Spasticity

Barriers:

  • May impede access to perineal area
  • May cause uncomfortable muscle spasms
  • May be difficult to find comfortable positions
  • May have decreased muscle control
  • May experience increase in spasticity before orgasm (Courtois, Alexander, & McLain, 2017)
  • Muscle relaxants may caused reduced libido (Hess & Hough, 2012)

Strategies:

  • Warm bath prior to engaging in sexual activity (Mioduszewski, 2012)
  • Partners massaging beforehand to help reduce spasticity (Courtois et al., 2017). Scented massage oil candle could be incorporated to increase intimacy and decrease spasticity.
  • Encourage client to experiment in various positions to see which is most effective for them
  • If client is prescribed muscle relaxants, could take medication 20-30 minutes prior to sexual activity (Moore, 2007)
  • Consider engaging in sex while the partner with spasticity is seated in a wheelchair. Armrests can be removed to aid in positioning (Hess & Hough, 2012)
  • Equipment that may assist in engaging in sexual activity (Sportsheets, 2018):
    • Thigh strap ons to allow for engagement in penetrative sex for people with impaired lower extremity motor control or erectile dysfunction.
    • Sex slings can maintain positioning for the individual with spasticity.
    • Straps can aid in positioning. This could be used by a partner with spasticity to substitute for hip motion, or it could be used by a partner without spasticity to aid in positioning the spastic partner.
  • Positions that may assist with engaging in penetrative sex
    • Penetrating partner laying in sidelying. Non-penetrating partner lays supine, with legs together draped over partner's hips (Moore, 2007). See figure below (Marin, 2014).
    • Placing pillow under hips to maintain flexion. This can help remain in an appropriate position for sex, as well as inhibit extensor spasticity in the lower extremity (Sportsheets, 2018).
  • Clients may benefit from using dilators to reduce sensitivity in the vaginal area due to spasticity (Pritchard, Kordes, & Hofman, 2012)

References

Courtois, F., Alexander, M., & McLain, A. B. (2017). Women's sexual health and reproductive function after SCI. Topics in Spinal Cord Injury Rehabilitation, 23(1), 20-30. doi: 10.1310/sci2301-20

Hess, M. J. & Hough, S. (2012). Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application. Journal of Spinal Cord Medicine, 35(4), 211-218. Retrieved from https://doi.org/10.1179/2045772312Y.0000000025

Marin, V. (2014). The cross [Online image]. Retrieved from https://imgix.bustle.com/lovelace/uploads/8/2984bd00-68fd-0132-699a-0e910e60be26.jpg?w=349&fit=max&auto=format&q=70&dpr=2

Mioduszewski, M. (2012). Stroke and spasticity. In B. Hattjar (Ed.), Sexuality and occupational therapy. Bethesda, MA: American Occupational Therapy Association.

Moore, L. A. (2007). Intimacy and multiple sclerosis. Nursing Clinics of North America, 42(4), 605-619. Retrieved from https://doi.org/10.1016/j.cnur.2007.07.007

Pritchard, V., Kordes, T. L., & Hofmann, A. (2012). Stroke and spasticity. In B. Hattjar (Ed.), Sexuality and occupational therapy: Strategies for persons with disabilities (pp. ****). Bethesda, MA: American Occupational Therapy Association.

Sportsheets. (2018, March 13). Sex with cerebral palsy: Toys and comfortable positions to keep you in the moment. Retrieved from https://www.sportsheets.com/blogs/sex-blog/sex-with-cerebral-palsy-toys-comfortable-positions-keep-you-in-the-moment-2018-3-13