Amputees

Addressing Sexuality

  • People who undergo amputations should always receive information about the potential issues that may occur in relation to sexuality (Woods, Hevey, Ryall, & O'Keeffe, 2017)
  • Use of the PLISSIT Model is suggested for use in addressing sexuality with people with amputations.
  • Woods et al. (2017) suggests that education addressing sexuality for people with amputations should be addressed early in the process of rehabilitation. Doing so will prevent the individual from completing avoiding sexual activity following the change.
  • Sexuality should be brought up in the rehabilitation process in the context of other aspects of daily living (Henderson et al., 2016). This helps normalize the discussion about sexuality between clients and healthcare providers.
  • People with amputations may also benefit from contacting other individuals who have experienced similar amputations (Mathias & Harcourt, 2014)

Barriers

  • Different types of amputations can result in limitations in weight bearing, ROM, pain, decreased endurance, etc. which can impact engagement in sexual activity
    • Below knee amputation (BKA),
    • Above knee amputation (AKA),
    • Unilateral hip disarticulation/Hemipelvectomy,
    • Bilaterlateral hip disarticulation/Hemipelvectomy,
    • Unilateral upper extremity amputation (above elbow, below elbow, elbow disarticulation, shoulder disarticulation, wrist disarticulation)
    • Bilateral upper limb extremity amputation (above elbow, below elbow, elbow disarticulation, shoulder disarticulation, wrist disarticulation)
    • A combination of the above listed amputations
  • Psychosocial factors, such as depression, performance anxiety, and negative body image may prevent people with amputations from engaging in sexual activity (Verschuren, Geertzen, Enzlin, Dijkstra, & Dekker, 2015)
  • People with upper limb amputations may have difficulty engaging in intimate touch with partners and masturbation
  • Difficulty with orgasm and arousal
  • Difficulty managing doffing prosthetic devices prior to engaging in sexual activity
  • Pain mediciations may cause erectile dysfunction and general issues with arousal
  • Balance may be altered due to the loss of a limb, which impacts the client's ability to safely engage in sexual activity (Verschuren et al., 2013)


Strategies

  • Encourage intimacy between client and their partner by kissing, touching, hugging and

Keep an open line of communication with the client and partner regarding interest in adapting positioning for sex. Below is a series of excerpts from expanding on recommended sex positions for different types of amputations.

Ellis & Dennison, (2014)

Single BKA/AKA 46

    • Male on top- use knees to support when thrusting and hands to support self on top. If AKA, female can place her hand or leg on back of male's leg as a support to thrust against. (Figure 1)
    • Doggy style- In kneeling position, use knees and hands (either on bed or partner's back) to provide support. Consider wearing prosthetics if kneeling balance in challenging, or using a pillow or wedge underneath an AKA side to level out kneeling balance. (figure 6)
    • Male sitting up - Use hands and arms to assist with her up-down thrust, or consider kneeling and leaning back with hands on the bed, to allow for pelvic thrusting. (figure 2)
    • Female on top- Male partner can use remaining foot to thrust upwards. Consider placing small bolsters under residual limb to push up on (similar to bridging), or angle female's lower leg and place residual limb over female's calf to assist with increasing trusting upward. (figure 4) (p. 46)

Bilateral BKA 47

    • Male on top- Similar to single BKA/AKA, consider wearing prosthetics if balance on your knees is challenging. (figure 1)
    • Doggy style- Similar to single BKA/AKA, consider wearing prosthetics if balance on your knees is challenging. A pillow or wedge can assist holding female partner at similar height/angle, or consider standing. (figure 6)
    • Male sitting up- Similar to single BKA/AKA. (figure 2)
    • Female on top- Consider placing a small bolster under the residual limb to push up on (similar to bridging), or angle female's lower leg and place residual limb over female's calf to assist with increasing thrusting upwards. (p. 47)

Bilateral AKA 48

    • Male on top- After sufficient desensitization of residual limb, attain position and thrust with increased core use and hand support. The female partner can assist by stabilizing the back of the residual limb with her hands or with use of her lower legs to prevent to residual limb from sliding back. This may provide leverage for the male to thrust. Considering limb length, you might be able to switch between positions without withdrawing ( such as Male on top to sitting upright). Consider using a pillow/wedge to support female's pelvis at a raised height to allow for easier/increased penetration. (figure 1)
    • Doggy style- After sufficient desensitization of residual limb, attain position and thrust with increased core use and hand support. Consider wearing prosthetics and stand up as alternate option if possible. Consider using a pillow to support female's pelvis at a raised height to allow for easier/increased penetration. (Figure 6)
    • Male sitting up- Thrust with primary use of arms on bed and pushing down into bed with residual limbs to thrust pelvis upward (similar to bridging), Spring mattresses will assist with thrusting. (figure 2).
    • Female on top- Similar to bilateral BKA. (figure 4) (p. 48)

Unilateral Hip Disarticulation/Hemipelvectomy 49

    • Male on top- Consider using pillow/bolster as a surface for the area of the hip disarticulation or hemipelvectomy to rest on to level out the other side of the pelvis. Place partner on wedge, and while on top of her, use forearms on wedge to assist with thrust. Partner can assist with maintaining your balance on top.
    • Doggy style- Consider using a pillow/bolster as a surface for the area of the hip disarticulation or hemipelvectomy to rest on, to level out kneeling or other residual limb height on the bed. Prosthetics are also and option to level out kneeling height and allow for genitals to be accessed.
    • Male sitting up- Similar to Bilateral AKA. If other side is a fully intact leg, then bending the knee with give a wide base of support and also will allow for some leverage for potential thrusting.
    • Female on top- Similar to Bilateral BKA (figure 4). (p. 49)

Bilateral Hip Disarticulation/Hemipelvectomy 50

    • Male on top- Consider using a pillow/bolster as a surface for the area of hip disarticulation or hemipelvectomy to rest on, to level male and female pelvises to allow for penetration. Lean forward and use core and arms to assist with thrust. Place partner on wedge, and while on top of her, use forearms on wedge to assist with thrust. Partner can assist with maintaining your balance on top.
    • Doggy style- The female can lie on her stomach (use of a pillow or towel roll under her pelvis, optional) with male partner on top and behind her, using core/arms to assist with thrust. Alternately, if male partner is seated in a chair or wheelchair, female can backwards straddle and thrust up and down.
    • Male sitting up- While female partner straddling in kneeling position and facing male partner, use hands and arms to assist with her up/down movement.
    • Female on top- The male partner can use his hands to pleasure her or to assist with stabilizing his trunk by holding on or pushing against headboard or side of bed. (p. 50)

Unilateral upper extremity amputee 51

    • Male on top- Use a wedge to help shorten the distance between arm and the bed. Consider using mushroom prosthetic against bed to assist with thrusting forward. (figure 1)
    • Doggy style- Consider using a prosthetic against bed to assist with thrusting. Use a wedge to help shorten distance between arm and the bed.
    • Male sitting up- Consider using a mushroom prosthetic against bed to assist with thrusting up. (figure 2)
    • Female on top- No modification needed. (p. 51)

Bilateral upper extremity amputee 52

    • Male on top- Similar to Uniateral upper extremity amputee. (figure 1)
    • Doggy Style- Similar to above. It may help to have one arm on the head of the bed and one arm supporting on the bed. Alternatively, the female can lie on her stomach (pillow or toll under her pelvis optional) with male partner lying on top behind her, using core/arms to assist with thrust. Another option has the male partner seated with female reverse straddling.
    • Male sitting up- Use prosthetics to stabilize yourself when seated, or use residual limb under partner's arms to assist her in thrusting up and down. (figure 2)
    • Female on top- No modification needed. (p. 52)

Triple amputee 53

    • Male on top- Similar to bilateral AKA/BKA/Hip or unilateral upper extremity amputee. (figure 1)
    • Doggy style- Similar to bilateral AKA/BKA/Hip or unilateral upper extremity amputee. Consider wearing lower limb prosthetics and do while standing. (figure 6)
    • Male sitting up- Similar to bilateral AKA/BKA/Hip or unilateral upper extremity amputee. Consider using prosthetic against bed to assist with thrusting up with assist from spring in bed. (figure 2).
    • Female on top- Similar to bilateral AKA/BKA/Hip or unilateral upper extremity amputee. (figure 4)(p. 53)

Quadruple amputee 54

    • Male on top- Use similar techniques as Bilateral AKA/BKA/Hip /Hemi or Bilateral upper extremity. Consider using prosthetics to assist with either upper or lower extremities. (figure 1)
    • Doggy style- Use similar techniques as Bilateral AKA/BKA/Hip /Hemi or Bilateral upper extremity. Consider using prosthetics to assist with either upper or lower extremities. (figure 6)
    • Male sitting up-Use similar techniques as Bilateral AKA/BKA/Hip /Hemi or Bilateral upper extremity. Consider using prosthetics to assist with either upper or lower extremities. (figure 2)
    • Female on top- Use similar techniques as Bilateral AKA/BKA/Hip /Hemi or Bilateral upper extremity (figure 4). (p. 54)


Figure 1


Figure 2

Figure 3


Figure 4



Figure 5



Figure 6



References


Ellis, K. & Dennison, C. (2014). Sex and intimacy for wounded veterans: A guide to embracing change. United States of America: The Sager Group.

Henderson, A. W., Turner, A. P., Williams, R. M., Norvell, D. C., Hakimi, K. N., & Czerniecki, J. M. (2016). Sexual activity after dysvascular lower extremity amputation. Rehabilitation Psychology, 61(3), 260-268. doi: 10.1037/rep0000087

Kamaday. (n.d.) Crossing Europe [Online image]. Retrieved from http://kamaday.com/2.html

Kamaday. (n.d.) Doggie Style [Online image]. Retrieved from http://kamaday.com/24.html

Kamaday. (n.d.) Eight [Online image]. Retrieved from http://kamaday.com/15.html

Kamaday. (n.d.) Emphasis Standing [Online image]. Retrieved from http://kamaday.com/29.html

Kamaday. (n.d.) New Amazon [Online image]. Retrieved from http://kamaday.com/37.html

Kamaday. (n.d.) Time Bomb [Online image]. Retrieved from http://kamaday.com/45.html

Mathias, Z., & Harcourt, D. (2014). Dating and intimate relationships of women with below-knee amputation: An exploratory study. Disability and Rehabilitation, 36(5), 395-402. doi: 10.3109/09638288.2013.797509

Verschuren, J. E. A., Geertzen, J. H., Enzlin, P., Dijkstra, P. U., & Dekker, R. (2015). Sexual functioning and sexual well-being in people with a limb amputation: A cross-sectional study in the Netherlands. Disability and Rehabilitation, 38(4), 368-373. Retrieved from https://doi.org/10.3109/09638288.2015.1044029

Verschuren, J. E. A., Zhdanova, M. D., Geertzen, J. H. B., Enzlin, P., Dijkstra, P. U., & Dekker, R. (2013). Let's talk about sex: Lower limb amputation, sexual functioning, and sexual well-being: A qualitative study of the partner's perspective. Journal of Clinical Nursing, 22(23-24), 3557-3567. doi: 10.1111/jocn.12433

Woods, L., Hevey, D., Ryall, N., & O'Keeffe, F. (2017). Sex after amputation: The relationships between sexual functioning, body image, mood, and anxiety in persons with a lower limb amputation. Disability and Rehabilitation, 40(14), 1663-1670. Retrieved from https://doi.org/10.1080/09638288.2017.1306585