms, hands, and fingers fatigue before the act can be completed. A vibrator can easily be held in one place and not have to be moved, or someone else can hold the vibrator. A flaccid penis or clitoris with some sensation can respond well to this vibrator stimulation and orgasm can ensue. In this situation, an erection is not necessary for orgasm of either male or female.

Dr. Reuben, in his previously-mentioned book for public consumption, discussed openly the value and use of a vibrator. Prior to this book, it was only discussed on a hush-hush basis. The more sexually creative persons had discovered this helper in the twenties and thirties, shortly after electrical power was available to vibrate or shake any object that could be sat upon or moved into any position that would stimulate the genitals of either sex. Before electricity, creative people used other methods such as women riding a horse bareback. Did you think that the strict code of ethics of riding sidesaddle had to do with modesty of getting on and off the horse. No, it was because a woman's genitals could be stimulated by the moving backbone of the horse or saddle and was therefore sinful. I wonder who the male culprit was that exposed this so-called sinful practice and declared it forbidden.

There are numerous vibrator "helpers" on the market, some in the form of vaginal vibrators that are powered by house current or by dry-cell battery power. One of my counselees offered the advice to shun those with batteries because of Murphy's Law: "You can be sure the batteries will go dead at the wrong time." Vibrators come in all sizes and shapes, and they can be used on one's body in many areas and in many ways for many reasons. Usually, the person being sexually stimulated by a mechanical device can personally direct this device more effectively than another person can, like scratching your own back or wherever you itch. My best advice at this point is to just do what works best for you.

How does one purchase a suitable vibrator?

Don't be cheap. Prices range from $7 to $200, depending on its complexity. Do your homework well and choose that which would be psychologically as well as sensually acceptable, as well as one that fits your budget. Don't buy the least expensive simply because you are only going to experiment. A poor device is no experiment at all, so I would advise something more in the $25-and-up bracket. Some prefer a gentle or wimpy vibrator, while others prefer a more robust one. Male or female genitals that have lost some degree of feeling probably need the more robust stimulation, while those with normal sensation may get by with the wimpy stimulation. A vibrator or other stimulating device may not extract music from your organ at the Bach or Mozart level, but several fingers playing Mary Had A Little Lamb or Yankee Doodle is better than no music at all. Give it a try!

Clitoral stimulation by any battery operated or 120-volt plug-in type vibrator works well. Be aware of the shock hazard if a 120-volt vibrator comes in contact with water or urine while you are grounded such as in a bathtub or shower. A water bed or regular mattress is not grounded and thereby safe. Urine is more dangerous than tap water because it is a better conductor of electricity than water because of its salt content It is just wiser to be safe than sorry. Ordinary massage vibrators are available in drug stores and other retail outlets, and are advertised as such. Although these vibrators can be used on the clitoris/penis, they are not considered sex toys and in many instances will not be found in adult bookstores or cataloged by other sex-toy providers. Some drugstore massage vibrators are shaped suspiciously like a penis, and some have many different types of fittings that can be screwed onto the vibrator to do various massages. There are massage vibrators that strap on the hand making the fingers the vehicle for the vibrations. One mail-order health-aids catalog advertised one of those penis-looking vibrators: "Deep, satisfying vibration massage for use anywhere on your body." No one is going to know that you may be purchasing it as an assist for sexual gratification, and no one is going to ask or suspect. However, the truly dildo-type vaginal vibrators (shaped in the exact form of a penis and the business end being made surprisingly of a material that also feels like one) are sold only from sex-toy adult catalogs or local adult outlets.

What about those of us women who shy away from the very thought of touching ourselves?

For women who feel it is dirty or evil or who feel guilty over touching their genitals with their hands or fingers for sexual stimulation, very often a vibrator seems to breach this hang-up because there is no direct hand-to-genitals involvement. The vibrator is doing the stimulation, not the person herself. She just happens to be innocently holding it and it just happens to feel good. Suddenly, out of nowhere an orgasm appears. If that rationalization works, fine.

Will the use of a vibrator diminish or destroy one's ability to enjoy regular sex?

Not according to the medical community that specializes in sexual behavior; rather, it is reported to enhance it. Nerve pathways that go unused fall victim to the old axiom, "use it or lose it." Sexual stimulation of the nerves by any means not only keeps these nerve pathways active, but also healthy. Vibrators to use as stimulators in developing these sexual nerves are recommend for those who have difficulty in reaching orgasm. It might seem like overkill to some, but one medical doctor suggests that a two-week period of daily stimulation be used, and that a woman should try to increase the number of orgasms that can be attained in one sitting, standing, or lying "treatment" until these nerve pathways respond almost reflectively to bring about a very good and quick orgasm. It is sometimes possible for a woman to be able to reach twenty or more orgasms in one of these practice sessions toward the end of the two-week period. So you can see that a vibrator can be used both to develop these nerve pathways and also to keep them alive and viable.

Is self-erotism more commonly practiced today than in years past?

Yes, and for two reasons. First, because the up-and-coming younger generation didn't listen to their elders who proclaimed it was a vile sin. Secondly, because of the AIDS scare in the nineties, sexual practices moved from a single partner here and there (one-night, one-week, or one-month stands) to one long-term, clean-partner participation as well as solo performances (self-erotics). In discussing sex with my clients I found more and more of them taking care of their own sex needs. One fellow said, "Sure, I prefer a woman, but it is better to masturbate than to take the chance and die from AIDS." Keep in mind that in 1994 the #1 killer of persons, age 22- to 44, was AIDS.

A forty-year-old divorcee told me she had not had intimate sex for five years and had come to prefer self-eroticism. It was available on demand; it was safe; and it was very satisfying with no worries or guilt, and there were no emotional strings attached. I asked her if she had ever felt guilty, and if so, how did she overcome it.

Her answer: "When I was seven my mother came into the room where I was watching TV. I was lying on my stomach with one hand under my skirt and wiggling around on the floor. My mother asked me what I was doing and I innocently said, 'I'm playing In-and-Out'. At that age I did not have orgasms but it just felt comforting and good. When I explained what I was doing my mother went ape. She yelled and screamed at me and made all sort of wicked threats of even physical harm to me if she ever caught me doing that again.

Being raised in a strict Catholic family, I was to later learn what I had been doing was called masturbation and that it was very evil--a sin against my body and a sin against God. Nonetheless, during my teens and early twenties I would masturbate whenever my body demanded it. I was married for several years in my late twenties, but it didn't last, and at age 30 I joined the Army. During my 10-year stretch in the Service there was never any problem getting sexual partners, so during that time I masturbated only occasionally.

I was diagnosed with multiple sclerosis shortly after my discharge from the Armed Forces and my sources of sex partners were greatly reduced. Then I began to worry about AIDS and decided I would do my own thing. And that's how it has been the last five years.

No, I got over feeling guilty in my early twenties about satisfying my sexual needs. I figured that God made me the way I am and that He would forgive me if it was such a great sin. My sex life couldn't be more satisfying and I am happy doing it my way." And so we moved into a new arena of sexual behavior brought about by fear of sexually-transmitted diseases.

What is the difference between a sexual turn-on, turn-off, and a hang-up?

These three terms regarding sex--turn-on, turn-off, and hang-up--are used indiscriminately by many persons. These purely psychological feelings are very often spawned in childhood, sometimes at the pre-school level, and often during the early stages of puberty. Turn-ons and turn-offs are more correctly used than hang-ups. Some researchers have postulated that some of these turn-ons and offs may be genetically transmitted, that is that in some cases there can be a genetic predisposition toward a particular type of turn-on or turn-off.

Let us look at hang-ups first and then go back to the other two. All too often a couple has discussed their sexual troubles with me and one or the other says, "He/she has this hang-up of ________." What was described most often was not a hang-up but a practice or desire a little off the beaten track.

What, then, is a sexual hang-up?

A sexual hang-up is when a person wants to do, think, or behave in a particular sexual way. The desire has not vanished, but the person cannot overcome negative feelings. However, these negative feelings such as guilt often stem from family, cultural, or religious taboos, or being reminded of a traumatic event such as being raped as a teenager or adult, or sexually molested as a child. Therefore, the normal desired action is often prevented by an over-powering force, and a hang-up exists. Remember, a hang-up is something that prevents one from doing or enjoying a particular desired behavior, be it sexual or social. Some of the more common learned sexual hang- ups are negative feelings about oral sex, not having sex during menstruation, guilt over masturbating, and other-than-so-called-normal positions. I think you get the idea.

What is a turn-off and what are some examples?

A sexual turn-off is easier to explain and understand. It is anything that represses or gets in the way of a desire for sexual activity--you want to do it and can't because the desire has vanished. Something just flipped your sexual switch to OFF. It can be your child needing attention at a very inopportune time. It can be an unbathed body, and in reference to sex, truly "cleanliness is next to godliness." Other parts of the body smell when unwashed; genitals stink when not washed. Of course there are smells from sexual excitement and activity that should not be confused with unwashed smells, and these can be very sexually stimulating. A dirty penis can also give a clean vagina a good case of non-venereal infection, and although not as common, vice versa. It can be bad breath. It can be accidental flatulence (expelling rectal gas). It can be words, deeds (or lack of them), smells, sights, or whatever it is that is distasteful to an individual. It does not necessarily have to be sexually distasteful to be a sexual turn-off. To some a misshapen or paralyzed body, or a wart or disfigurement can be a turn-off. Boorish or less-than-considerate behavior can be a turn-off. The environment can be a turn-off. Some of us would be turned off trying to have sex on a greasy, oil-stained garage floor. Fear of being "caught in the act" can be a turn-off.

Turn-offs come in all sizes and shapes and are truly individual in nature. We must stress individual because few persons would have the same list of turn-offs, and what turns one person on may very easily turn another off. Hopefully, it is not your sex partner. During sexual activities, once the sexual switch is turned off, it takes an earthquake to turn it back on again. Better start over or make another date for sex, correct the problem, and give the brain a chance to repress or forget the turn-off.

Can medications sometimes turn a person off to sex?

In the case of a disability or treating medical conditions, drugs are often used in treating these symptoms of the disease or condition. Sometimes the body turns itself off to sex with the introduction of certain prescription drugs into its systems. Drugs can cause both lack of interest and lack of performance. Drugs treating high blood pressure are notorious for turning one off to sex. It seems that nearly every drug we ingest somehow has side effects. Because sexual disinterest and disfunction are not a medical concern among drug companies and many doctors, these side effects are usually not listed and it is most often by accident that we discover our diminished sex drive has returned after we quit taking a particular drug. If you mention this loss of interest or performance to your physician he may be able to change prescriptions to see if anything improves.

Can the disability itself be a factor in a turn-off?

Let's not forget that any brain or trauma to the nervous system can destroy one's sex drive or greatly alter it. When a disability is involved, sometimes the turn-off can be all the extra mechanics necessary in getting ready for sex. By the time your body is ready for sex, your head has forgotten about it or you are too fatigued from the effort. Sometimes the preliminaries take so much energy there is nothing left for the appointment. Catheters are not conducive to sex play, neither are paralyzed legs, arms, or other physical abnormalities. If your partner expresses pain in what is taking place, that often ends the performance with hurt and/or anger. Why would one even attempt to have sex with someone who elicits any of these turn-offs? Most often it is because they are loved, but sometimes it is because it is the only acceptable and safe source of gratification. Sex drive is not something that one can turn on or off, so don't blame yourself or your partner for lack of response.

What about turn-ons?

Now that we have discussed hang-ups and turn-offs, turn-ons should be more simple. Simple? Absolutely not. All three are often deeply-seated, complex patterns of thinking and behavior seldom yielding easily to treatment or to understanding. Turn-ons seem to be more diverse and wide-spread than hang-ups or turn-offs. A turn-on is the complete opposite of a turn-off. It is whatever we feel, see, smell, or hear that stimulates our desire for sexual activity. It might be different articles of lingerie for different persons; having sex in the shower, bathtub, pool, or spa; having sex with or without certain items of clothing, ad infinitum.

Yours might not be the act of masturbating with your partner's feet or ejaculating on her feet. It may not be exciting for you as a man to dress in women's clothing. It may not be exciting for you to wear rubber or leather boots, skirt, or bra, etc., and then indulge in sexual activity. It may not be exciting to you to be spanked or have someone inflict minimal pain. It might not be exciting for you to suck on the nipples of a woman's breast full of milk, or to fondle it until it until she, you, or her bra becomes soaked with the milk. It may not be exciting for you to wet your pants or panties or see someone else wet theirs under different erotic circumstances. It may not be exciting for you to have anal or oral sex. It may not be exciting for you to have semen in your mouth or rubbed on your breasts or genitals. It may not be exciting for you to view someone else in a sexual act doing this thing or that thing. The list could go on forever, but what I want you to see is the variety of sexual turn-ons and be accepting of those that are not yours.

What, then, is a fetish? Are they different from turn-ons?

The definition of a fetish is: any object or non-genital part of the body that causes a habitual erotic response or fixation): The classic example of a fetish in one of my textbooks was the man who was seeking therapy from a psychoanalyst regarding his strange fascination and desire to be brought to orgasm by fondling his penis with a silk slipper. Later in therapy it was discovered that as a baby his mother had worn silk slippers and when he was fussing she would take her silk-slippered foot and play with his penis to quiet him down. We seldom know the roots of these turn-ons or fetishes, but those in whom they dwell know they exist and that they cannot be ignored or stifled. Counsel or therapy is sometimes successful in helping persons understand their turn-ons or to challenge and change a dangerous or hurtful sexual behavior. However, if it is neither dangerous or hurtful, I strongly suggest that you don't try to eliminate it. You may just kill the goose that lays the golden egg ( a primary source of deep and necessary sexual stimulation).

Yes, they are different from what we call a turn-on even if the fetish turns one on. Some tend to label some of the seemingly unusual turn-ons as fetishes. These are only fetishes when the person can be stimulated by looking at or touching a non-genital object apart from or off of a body. If a woman can look upon some sort of non-sexual object on a shelf and get sexually excited, it is a fetish. If a man can get as excited over a pair of woman's panties just holding them in his hand or seeing them on a department store rack, it is a fetish. If someone gets turned on by looking at feet or ears or some other non-genital part of the body, it is a fetish. Fur can be a fetish. Fetishes in themselves cause no problems. However, fetishes disclosed to a non-understanding sex partner can spell disaster. Again, my suggestion is not to mess with Mr., Mrs., or Miss Fetish unless it is causing serious trouble, like stealing panties from your neighbor's clothesline. Many men feel self conscious about what some have labeled a lingerie fetish. A great attraction, yes; a fetish, no, unless one gets as excited with the article of lingerie off the woman as on her.

Are these turn-ons and/or fetishes common?

Destructive fetishes are very few and far between. However, in my counseling practice helping partners understand and accept turn-ons has outnumbered by about a 10-to-1 ratio those who struggle with turn-offs or hang-ups. Either the man or the woman will sheepishly look at the floor after telling me what turns them on, and ask, "Is this normal?" I think the question should rather be, "Is this dangerous?" There are myriads of turn-ons, with some being more widespread than others. Personal inhibitions to discuss ones sexual behavior tends to give the impression that some particular turn-on is unique. All too often the word queer (meaning odd and not gay) is used to describe a turn-on or fetish. Persons don't mind being unique, but don't want to be considered queer. To the persons who question the bizarreness of his or her turn-ons, I simple ask, "Have you ever seen this particular turn-on displayed, discussed, or even suggested in print or movies, or viewed in explicit photos or videos?" To date very few have said, "No, I have never seen or heard of it." My answer is that if you have seen it or read about it, someone else has a similar turn-on.

Usual turn-ons for women are kindness and sensitivity--a smile or a look--a caring, soft touch, not necessarily on the erogenous zones--and unfortunately for those of us with less-than-perfect bodies, a beautiful body specimen. Words of love and endearment are very important to most women. Atmosphere plays a heavy part in turning on a woman such as smelling a particular after-shave lotion. That is why it is important to give flowers or other gifts, and have a candlelight dinner that "just happens" to end in bed. Many women intensely dislike a programmed sexual encounter. They like to think it was spontaneous, and it is up to the man to let her think so.

What are some of these turn-ons?

Men are usually much more physically sensual. Forget the flowers, the candlelight dinner, and lets get on to important things. Did you ladies ever wonder about your lingerie? You don't for a moment think it was designed for women by women. Lingerie is a see/touch turn-on for men. In most lingerie there has been a man's hand in designing it somewhere along the line. Men are suckers for Victoria's Secret and such shops, or a lingerie show where the girls come out modeling scant, silky, and/or translucent underwear or bed wear. He hopes to buy something that turns him on and brings it to his partner hoping for a repeat performance of stimulation. Most women have a difficult time understanding a man's fixation with any type of clothing under, over, or around. "Why does my partner need props to excite him. Can't he just be excited with me?"

In my practice over the years I have heard a number of turn-ons, some were on the unusual side, but never on the bizarre side, at least from my prospective. One fellow sheepishly told me he enjoyed having sex with his partner with her panties on. "Is this normal?" he queried. My answer was that this was normal enough so that someone else must enjoy the same thing because crotchless panties were available for this type of turn-on from Frederick's of Hollywood.

Another stated that his turn-on was seeing women in wet (soaked) clothing. He said it began as a child. A family friend was caught in the rain and came to his parent's home to get her body dried off and get dry clothes. He said, "Even though I was of preschool age, I remember it as though it were yesterday. She stood in the room slowly taking off her wet clothes paying no attention to this little kid. Those wet clothes were almost transparent, stuck to her and exposed what was beneath. I was too young to understand what was happening as I watched her, but those feelings never left me. To this day I want to duplicate that irresistible turn-on."

Men are not alone in this department. Some women have told me some of their turn-ons. One became stimulated in a make-believe setting of being forced to have sex. Perhaps she had developed guilt feelings about sex as a child and could best justify the act if forced to do so. Another told me that her husband demanded she see a psychiatrist or he would seek a divorce because she must be crazy. Frequently she would get this undeniable, unquenchable urge toward self eroticism. She would get totally dressed, go into the shower, get wet all over, and then bring herself to orgasm He was unwilling to view this behavior as acceptable--to him, anyway. In a sense he was the one with a hang-up--his unwillingness to understand his mates turn-on.

Some persons enjoy sex better in darkness, some in semi-darkness, while others would be happy with spotlights and/or mirrors. If we are to have happy sex lives we must understand and sometimes give in to the turn-ons of our partners. How about a little barter? Trade one of your turn-ons for one of your partner's. That's not sleazy behavior--it is tit for tat, or even-steven. However, let us not forget that what can be a turn-on for one person can be a complete turn-off for an other. That makes for a complicated situation if this is true of one's partner.

Can't these turn-offs and turn-ons just be ignored?

Believe me when I say that these turn-ons and turn-offs cannot be ignored if sex is to be fully enjoyed. Communication or willingness to talk openly with our partner or counselor about these is important. Many are so reluctant and guilt-ridden about their sexuality in this area that it remains their own private secret for a lifetime. Some seek the assistance of prostitutes who will indulge in "individual services." There have been instances of clerk and clergy alike seeking these services to satisfy that intense, inner drive. Careers, marriages, relationships, and self respect have been the price some have paid. Don't be foolish and try to convince yourself your partner's turn-on is unimportant. Relationships have dissolved because of inattentiveness to a partner's turn-on.

How do turn-ons relate to disability?

Disability often destroys something in sex, spontaneity for one thing. Drugs, fatigue, depression, neurological impairment can also be a destructive force. Utilizing the turn-on can sometimes partially make up for what has been taken away. The built-in factors of disability relative to sex often requires a little or lot extra. Patience is truly a virtue in disability-related sex. Sometimes erotic books, photos, or videos can enhance the performance. The type and degree of disability often demands traveling that extra mile or two. Whatever turns you or your partner on, do it! Doesn't fatigue and/or stress play a part in diminished interest in sex for persons with disabilities and perhaps even those who are able-bodied?

Absolutely, but men often do not understand this. They come home from work or play all revved up for sex. Even if he has done very physical work and is dead tired, by the time he gets home his muscles are rested and ready for action. Brain drain is much more a factor in stress than is physical fatigue. It takes more than a drive home to relax and rest the brain. Sometimes sex will do the trick, but sometimes the head is too full of work-related or home-related problems to make room for sex. The job or home demands on anyone, particularly someone with a physical limitation, often finds that person absolutely exhausted when it comes time for bed. It can be either the man or the woman. This is why it is sometimes necessary to take time out and make sex a priority. Help each other with work whenever possible. Go out to dinner. Get a baby sitter. It will pay off handsomely.

If love is a part of the marriage or cohabiting relationship, an open mind to the feelings and needs of both participants is essential. You should keep in mind that fatigue, either from a disability or other stress such as a woman who has done household chores and entertained children all day, is not often receptive to sexual stimulation. In life, some of us (notice that I include myself) use food or any pleasant physical phenomenon including sex as an escape from stress. We are frustrated and craving relief. An orgasm is God's tranquilizer for relief from stress. Both men and women use sex as a relief from the weight of life-- it anesthetizes the brain for a short time. Perhaps a big piece of chocolate cake could also do the trick. However, when the piece of cake is gone or the glow of the sexual climax ebbs, the problems of life are yet present, but a least there were a few moments of relief and relaxation. Sometimes they are even made worse if with the cake you might add unwanted fat, but the pleasures of sex usually lasts longer than eating and have no ill effects apart from possible pregnancy. The afterglow of sex can often last two or three days. With cake you are fortunate if it lasts thirty seconds after the final swallow.

What do you believe is the key to sexual contentedness?

Couples must learn to communicate their desires and feelings to each other in every aspect of life. However, in the area of sex this is the key to happiness. Neither I nor the books can tell you what turns on or turns off your partner. You must communicate honestly with each other and be alert and sensitive to your partner's feelings. When it comes to sex time, remember that some of us are morning people and others are people of the evening or night. Others are anywhere, anytime folk. Some of us like spontaneous sex, while others like it planned. One counselee said that her partner never understood her sex moods. Had she ever expressed them to him? No! She and you must realize that others are not emotional mind readers, especially men. Tell us, and tell us again.

Are sex games helpful in enhancing a sexual experience?

In many cases, yes. There is role playing along with other games. In one instance the husband would occasionally ask his wife to make up, dress, and act like a provocative prostitute. Part of the game was for him to pay her for her favors as one pays a prostitute. Sometimes they would play it even more realistically and he would arrange to "accidentally" meet her on the street, proposition her and take her to a motel. The next time around for her turn, she would ask to be dated, taken out to dinner, and made love to in their automobile, or whatever would satisfy her current fantasy. Sometimes you may agree to forego personal pleasure and only please your mate. These are harmless and fun-type games, and do satisfy an itch that needs scratching. After all is said and done, a little or lot of fantasy and play acting can go a long way in enhancing sexual stimulation and satisfaction, whether the participants are dealing with any disability or not.

Many of the relationships I see disintegrating might be saved if the partners would take turns talking and then listening to each other. Truly some are hung up on sex today. After a frenzied search for something that only exists in the minds of the producers of X-rated films and the authors of many of the sex manuals and other erotic material, these fantasies may destroy rather than enhance what former peace and pleasure we had with sex. These fantasy items can go a long way in enhancing your sex life, but it must be remembered that when you begin to interpret these fantasies as facts, you are in trouble. Know that these women, these men, these situations you read about or see in movies or videos just do not occur in real life, and that if you believe they are real you are simply chasing sexual rainbows--sometimes for a lifetime.

Are there other common ways to enhance sexual satisfaction?

There are very few persons, able-bodied and disabled, who cannot achieve sexual satisfaction of some kind from a creative source. That source is up to any and all those indulging in sex, and every human being should be creative in his or her approach if sex is not to become ho-hum. However, the couple where one or both are disabled, creativity is not the key that unlocks the door to greater pleasure, it is the key that unlocks the door to sex-- period. Satisfaction by mutually-agreed-upon activity is the panacea for all persons, but especially those with disabilities. Take turns in satisfying each other if it cannot be simultaneous pleasure. It can be individual pleasure and then simultaneous pleasure spaced by a few minutes to a few hours or days. This often works best as a give-and-take performance. If each of you are trying to simultaneously stimulate the other, it is difficult to concentrate on your own pleasure. Take turns stimulating each other and be generous when it is your turn to give and be selfish when it is your turn to receive. Of course, if you both prefer simultaneous stimulation and/or orgasms, go ahead, it is your choice.

Are there some rather unusual turn-ons?

One of the later college courses that helped me understand the emotional and physical aspects of sex, used the textbook, Sexual Deviance & Sexual Deviants, by Drs. Goode and Troiden. We have talked about wet clothes and water. In Freudian theory, water is a symbol of sex, perhaps because of the wetness attributed to sexual activity. Freudian theory said that in our dreams, water or wetness represented sex. Some persons get stimulated having sex or foreplay in a swimming pool, spa, or shower. Show me the couple who has not showered together, and I'll show you a couple who one or both are sexual corpses. These are not unusual and are quite widespread. Although some of Freudianism has been rejected, he might have had something in his water symbolism.

A very few defecate before, or during sex. In a popular movie, Where's Papa, back in the 1960's, there was a scene in which the woman was telling the horror story to her new boyfriend why she divorced her husband immediately after their marriage. The reply to her shamed whisper that on their first night he made a caca in the bed, the boyfriend stammered, "He took a dump in the bed? Well, what in the world did he say?" To that, the woman quoted her ex-husband as saying in surprise, "Doesn't everybody!" Whether in a movie or in real life, some of those with unusual sexual behavior view it as normal--"Doesn't everybody?"

Some have a fixation with urination before, during, or after sex. After all, in some way it calls attention to the same area of the body used for sexual enjoyment--and it is wet. Perhaps this also fits with Freud's theory. It is also sexually symbolic of total relaxing and surrendering one's mind over to his or her body to do its bidding. My advice that during sexual excitement, never say no to your body unless saying yes is dangerous.

Some have speculated that a fixation for defecating and/or urinating is more related to the pleasure of the procedure itself. It feels so good to have a good bowel movement or empty the bladder when it is full. What many adults do not know is that the both the anus and the urethra, or urine duct, are erotic areas. For women the most stimulating area of the urethra is that closest to the clitoris, in most cases it is approximately the last several inches before the vagina. In men it is the entire length of the penis and as far back as the prostate gland. What has destroyed the sexual pleasure of urination is that most persons are appalled by the very suggestion that they can possibility be enjoying a sexual act when the pleasure of urination or defecation takes place.

Even thinking about urination and defecation really turns me off. Why do you even discuss this?

It is discussed because this booklet is to educate in the area of sexual practices and not intended as something to turn anyone on or off. Granted, the defecation arousal and/or practice is perhaps only stimulating to .5% or less, and the urination arousal perhaps stimulates only 5%. In the heterosexual world anal sex is practiced at about the same level as urination (5%). What I am trying to help you understand is the wide variety of turn-ons, and that if you have one of these less-common desires, that it is not some great sin if you do it in private or with some other consenting adult. For those of you who are turned off by such practices, know that for those who are turned on by any of these, it is sacred ground you are trampling.

What about sadism, masochism, and bondage in sexual practices?

These are outside of my realm of experience but not outside my academic study. I know what they are, but my experience is only textbook in these areas. In the so-called "kinky" sex world sadism and masochism are linked together and abbreviated S&M, and there is obviously a following or there would be no market for their products. However, it is my opinion that sadism and masochism are the lunatic fringe of behaviors that often end up with murder and mutilation.

Sadism is defined: The love of being cruel. The compulsive tendency to vent aggression and destructiveness upon another person. Sexual satisfaction may or may not accompany these behaviors. Often this tendency can be seen early in child development when a child or adolescent seems to enjoy physically hurting animals as well as playmates.

Masochism is defined: Erotic or sexual excitement/satisfaction from being subjected to pain, whether by oneself or another. During my seminary years there was a an exposť of four or five seminary student couples involved in what the newspaper reported as a "whipping cult." They would strip naked and supposedly were attempting to whip the sin out of each other, but beneath that facade it was erotic--a perfect example of masochism.

When pain is involved in bondage, it is usually directed by and upon the one desiring to be aroused. One textbook researcher claimed that bondage was one of the more practiced forms ofunusual turn-ons. If one gets sexually excited over being physically or mentally subdued or to be subdued, or be restrained and be turned on by his or her own subjugation or that of another, justmake sure your bondage partner is in agreement and not forced. Remember, what two consenting adults do is their business only!

It is the sadistic persons who are feared by prostitutes, and what might appear to be the non-aggressive demand for masochistic or bondage behavior can sometimes escalate into full scale sadism, and the body of the prostitute is found in a river, deserted area, or dumpster. Need I warn you to avidly avoid this type of sadistic partner? The life or body you save may be your own. Be aware and alert!

Would you comment on child molesters?

Well, I would prefer to leave this one alone, but in keeping with my desire to assist in your sex education, it must be discussed. The sociological term for those who get turned on by and molest children is pedophile. Pedo is from the Greek and means child; and phile, also from the Greek means love, friendly, lover, or an intense interest in, such as in the word audiophile in describing one who has deep interest in the recording and reproduction of sound. Only the child molester him or herself can understand the phenomenon of being sexually turned on by a child. Most of them hate it and hate themselves, but some know that the urge is too great to conquer or control.

The child molester is not being arrogant when interviewed in his prison cell and says, "If I am let out of here I will do this again." He is crying for help, and no one is listening. Everyone seems to hate the child molester, even the prisoner's peers. CMs are often beat up or murdered in our prisons, and when it happens most of us are joyous and say this is what they deserved. The cry is, "Castrate these bastards!" No person on earth is hated more than the child molester. Keep in mind that sex drive bent in an inappropriate direction is nonetheless a drive that must be satisfied. This is why we call it a drive, because a drive must be satiated or satisfied.

One of my clients was a child molester just released from prison. His prison counselor suggested that when he returned to society, and when he saw a child and was even slightly aroused, he should immediately seek the nearest private place possible and masturbate. That didn't take away his sexual desire for children, but it reduced the sex drive to zero long enough for him to get away from the temptation. A quick orgasm has saved many a person from doing something stupid or criminal.

Isn't there some type of therapy or help for these persons?

Yes, one method that was used back in the early sixties and continued around the country until the nineties worked quite well, but it brought about a scream of protest from the ACLU and its ilk, that it was cruel and inhumane. The general public who hated the CM and who would be willing to "castrate the bastard" jumped on the ACLU bandwagon and the practice has all but been abandoned. It's okay to put someone in prison to be murdered, but something that may work as a cure would be considered inhumane? There are a lot of weirdos in the academic world who might be able to work the most complex mathematical equation but are devoid of good, common sense, and there are enough in the general population stupid enough to join them.

This treatment was based on stimulus/response theories in conjunction with reward/punishment. It was only used to my knowledge with men, and it was a device strapped to the penis that when even the slightest erection began taking place, the sensor triggered a slight noxious electrical shock to the organ. Pictures were shown of children or whatever negative sexual stimulus that was to be erased. For those who truly wanted to be cured, there was a relatively high success ratio. If the person began to once again be aroused by the offending stimuli, he went back for more treatment. It did not work well with those who only took this therapy as a court order.

Do I hate child molesters? No, but I hate what their minds force them to do, and I do have deep sympathy for them. Society cannot and will not tolerate this deviance. And by the way, castration is not the answer because castration of adults usually only lowers sex drive, it does not destroy or divert it. Only when done before puberty does castration eliminate the sex drive because it never has the opportunity to develop.

Will you discuss homosexuality?

No, I don't think it is necessary. This is an explosive and complicated issue of both moral and political significance. My only comment would be in direct opposition to those who think homosexuals are made. From every shred of evidence I can find, it points solidly to the opposite opinion, and that is that homosexual tendencies are inborn-- a twist of nature that is evident even in many of the animal species. Only those with homosexual tendencies with bi-sexual attraction actually have a choice of preference. Now I know that my argument will not convince anyone of anything because it is such an emotional issue. However, remember that turn-ons in humans very seldom can be denied or changed, and that also includes being turned on by the same sex no matter how much society would like to disagree. Unfortunately, emotions clog the pipe that leads to sensible, rational thinking.

Is it fair for one partner to demand the other to have sex?

Absolutely not. Forced sex is R-A-P-E. There is no other word for it, and the penalty for rape should be the same within and without marriage. No man or woman has the right to demand sex from someone who is not interested or becomes disinterested. That means that even five seconds from orgasm your partner changes his or her mind and says STOP, anything short of stopping that moment is RAPE. We no longer live in a time when any human being is another's property to do with as he or she pleases. Neither sexual partner has a right to demand sex from his or her partner. If you can be excited enough to have intercourse with someone who hates your guts at that moment, it is my opinion that you are the one with the problem. Even in the animal world, in most species the female has the nod of nature to be selective regarding who and when. Unfortunately, this illicit use of sex as a power tool is all too common. Withholding sex and using it as a reward, punishment or a weapon will backfire and injure both partners in the long run. There will be an explosion!

How about depression affecting one's sexual interest and performance?

Depression is common with most everyone, but especially persons with disabilities. Among other things this can be the result of the total or partial loss of satisfying sex. I counseled with a man with a disability who was in his mid-forties, severely depressed, and being treated with anti-depressant drugs which were not working. What he appeared to be his deep-seated need was continuing and satisfying sex. This is a transcript of our conversation:

"Let's talk about what you said of your being partially impotent and perhaps always had been but didn't know it. Of course you didn't know how other men's organs functioned. The impotence problem is not as important as you might think. There is more to sex than a hard penis, and that is satisfaction in coming to an orgasm for both you and your friend. Because of the differences in men and women, an orgasm doesn't seem to be quite as important to some women as it is to a man. A woman can often feel somewhat fulfilled after cuddling, fondling, kissing, etc., but that doesn't work very well with a man. Not only that, but our brain is designed to get pleasure from seeing someone we love getting sexual pleasure. Many of my clients have told me they get more satisfaction from seeing their partner have a good orgasm (sometimes many orgasms during their sexual excitement) than they get from their own orgasm.

"Besides the man/woman difference, there is also the age difference in your relationship, she being at least a decade older than you. As both men and women age they generally lose some, if not all, of their sex drive. The hormones that made us want to reproduce diminish and we don't get as excited as we did earlier in our lives, nor do we get excited as often. During mid-life, men's testosterone levels begin to drop as do women's estrogen levels. Some persons stop having sex in their forties or fifties while others continue into their eighties. If you need total satisfaction at age 20 or 80, you can have it unless you have no sensation in your genitals. I think I mentioned in the printed discussion of sex that an orgasm is essential to the feeling of completeness in both a biological and emotional sense. Keep in mind, however, that there are a few people on this earth (5%) who care little or nothing for sex and don't need it, but that leaves 95% of us wanting and needing the biological and psychological satisfaction it brings.

"The next topic of discussion is that your partner thinks anything outside of what is normal is wrong. Normal? Normal for whom? I think she would be shocked to learn that oral sex is normal. That means that more than 80% of persons having sex include this in their sexual diet. This thinking that oral stimulation is not normal is a common curse found in many women and a few men. Psychologists label these as hang-ups. I have counseled both sexes who were absolutely aghast at the thought of oral sex and under no circumstances would involve themselves in it regardless of how much their partner desired or needed it. This is not something new; it is as old as the human race. It is only the older Western culture that has thought of it as evil. Fifty years ago most men who desired oral sex visited prostitutes for that pleasure. Today's couples take oral sex as part of the normal activity. One counselee told me she loves oral sex for herself and her partner as long as he doesn't ejaculate in her mouth. Keep in mind that I am a part of the generation who grew up with all these no-nos.

"My generation from a religious point of view, both Protestants and Catholics, vehemently taught that self-eroticism was very sinful. So I, too, had to overcome this feeling that self-eroticism was very wrong. Your problem with it is not the act itself; it seems to me it is your attitude about it that is the problem. As long as you think it is wrong you will feel guilty and lose a great deal of satisfaction from the act as well as the depression the guilt brings upon you. Rather than an afterglow, you have an afterguilt. The moment of release, you feel rotten and sinful.

Let me tell you something. In today's world of AIDS and other serious sexually-transmitted diseases, outside of a clean and safe monogamous relationship, considerably more sex is now done by self-eroticism than any other form. The only safe sex is abstinence or masturbating. The market is flooded with X-rated videos of everything you can possibly imagine. These videos are primarily used to turn on the viewers so they can self-eroticize themselves or each other. Many couples use mutual masturbation, that is, one does it to the other and then the other does it back.

"I don't know what more I can say except the priest was wrong, if you can come to grips with the possibility of a priest being wrong. I can tell you that there is nothing in the Bible that says it is wrong. It is only wrong in the minds of too many old and religious persons. I am both old and religious, and it took me many years to understand this taboo, so don't waste as much time as I and so many others did. The former Surgeon General of the United States, Dr. Jocelyn Elders, had masturbation in the right prospective when she said it was a normal and natural part of life, and that it should be taught. Her remarks were taken out of context and Bill Clinton fired her for saying that, but I believe she was absolutely correct. She was not advocating teaching people how to masturbate for I doubt that anyone ever had to be taught, but rather teaching them it was a normal, gratifying sexual activity and not wrong or sinful."

Is sex all that big a problem with persons with disabilities?

In some cases, yes. Earlier we discussed those who want to urinate during their sexual excitement. However, some urinate and don't want to. This happens to women and not men because when a man has an erection it shuts off his urine duct between the bladder and the prostate gland, and he cannot urinate even if he wants to do so until the swelling somewhat subsides. However, many women with multiple sclerosis and other diseases and conditions have lost some control of their bladders and often wet themselves and/or their partner during intercourse. One woman tearfully told me that their sex life had come to a stop because of her inability to not urinate when they were making love, and that her husband was very angry about her loss of control. "I don't drink before sex and I empty my bladder just before we begin, but it always seems to happen." I showed them a video of a woman urinating each time she came to a climax to help them both to realize that even non-disabled people sometimes wet themselves during intercourse either accidentally or on purpose. Her husband had never heard of such a thing and through our counseling he came to accept his wife's problem. All they had to do was put a large piece of plastic on the bed or on whatever or wherever they chose to have sex, place a large, heavy bath towel over the plastic and under them, and just let whatever happened happen. In time they turned her wetness into a turn- on for both of them.

Another very similar case was a women in her late forties. She was fearful of finding a partner for sex because of AIDS. She said she gave up self-eroticism because she had to lie on her bed to be able to bring herself to orgasm and more likely than not would wet her bed. I offered the same solution to her about the plastic and towel on the bed. Later in the week she called saying she had the most satisfying orgasm she had in years because she was not worried about wetting the bed, and could focus on her fantasies to bring herself to orgasm. She said it felt so good, and just as she had an orgasm she finally totally relaxed and wet all over herself and the towel, and that the act of giving in to urinating in conjunction with the orgasm made it one of the best in her memory.

Do men or women have the most problems sexually?

Before I answer that I would like to recommend the book, Men are from Mars; Women are from Venus, By John Gray, Ph.D. Men and women do not think alike, talk alike, or respond alike, and certainly don't look alike. We have known that for centuries, but no one bothered to tell us why (men and women come from different planets). Dr. Gary Smalley, a well-known marriage counselor graphically stated that men and women are also different in sexual stimulation in that men are more like microwave ovens while women are more like crock pots. The quicker we all learn gender differences, the better relationships we will have with each other.

I counsel both men and women regarding sex, and a good guess is that it is about even at 50-50% However, gender poses different problems. Strange as it may seem, men (Martians) are more reluctant to talk about or seek help for their sex problems than are women (Venusians), but men in general are reluctant to discuss or seek help for any problem. Men are more worried about impotence and not satisfying their partners--or worried about their masculinity/ego. Many of my clients are women who are single or divorced and worry about satisfying themselves.

You remember I mentioned earlier using some type of 120-volt or a battery-powered vibrator for sexual stimulation? Re-read that and perhaps you can convince yourself what a great aid it can be for total satisfaction. Your partner might even find it exciting if you can get him or her to understand this is NORMAL. I have counseled many married as well as single women, both disabled and able-bodied, that use a vibrator or some sort of helper. Sometimes it works well to get your partner very excited with fondling and then let them reach orgasm with the vibrator. Believe me, a good vibrator can do the trick very quickly for most women and they often orgasm within 30 seconds. An excited man can often orgasm in less than 10 focused seconds, but most of the time both men and women use the vibrator to tease themselves before giving in to the orgasm.

Often the non-vibrating partner sucks, kisses, and licks breasts or whatever, or any other act that the partner likes. However, some don't want to be touched when stimulating themselves. Some want to vibrate or self-satisfy themselves in private; others enjoy being watched or watching. This is why partners must discuss this with each other and not hold anything back. NO SECRETS. Remember, when using a vibrator a man does not need an erection, just a penis that has even minimal feeling. What you really have to do is to get over the guilt of self-eroticism or any method that is not penis-vaginal intercourse. In today's world there is no valid reason to feel guilty, but that removal of guilt has to come from inside of you, not from me or anyone else.

You mentioned earlier that some persons with disabilities could perform with help. What did you mean by help?

At the beginning of our discussion on sexuality I mentioned that some could perform with help. Let me illustrate by telling you of one young man, age 22, who had cerebral palsy and no control over any part of his body. He had normal sex drive and was going crazy. His behavior had become angry and destructive. His mother called one day and said to me, "I suppose you heard that Bill went on a rampage again yesterday."

Why should a normally docile young man behave in this manner? How could a man with no control of his body be destructive? Well, he had a power wheelchair and would ram and crush waste baskets or anything that would break, and sometimes he would attack the employees and other residents with his power chair. He spelled out his problem to his mother on his word board, and she called and asked me, "What in the world should I do--should a hire a prostitute for him?" A week later he was suddenly contented, but shortly after he began reverting to his anger, hostility, and destructiveness. This angry/happy cycle repeated for many weeks. The care-center social worker was determined to get to the bottom of these mood swings, and after some detective work she discovered that one of the nurses aids had felt sorry for him and was masturbating him.

They caught the benevolent girl in her charity work and fired her with vengeance and threats of filing a civil complaint for sexual abuse and of blackening her employment record so that she could never get another job in a nursing home or care center. However, there were others that came along and helped him out: nurses, aids, orderlies, and friends. As you can see, society frowns on such charity, and there are thousands of severely disabled persons in the same predicament, but few are fortunate to find someone to give them their gift of contentedness.

Several years ago I viewed a documentary video on a thirty-year-old man with muscular dystrophy. He needed total physical care, but refused to submit to a nursing home or care center. The video did not specify his source of income, but he was able to hire personal care attendants. It began with him giving a ten-minute explanation of the problem of severely disabled persons being sexually unfulfilled and how it affects one's total outlook on life. His first question to the personal-care attendant applicants was if he or she would also be willing to take care of his sexual needs. Several refused, some in disgust, but he found a willing one. She agreed to this arrangement and the documentary went on to illustrate their ability to overcome the limitations of his paralyzed body and give him, along with his personal care, that which nature was also demanding.

Are there any key words or behaviors that you use in sex counseling?

If there are key words to success, to me they would be concern for yourself and your partner, commitment toward solving these individual problems, communication in understanding your own and your partner's needs, using creativity in your approach to solving your problems, and conditioning one's self for satisfying orgasms. These are the prominent tools in working out the solution. That is also true for unions in which neither partner is disabled; and during my 40+ years of counseling, I have witnessed many instances of sexual maladjustment in couples in which their only disability was between their ears.

If there is a priority, it is communication. All counselors voice the same opinion. Please listen to us. You will find that if a couple can openly and sensibly discuss each other's problems and priorities in sex, it will flow over into the other areas of living, and vice-versa. If you do not communicate with each other there can be no commitment or creativity in sex, finances, child rearing, and all the other aspects of living as a couple. You can talk with each other forever and never make contact if there is no connection between your telephones. If you do not understand the Men-are-from-Mars; Women-are-from-Venus approach to gender differences, you cannot communicate because you are talking two different languages.

Try to learn each other's language and you will understand when a women is upset and says, "Don't touch me!," she just may be saying, "Hug me--hold me." So often a Venusian will say to me, "Of course I said that, but doesn't he know that's not what I meant? Couldn't he understand that I needed a hug?" No, he didn't because Martians are literalists. Don't expect us men to be able to understand that "Don't touch me" really means hug me. Don't expect your partner to be a mind reader. Say what you mean and mean what you say in all of your communication. Now we Martians can hear you Venusians, and knowing we speak different languages, should ask for a clarification. Venusians also hear us Martians and should ask for a clarification. Snorting, "You heard what I said!" is not the solution to any language barrier and it is one of the greatest barriers in and of itself. Have as much patience in decoding each other's language as you do decoding the speech of a child. Play 20 Questions and ask, ask, ask, and prod, prod, prod to discover the true interpretation. When you both know exactly what you are talking about, then proceed to the commitment and creativity platform. You will be amazed at what will happen.

After 14 years of marriage, while taking a particular course in psychology, I decided to analyze our little (or big) family misunderstandings. In just about every case it boiled down to one of us saying, "I thought you said _______," or "I thought you meant ________." We discovered that was also true when trying to solve problems with our children. Check this out and see if it may also be true in your relationships.

Is this a comprehensive or complete coverage of sex as related to disability?

Absolutely not. There is no end to the sexual areas we could peruse relating to this subject. However, it was my intention to cover the basics and give each of you a springboard for launching out to find your own solutions for sex, particularly those relative to any problems precipitated by disability. Because there are no two people alike, there can be no two problems alike. Therefore, it was impossible to be as specific about some of these answers as some of you might have liked.

Another good axiom would fit here because we have different sizes and types of feet (problems): "If the shoe fits, wear it." I would have liked to have injected a little more humor in this booklet, but the nature and seriousness of the subject subdued my attempt and love for comic relief. However, if you are alert, you will catch some words and phrases with double meanings here and there that were not accidental. If you feel like a chuckle or a good laugh, go ahead. Laughter is great medicine for a tired or an aching heart.

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