One product we carry that I think is excellent is the Liberator ramp and wedge. It eases the possible discomfort of many different positions and opens up a range of possibilities to spice things up for people of a range of physical abilities. Maybe you just have sore knees, or weak wrists, or simply want a pillow that does not slip; these sturdy foam pillows give you options. And who doesn’t appreciate a few more options?

Not everyone is aware of the many uses of the Liberator. I was assisting a young couple at our video rental counter. She was paying and he was looking around at our displays. The excitement is his voice was palpable, he had discovered our Liberator wedge. He implored her to try it with him but she was having none of it. She scoffed at the idea that anyone would need it, that they should just simply get on their knees. I was taken aback at this, wondering how anyone could not realize there are various ranges of ability and we don’t all fit in one simple mold. Her partner was disappointed, and joined her at the counter. I felt I missed my moment to explain the uses of the liberator but to make up for that I want to share it with all of you. The ramp and wedge are useful and beneficial and opening ourselves up to the possibility to try something new is rarely a bad idea.

Even today, low back pain and sciatica (radiating pain down the buttock and leg due to a low back problem) can cast a pall over one’s love life. I’ve lived with chronic back and radiating leg pain for seventeen years now, through relationships with nine sexual partners.

Back troubles contributed to the break-up of my first marriage, and they continue to present challenges during the eight years of my current relationship. I’m an extreme case, but I’m not unique. About eighty percent of Americans suffer from back pain at some point in our lives, so even that lucky pain-free twenty percent are probably going to want to make love to somebody with back pain someday.

Here’s how:

Be creative.
Don’t limit your idea of lovemaking just to sexual intercourse. For someone with very brittle, acute back pain, intercourse may not always be possible. If you think only intercourse is real sex, you’re sunk. If you can enjoy touching and being touched, massage, mutual masturbation, oral sex, sex toys, role-playing, talking “dirty” and phone sex, you’re going to be a much happier camper whether or not you or your partner have degenerative disc disease.

Be patient.
It’s not always a good time for sex. If either partner is in too much pain, it’s better just to wait until another time. If you’re the one in pain, be clear about your needs and your limits. If your partner is in pain, try to be secure enough to wait until he or she says it’s a good time.

Know when to stop.
What has made sex the most fun for me is my husband’s security with his own sexuality. If I say I need to give it a rest, he stops, and he’s not threatened, crestfallen or sulky. That lets me know that if I start having sex, I don’t have to finish it in pain. It makes it easier for me to begin, and we have more good sex in the end.

Play with toys.
When intercourse is just too painful, don’t be afraid to whip out your vibrators and other sex toys, which you can find conveniently at www.goodvibes.com.

Do your homework.
Nobody wants to think of sex as work. But if you or your partner has a bad back, a little leisure reading about sexual positions is going to lead to a lot more fun in the sack. Besides which, you might even get off looking at drawings of couples in different sexual positions. There are plenty of books and articles out there on sex with back pain that read like a Kama Sutra for the creaky.

Here’s a partial list (click on link for more information):

• Sex and the Back: Taking the Pain Out of Sex
• Sex and Back Pain
• Sex and Low Back Pain

You can get physical therapist Lauren Andrew Hebert’s illustrated Sex and Back Pain as a pamphlet, an e-book, or a see a video.

You can let your fingers do the walking to Amazon.com and order the paperback book version, Sex and Back Pain: Advice on Restoring Comfortable Sex Lost to Back Pain (Impacc USA; 3rd edition, 1997) by the same gal. Or, you can read Loving With Back Pain: Good Sex With a Bad Back by Kathy Ulrich and Vicki Chandler (Wondersight Ltd Liability Co, June 1996).

Most of these books and articles will give you a few basic tips:

Make love on a firm surface. Try using pillows under the knees if you’re on your back or between your knees if you’re on your side. Some people might find a towel rolled up and placed for support in the small of the back helpful when lying on their back. Try positions that don’t put as much of a strain on the sore back, such as lying like spoons, and having one partner enter the other from behind. Alternatively, the partner with back pain can lie on her back while her partner lies on his or her side next to her. She can lift her legs and then drape them over the pain-free partner’s legs as the pain-free partner enters her. There’s even a physical support designed specifically for people with back pain called (perhaps wishfully) the Harmony System. It looks like it would allow you to try a few more positions with less strain on the lower back. While I haven’t tried it myself and can’t specifically recommend it, I found looking at all the pictures of couples using it in different positions a mild turn-on. (Okay, I tend to find almost anything a mild turn-on.) Check it out for yourself and see if you’re as pervy as I am.

During my recent evaluation at the UCSF Pain Management Center, a psychologist gave me a copy of Hebert’s Sex and Back Pain. She earnestly cautioned me not to try the positions exactly like they were portrayed in the pictures—because all the couples were drawn wearing bathing suits! I left the booklet out on the kitchen table, where my husband and I like to read over meals.

Just having the book out there got us thinking more about sex, and looking at the pictures got us in the mood. Trying the different positions has been a huge amount of fun, reminding me of when I was in my early twenties and first experimenting with somebody who had read a lot about Tantric sex.

I developed back pain when I was twenty-seven. Most people don’t really start to be bothered by it until their mid-thirties. Somewhere around thirty-five or forty, you discover sitting around at a party of your age-peers that everybody is complaining about some joint or other that hurts. So if you’re poised on the threshold of that host of orthopedic problems, don’t despair! Know that there is a literature of illustrated sex books out there just for you. Find one, crack it open, and let the games begin.

Unfortunately, most of the written guides assume that sex is between a man and a woman. Perhaps it’s not as exciting a prospect as marriage equality or getting all our civil rights, but it will be a great day when sex manuals for people with back pain include drawings of men making love to men and women making love to women. Will you be the one to write one? If you know of one, please tell me about it. The closest I’ve seen is the following sentence from the booklet Relationships, Intimacy and Arthritis put out by Arthritis Care, a British national charity:

“The illustrations and descriptions are of heterosexual couples, but gay couples should find it easy to adapt and use these positions.”

Kudos to Arthritis Care, but a picture would be worth a thousand carefully chosen politically correct words. How about tasteful line drawings of a woman with a big black dildo in her thigh harness doing a nipple-ringed butch who’s hanging blissfully in a suspension system? Personally, I’m holding out for the watercolor/gouaches of the intersex person wielding a ribbed, rotating vibrator gleefully sodomizing the non-op tranny boy shown yowling in unrestrained ecstasy. Or perhaps in four-point restrained ecstasy.

I think I’m getting mildly turned on now. Gotta go.

It was a room that discussed the racier topics and most of the people there that night had a kink that they considered on the edge. Jerry was very quiet, but something told me he wasn’t there just to get juicy tidbits to chat about at the office the next day — he was there to see if others shared his kink. He was hesitant to talk, but he spoke up later in the evening when the group was smaller. After that night, we stayed in touch through e-mails and eventually we developed a steamy on-line and on-phone relationship. Jerry’s kink is that he has a fetish for women’s panties; my kink is that I enjoy dominating people. This is the story of the first time Jerry and I met in person.

We’d decided to meet at a restaurant — nice and public. We’d traded photos through e-mail rather than do the carnation bit. When I showed up, Jerry was already anxiously waiting at a table in the corner. I caught the disappointment on his face when he saw that I had worn jeans. I knew that he’d expected me to wear a skirt so that I could tease him with flashes of my panties.

Soon, though, Jerry realized that I was not alone. I had brought Deidra, one of my lustful lovers. Deidra wore a short leather skirt and a tight leather vest. It became obvious rather quickly that she was taking orders from me. I sat her on a chair between Jerry and me, positioning her slightly facing him and a bit back from the table.

As we talked, Deidra was attentive to me, but glanced often at Jerry. Sometimes she’d rub her legs together slightly as she tipped her head just a bit in his direction. Occasionally, she’d spread her legs a little further apart. Her skirt was so short that, before long, it rode up high enough to give Jerry little glimpses of her white lace panties as she moved her legs.

We had coffee and rolls. I “accidentally” dropped one of my rolls on the ground on the side opposite from where Deidra was sitting. She immediately stood and began to walk around the back of my chair to pick up the roll, but I told her to get it from the front. This meant she had to bend down and crawl under the table to reach it, giving Jerry a view of her beautiful ass in the lace white panties. There was no way she could keep it covered with that short skirt at that angle.

Deidra settled herself in her seat again, but the skirt was pulled up higher. Sometimes she’d place her hand on her thigh and rub an “itch.” I picked up a breadstick and ran it down Deidra’s neck and she responded like a purring kitten. I took a bite, I gave her a bite, and then I suddenly turned to Jerry and said, “Do you want Deidra’s panties?” Of course he did.

I told Jerry that he’d have to wear my leather bracelet to get them. In our e-mail conversations I’d told Jerry about how I always have a studded cock ring clamped to the armrest of my wheelchair that I use as a bracelet to indicate when I am “in scene” with someone. I knew that Jerry had never been involved in any dominance and submission role-play in his life, though we’d played a bit with the concept on-line and on the phone. He agreed to wear the “bracelet.”

As I snapped it on his wrist, I told him that as long as he wore the bracelet, he’d have to do whatever I said, unless he called out the safe word “red.” I asked if he understood. He nodded cautiously.

Deidra stood and took Jerry’s hand. The three of us moved towards the women’s restroom. Jerry went along, though he was obviously nervous and unsure what he wanted to do. We entered the door as a woman was coming out and she looked at us with something between amusement, embarrassment and disgust. Deidra and I ignored her, leading Jerry into the women’s room as if it was a natural thing. We took him into the wheelchair stall, which is much bigger than the other stalls — room enough for the three of us. Deidra and I each took off our bras without removing our tops — a tantalizing trick. Deidra used our bras to tie Jerry’s wrists to one of the grab bars, leaving him standing. Every now and then we’d hear a woman come in and use the adjoining stall.

Deidra began to dance, or perhaps it would be more accurate to say she began to move. She is so sensual and delightful to watch. She teased Jerry with her body movements and with flashes of her panties. She rubbed the inside of her thighs all the way to the crotch, without actually touching the crotch. She turned around (facing away from Jerry) and rubbed her ass through her skirt, gradually pulling the skirt higher and higher as she slowly bent over. She spread her legs and reached underneath to rub her thighs. I enjoyed watching her movements and ignoring Jerry.

I told her to check to see if Jerry wanted her panties. Deidra went over to Jerry and undid his pants. Slowly she pulled them down to his ankles, revealing two attractive sights: (1) A bulging, beautiful cock inside (2) a creamy colored pair of women’s panties. Deidra pulled the panties up (careful not to touch the cock!) so that they cut into Jerry’s crack. She left him standing there like that, tied to the grab bar with panties pulled tight over his cock and his pants down around his knees. Then, like a good girl, she came over to give me attention.

Deidra removed her skirt and vest and we began to make out and feel each other. Her tits are so lovely — I licked and sucked them. Her tongue chased my tongue. She opened my shirt and found my breasts with her hands. We enjoyed each other’s smooth bodies. I took my hand towards her crotch, feeling the heat through the panties. “You are soaked!” I turned her around to show Jerry how wet the wench was, pulling her panties aside at the crotch. He saw that, indeed, she was very wet and that she had a shaved pussy, another one of Jerry’s fetishes that he had revealed to me on-line. I moved my fingers around her clit and she arched in pleasure.

I wanted Jerry to smell her, because her pussy smells so good. At my direction, she stood on the arms of my wheelchair and I moved to position us in front of Jerry. Her crotch was right at his face. She started to play with herself through the panties.

Meanwhile, I was at Jerry’s cock level, enjoying the view: his cock and balls through the cream-colored panties. I put my mouth near them, licked my lips with my tongue, nibbled my lips with my teeth, but never touched. While Deidra delighted Jerry with sight and smell, I watched his throbbing cock and sucked my fingers. Deidra slipped a finger inside herself and wiped some of her moisture under Jerry’s nose just as I scratched my nails down the inside of his left thigh. I dug my nails into his buttocks and watched Deidra from below as she masturbated to orgasm, sometimes only an inch from Jerry’s face.

Deidra knew she would have to pay the price for that orgasm. She got down from her standing position on my wheelchair, got into her purse, took out a brush and bent over the toilet. I spanked her first with her panties on and then pulled them down to her knees and spanked her until her cheeks were bright red. Then I plunged the handle of the brush into her and fucked her with it a few times. The slut had another orgasm.

Somewhere along this road Jerry had slipped into an altered state of mind. He told me later he had found it surreal. There he was in a women’s restroom, tied to a grab bar with bras, watching a lesbian (whom he had never met before) get fucked with a brush, now and then hearing a toilet flush somewhere else in the room.

After thanking me for the spanking, Deidra rose from her bent over position and gave me a long, passionate kiss. Then she and I dressed, completely ignoring Jerry, who still stood tied to the grab bar, pants around his ankles. I retrieved the bracelet from his wrist, saying, “We’d leave both arms tied, but I want my bra. Deidra can get another one.” Deidra untied one of Jerry’s arms to collect my bra.

Jerry had earned his reward, so as we left, Deidra hung her panties on the handle of the stall door, leaving it slightly ajar. We knew he’d get untied fairly quickly, since one hand was free, but we giggled all the way through the restaurant wondering how many women would go into the restroom before he got out of there. I sent up a silent thank you to Aphrodite that no one else needed to use the disabled stall while we had had it so thoroughly occupied.

Much of the information that has been available about sex and diabetes has focused on erectile dysfunction in diabetic men. And, in fact, it is estimated that half of all diabetic men over age 50 do have erectile dysfunction — it’s one of the leading causes of ED in men. But women also experience many sexual symptoms of diabetes, including decrease in sexual desire, vaginal dryness or tightness resulting in pain during penetration, difficulty reaching orgasm, menstrual problems and a greater tendency toward yeast and urinary tract infections.

Still, don’t think that all these problems have to add up to a diminished sex life. The sexual difficulties associated with diabetes can often be dealt with by taking relatively simple measures. That includes erectile dysfunction, which men sometimes think will spell an end to their sex life. But there are many, many ways to be sexual, and with a little exploration, you can keep your sex life as exciting as ever.

Sexual Concerns for Diabetic Men and Women

The most important thing that you can do to maintain your sex life, whatever your gender, is to maintain good glucose levels. Like other forms of exercise, sexual activity can cause blood glucose fluctuations, so be aware of that possibility and be sure to let your partner know that you’re diabetic. Keep a supply of glucose tablets or appropriate snack foods near the bed. And, if you fear you’re having a hypoglycemic reaction, however uncomfortable it may be to check your blood glucose while you’re in the middle of having sex, it’s better to be sure. You can always pick up where you left off — with renewed confidence.

Aiming for good long-term glucose control, however, is much easier than trying to take action to control it while you’re making love. Long-term control will do the most toward keeping you healthy and sexually active.

Sexual Concerns Specific to Diabetic Women

One of the most common sexual concerns women with diabetes have is difficulty in reaching orgasm. While this can sometimes be related to diabetic neuropathy in the genital region, it is often the culmination of other symptoms.

First, vaginal dryness and tightness can lead to discomfort during penetration and rubbing, not to mention difficulty reaching orgasm. If you enjoy focusing on penetration during sex, water-based lubricant should help. If you do focus on penetration, now might be a great time to explore other forms of touch, including clitoral or vulva stimulation, not to mention incorporating sensation all over your body: breasts, nipples, back, buttocks, anus, arms, legs, face. You might want to try a vibrator or some sensation toys, with a partner or alone. Even if you prefer clitoral or vulva stimulation, lubricant can greatly decrease any discomfort you’re feeling. And if you do choose to have intercourse or other forms of penetration, try experimenting with different positions; being on top of your partner may make it easier to relax your vaginal muscles and may decrease tightness.

However, if you find that you can’t reach orgasm through direct clitoral stimulation that could be a sign of diabetic neuropathy, a problem with the nerves of the clitoris. Mention it to your doctor right away.

Second, a greater tendency toward urinary tract infections and vaginal yeast infections can cause plenty of sexual discomfort. If you’re experiencing UTIs, try urinating before and after sex; it helps flush any bacteria out of the urethra. Even if you don’t experience UTIs, urinating before and after is a good idea because it may help prevent them. If you have cloudy or bloody urine or feel like you constantly have to urinate, you should contact your doctor immediately; any of these may be signs of a serious infection.

Yeast infections are an overgrowth of the body’s natural organisms. Since the growth of those organisms is tied to sugar, the best thing you can do to prevent and control yeast infections is to maintain good long-term control of your blood glucose — see above.

Thirdly, you may note an increase in blood glucose levels immediately prior to your monthly cycle. As mentioned above, this may cause yeast infections or other problems related to high blood glucose. If you experience this, your doctor may indicate that you should plan to increase your insulin during these days (if you have insulin-dependent diabetes). Similarly, menopause can affect your blood glucose control. If you’re starting to go through menopause, make sure that you talk to your doctor about your diabetes and how menopause may affect it.

Sexual Concerns Specific to Diabetic Men

Again, the most common sexual side effect mentioned in the diabetic literature is erectile dysfunction in men. While there are many sexual options open to a man regardless of whether he can get an erection, many times men with erectile concerns don’t feel empowered to explore them. But now might be the time for you to explore other ways of being sexual with your partner or alone, including stimulating erogenous zones other than your penis.

But even so, erectile difficulties do present a great concern for many diabetic men; if you’re worried about difficulty attaining or maintaining an erection, it may be hard to enjoy other forms of sex. Erectile dysfunction in diabetic men comes from either circulatory (blood) or neurological complications. One notable fact is that high blood sugar levels can interfere with the transmission of sensory messages through the nerves. What that means is that even if you’re aroused, your penis might not be getting hard — not because of a circulatory problem, but because it’s not getting the message that you’re turned on. High blood sugar also interferes with circulation, making it more difficult for the blood to flow properly into the penis.

All of these problems may contribute to a performance anxiety that makes erectile dysfunction worse. For that reason, my earlier recommendation to focus on other kinds of stimulation is doubly important, because enjoying your body may help lessen that anxiety.

For Further Help

If you find that simple techniques such as those mentioned in this article aren’t helping with your sexual concerns around diabetes, ask your doctor to refer you to a qualified sex therapist. Many sex therapists have specific training in diabetic concerns, and may be able to help you more than your primary care physician or endocrinologist would.

The most important recommendation, however, is to maintain ownership of your sexuality. Often when we have health problems, we get the sense that sex should be the last thing on our minds. This view may be exacerbated by the discomfort many health care professionals feel about discussing sexual concerns. Try to remember that it’s your sexuality, and you have as much right to a vibrant sex life as anyone. In fact, maintaining your sex life and enjoying yourself is one of the best things you can do for your health.

So now on to the question of “How do they do it?”

The first order of business is having “The Talk.”

To the degree that someone has “limitations” (the quotes are necessary for such an infamously relative term), communication is indispensable. There are few better ways to throw ice on a passionate scene than to bump into an expectation that isn’t going to be met.

An experienced disabled lover knows their body well, has been through the routine before, and knows that describing in advance what won’t happen is what makes for a good time. You relax and enjoy what is possible. Which, of course, is a great deal.

But not everyone is going to be experienced or clear about their sexuality. Whether their disability is acquired or a feature of their life since childhood, they have a process of discovery to address. Someone disabled since childhood is often denied the normal process of development. They often get disqualified as potential partners in a society that assumes they are asexual. The newly disabled partner has some redefining to do. A non-disabled partner might need to initiate The Talk, to make it clear that it’s safe to go into the “what’s different” territory.

Note how The Talk sets a tone of openness and honesty. Even if you’re out for some casual erotic fun, trust is still an issue, right? It works on all levels.

So what’s possible? It’s impossible to generalize, since there are many kinds of disabilities. Whether it be cerebral palsy or spinal cord injury or vision or hearing impairments or multiple sclerosis or post-polio or wrist tendinitis — there is a huge range of degrees of impairment. Someone could have sensory loss on some parts of their body, but be fully orgasmic. A man might be unable to walk, but get healthy erections. Each person has to speak — and explore — for themselves.

Of course, when someone asks, “Can they do it?” they’re referring to insertion. Intercourse is typically possible, though it might need a little help, be it with water-based lubricants or pharmaceutical help with erection. Men can also use a vacuum pump and cock ring, and some have gone as far as surgical implants — which can be very risky. Some women with cerebral palsy have difficulty with vaginal intercourse because the spasticity inherent in their disability has made the vaginal muscles so strong that they just don’t let go enough — though some are able to address this with dilators.

If someone can’t feel genital intercourse, the sheer intimacy of it is still stimulating. The emphasis also shifts to the visual. Sex is lovely to watch, as are the reactions of your partner. This asks an able-bodied partner to get creative with positions to bring things into better view. (”Excuse me while I put my glasses on for this, dear.”)

Instead of requiring orgasm to be an earth-shaking peak, it may need to be redefined. The pleasure is in the process, which moves from attraction to arousal, to the various physiological responses — erection, lubrication, elevated pulse, sweating — to some kind of relative peak. Which might involve ejaculation for a male, or that quality of going over the top for a female. Or not. It’s a matter of what is physiologically possible, and getting into alignment with that. For the disabled lover whose orgasmic response is not so cataclysmic, getting there may be a lot more satisfying.

Thus, subtle sensations might be a higher priority, and can be quite intense. Sex becomes a sort of meditation exercise, focusing one’s attention on the area being caressed or licked, zeroing in on even the slightest responses of the body. And in the course of that, everything else becomes amplified. The sensitivity dial gets turned way up — even the slightest erogenous zone counts.

The sexual space can offer a truly deep and unique quality of relaxed release. For people who spend many hours each day using a wheelchair, who walk with crutches, who don’t have a visual orientation to the horizontal, who can’t use their lower body to support their upper, their normal daily activities can be physically stressful. The chance to really let go of the body — to be deeply comfortable — can be an especially treasured gift to a disabled lover and uniquely accomplished through erotic contact. The stereotype of sex with a disability is to forgo intercourse and concentrate on oral sex. Not everyone has a taste for it (please forgive the obvious pun), but oral sex is an option that allows the disabled partner to play a more active role. For some who experience their disability as a loss of control in a society which devalues people with disabilities, being more active and in control speaks to an essential need for control of one’s life. Oral sex need not be an obligatory consolation prize, but it can be high on the preference list, and enjoyable to boot.

And then there’s kissing. Ah, kissing. So vastly underrated and ignored. When there’s less rush to fuck, one pays due attention to nipples and kneecaps and ears and the back of the neck, the fingers and the palm and the inside of the elbow. This is huge territory that so many people never venture into — until a disability leads them into a more exploratory and sensual style of lovemaking.

There are devotees out there who are erotically turned on by disability. This has been stigmatized and caricaturized over the years, but if some people are turned on by blondes or a large penis, then why not an amputated leg or the inability to walk? The issue is to recognize the whole person, not just the disability. Some devotees do try to cast their partner into an unhealthy, submissive role. But there are plenty of couples out there which include a devotee and have an integrated relationship. Rather than assuming devotees are a scourge from which people with disabilities must be protected (a paternalistic view), the disabled lover has a right to choose for themselves.

Sex in the context of disability invites us to open the boundaries, to forget loss and pursue possibility. To explore sex toys, erotica, striptease, fantasy, and role-playing. The sexual style of people with disabilities runs the same gamut as the rest of humanity. Limited by physiology and/or social stigma, people with disabilities have as much right as anyone to pursue what is safe, sane, and legal.

Someone once asked me what I thought a high quadriplegic like Christopher Reeve and his wife do when they have sex (their having confirmed on television that they still do). Well, he’s got sensation on his face and neck, so she probably lets her tongue wander. His mouth works just fine, so she just needs to get whatever part of her body he prefers in range. He’s an actor, so perhaps he invents and performs erotic stories. Maybe she strips or masturbates for him. He almost certainly can get erect, by whatever method. There are always possibilities.

So, the way it’s done is… any which way you can.

For more information check out the Good Vibes Disability Shopping Guide.

“Are you sure you can do this?” she asks again. Most wives, she’s told me, refuse to lift wheelchairs, insisting their husbands are lazy and should walk.

David cannot even make it to the mailbox.

I practice manipulating the wheelchair, which is a handsome dark purple. I break it down, heft it to and from the car, reassemble it. The chair is 211 pounds assembled; apart, the heaviest piece is about 80. Satisfied, Theresa turns to David.

“Ready?”

My husband sits and rolls around the parking lot. He is 29 years old.

“Outrun your wife!” Theresa yells gleefully. The other therapists laugh and applaud. Slowly I back into the shadows of the garage, attempting to compose my expression, myself. I manage a cheerful façade.

Outrun your wife!

It was my 31st birthday.

I always knew David would end up in a wheelchair. I viewed this fact like the knowledge of mortality: unavoidable, but far in the future, beyond my control and therefore not worth dwelling on. As his strength waned, my workload in taking care of him slowly increased. I devoted little thought to this until he needed the chair and our relationship tipped precariously into “me nurse, you patient.” The lines between caretaking, loving, and retaining my personhood vanished. So did my libido.

Welcome to caretaking’s dirty secret: you don’t want to fuck someone you’ve just picked up off the floor.

Our sex life dwindled. A week, two weeks, sometimes three passed before my guilt overwhelmed me and I smeared his dick with lube, climbed atop him, fucked him with a few quick strokes, and rolled off, dry, disinterested, guiltier than before. David, always a quiet man, grew quieter. He felt responsible for the turn our lives had taken and did not pressure me for sex. Instead, he handled the sickening trip into a wheelchair with uncomplaining dignity. Despite our problems, I encouraged him to express his feelings.

“I had hoped,” he said one late night, “I would make it to 30 before I needed a wheelchair.”

The next 18 months were a nightmare. My physical and mental health broke. Doctors prescribed steroids and tranquilizers to no avail. Therapists “actively listened,” offering me a smorgasbord of antidepressants. I refused, repeatedly pointing out that my problem wasn’t a skip in neurotransmitters, that happiness in the face of my lover’s illness would be an inappropriate response.

I also brought my sexual dysfunction to every medical professional I saw. The ones who didn’t avert their eyes and dismiss me outright were simply sorry.

I didn’t have the energy to be enraged.

Throughout this sexual drought, David and I talked openly, often before intercourse, now relegated to Sunday afternoons after I’d done all the laundry, snuck in a nap, and was nominally rested. I remained jumpy, often drinking to calm down and crying while we talked, trying to hash out some way around the imbalanced mess we were in. Predictably, our problems revolved around money.

The disabled represent a captive audience. Attendants, wheelchairs, breathing equipment, modified vehicles, and shower bars come at enormous costs. Nobody wants to pay, even when they’re supposed to, leaving the patient, or in this case, the patient’s wife, to wage battle. I fought our HMO for the aforementioned wheelchair, then engaged in a two-year fight with the state government for assistance with a modified van. Stress left me pulling handfuls of my hair from the shower drain.

A few months ago, I met a young man whose sister was shot and paralyzed from the neck down. He left college, moving in with his mother to help care for his sister. He was kind, intelligent, and appeared happy.

“The first two years are the worst,” He told me. “After that, you get your van, you get used to it, you figure out how to live with it.”

On December 7, David finally got his van and resumed driving after a two-year hiatus, calmly learning an entirely new system of driving. Sitting in his wheelchair, he accelerates by pushing the small steering wheel forward, braking by pulling it toward him. All other controls are on a button panel.

“What’s the hardest part?” I asked.

“I keep wanting to move my leg. My knee is sore.”

I no longer have to lift the wheelchair. I no longer have to overstock the pantry for fear I’ll catch flu and he’ll have nothing to eat. I can say: “Go get the dry cleaning, will ya?”

From such prosaic things comes respite, equality, and the flickering of my sex drive rekindling. We spent a recent Sunday in bed. The entire Sunday.

“When’s the last time we did this?” I asked. It was cold out; the space heater hummed. We’d been caressing each other for hours. The overheated room smelled intensely of aroused female.

“Too long.”

I lay on my back, cupping my hands over my torso. David slowly maneuvered himself over me, leaned onto my hands, and lowered into me, sliding his arms around my back. We tried to go slowly. We failed.

All we can do is try.

For most people, this inspires mixed feelings. To them, her disability seems to be in blatant contradiction with her sexual radiance. Their hormonal response says one thing, while social mores say something entirely different. But consider this: someone with a disability could be just as likely as anyone else to be a satisfying lover.

This is not a notion easily grasped in an age of intensely idealized commercial images. These images don’t portray real personal connection — much less authentic sensuality. Everyone is a victim of this, but someone using a wheelchair doesn’t stand a chance of fitting the image — even someone as attractive as Jen.

In truth, the best sex is about chemistry between people, about being open to passion, being tuned to sensuality. It’s about real trust and vulnerability and caring. When these elements come together, wonderful things await. People who want to please each other find a way. Disability is no obstacle to these experiences. Plenty of people have proven it beyond doubt — people who come nowhere near the image of what these cultural images suggest is sexy.

We’re talking about a growing population of vibrant and sexually active people with disabilities. Nowadays, more and more people survive injury and illness thanks to medical advances. Dramatic developments in wheelchair design extend mobility. The fight for access to work and housing and the public milieu has made strides. Disability is far less “un-abling” than ever.

But our culture has yet to catch up with this truth. “The disabled” are still seen as either tragic or heroic, and always chaste. But they’re not looking for either pity or admiration. They’re just adapting and insisting on living their lives. That means work and play and family and art and community and spirit — and getting it on.

Last October, the Paralympic Games were held in Sydney following the Olympics. 4,000 world-class disabled athletes from 122 countries participated, competing in front of over a million fans. At the Paralympic Village where they stayed, the welcome packages included half a dozen condoms. They were soon demanding more. These folks were definitely getting it on.

These issues need to be made really clear. While there are people who face deep struggles with their health and their psyche, most people with disabilities do not see themselves as tragic, or sexless. They do not identify themselves totally by their disability, no matter how unfortunate the initial circumstances. Anyone with a disability should be approached on these terms — no matter how significant (the PC term, rather than “profound” or “severe”) their disability.

The inevitable question, of course, is “Can they do it?” Plenty of people with disabilities are fully sexually functional. But this misses the point. The real question is, “should we be defining sex only in terms of genital intercourse?”

If one imagines that strenuous intercourse is the only means to a satisfying sex life, then they’re going to believe that their sex life is over once they can’t do that — a circumstance likely to occur in everyone’s lifetime. Disabled people who have addressed their sexuality know that this ain’t so. There are lots of ways to enjoy yourself — and please someone else — without being a sexual athlete.

Of course it’s a different kind of sex. Of course there are options that fall off the list, depending on the disability. Of course there is grief to face after an acquired disability (a non-issue for people disabled since childhood). But however traumatic it might be to lose sensation or “normal” genital function (normal, of course, being a relative term), the impulse to express our sexuality is quite unquenchable. People transcend their grief, because they discover that they still have a sexual nature, and want to express it.

Some who lose sexual function repress their grief, are afraid of trying, or are attached to needing sex to be “the way it was.” Some are influenced by issues that predate their disability, or by any of the many issues — social and psychological — that might lead someone to suppress their sexual impulses. In other words, being disconnected from your sexuality often has little to do with the disability itself. Plenty of people with a disability are fantastic in bed. Plenty of so-called able-bodied people are duds.

Assuming someone wants to be sexual — and most of us do — it follows that they’re going to explore whatever is possible. Especially if they’ve lost some capacity. Every possible sensation counts, and the desire to discover them leads you to a more creative style of lovemaking, one that favors slowness and subtlety. It makes you want to know every little corner of your body. If there are things you can’t feel, then the things you can feel become that much more precious.

It makes you want to find every little corner of your partner’s body (the widely underrated tongue-on-the-inside-of-the-elbow is one of my personal favorites). If there are things you can’t do for your partner, then the things you can do become that much more gratifying.

Many people with disabilities report that they become more focused on pleasing their partners. If your orgasmic response is reduced, then you may want to get your partner off so you can go along for the ride, so to speak. Able-bodied partners of disabled lovers often feel guilty because believe they experience a level of intensity not available to their partner, and hold back. But once they realize that the disabled partner really wants them to go for it and have the fullest, most selfish erotic experience they can, that’s when the good stuff starts to flow. Isn’t that the mark of any good lover?

But take care not to assume that disabled lovers forget about their own gratification, or that they are not capable of it. Their focus on pleasing their partners is not about compensation for loss, it’s what feels natural and balanced in the context of disability. You better believe they want — and are able — to be satisfied in kind.

But intercourse is almost always still possible. Folks who wish to penetrate can use a dildo, strap-on, or fingers (some males use Viagra or an injectable drug to help achieve or maintain erection), and the receptive partners might want to supplement with store-bought lubricant in lieu of natural juices — which goes for both the disabled and not. If there is loss of sensation, then things like genital intercourse just fall down the priority list. When it doesn’t get you off, you become more interested in other options. Dwelling on wanting to feel what you can’t feel just draws your attention away from other enjoyable options.

Even with reduced sensation, intercourse can be a very intimate act, and a lot of fun to watch. And it usually lasts longer, too. Fucking may have fallen down the list, but it hasn’t necessarily dropped off.

Many women have told me that in their experience most men are interested, mainly, in getting to insertion, and when they’re done, then sex is over. That gives paraplegic men a definite advantage. Since intercourse is not their first interest, they are more than happy to indulge in plenty of kissing, licking, and touching. In other words, the very style of sexuality that many women prefer. (I hope here to achieve a repeat of the brief period of increased sexual opportunity for paraplegic men that occurred after Jon Voight went down on Jane Fonda in Coming Home.)

Ultimately, sex in the context of disability leads you to choose partners that you truly care about, with real intimacy, friendship, and trust. (There are “devotees” who are turned on by disability, but I’ll save that topic for the next article.) Folks on the more shallow side are a lot less likely to consider someone with a disability as a life partner — much less as a lover. So disability turns out to be a bit of an advantage — a sort of filtering device. Those who are able to see beyond the social stereotypes of disability are more likely to see the whole person, and so be interested in whole relationships.

The “lick, suck, fuck, and come” model of porno video sex can get old in due time. The exploratory, intimate, mutual-desire-to-please quality of sex that many find in the context of disability can be a lot longer lasting and satisfying.

Not that it’s easy to find a partner. The widespread experience of people with disabilities is that they are simply set aside from the get-go as potential partners, immediately disqualified by cultural assumptions of their incapacity — to have sex, to partner, to parent. These cultural assumptions are simply wrong.

For my attractive friend, Jen, men fall into one of four camps: “Some probably see only the wheelchair and look no further; these I ignore. Some are confused; for the most part I don’t have time to educate them. Some are intrigued, and think of me as either great because I’ve ‘overcome’ something, or as an interesting novelty to explore; these I might date. And to some, the wheelchair is completely irrelevant; these often become my boyfriends.”

What a shame for the first three groups. They’re really missing out.

So the next time you meet someone with a disability, and you find yourself attracted, making a real personal connection, feeling that quality of karmic chemistry, don’t jump to conclusions about what’s possible. If the person appears interested, they probably have a pretty good sense of their sexual identity. And if they’re letting you know they’re attracted, then chances are they have a few ideas about what to do about it. And would be more than pleased to demonstrate.

“I’ve some news!” Cried my neighbor in her English accent. I stared. Had she finally found a house?

She clasped her hands and stared at me in the ancient, wordless of language of women. This was no house.

“How late are you?”

“Five days. But the pee test was positive!”

“Forget the test. What does your body tell you?”

Her hands traveled the length of her torso, cupping her abdomen. My eyes followed, inquiring.

“I’m sure.”

More shrieking, embracing, counting off days, months. Mixed with my genuine happiness for her was a thin sharp needle of pain. I like to think she didn’t notice.

As I write, the familiar pain of my period pulls heavily at my belly and low back. I’ve swallowed pain pills, eaten chocolate, cried at nothing. My body’s grudging monthly announcement of failure to conceive.

Mine is a body made for babies. Made to carry then easily within my round belly, slide them out quickly from my broad hips with strong pelvic muscles, let them breast feed at double-D breasts, carry them against the perfect nestling point where my waist tapers in, chubby baby legs wrapping round the hourglass curve where my hip resumes.

This curve of my hip, a “C” shape of contoured fat, is called the “violin deformity” by cannula-wielding plastic surgeons who would happily suck out my offending womanliness, rendering me a good clothes hanger and palliating my seamstress, a bewildered Korean woman who tapers my jeans over my ass and hips, nipping them at the waist. The resulting uneven seam trailing up the backside of my pants irritates her sensibilities.

As a child I played with dolls, assuming I would have children. In my teens and twenties, I began questioning that assumption; something nameless was wrong with me. I started a raft of medications whose long-term effects remain unknown. Then I met David, and though he could father a healthy child, if that child were a girl, she might be a carrier of his Muscular Dystrophy, passing it to our grandchild. Though on the Pill, I didn’t want to be the two percent who got caught, lying on a table while David’s child, poisoned with pills and genetics, was suctioned from my uterus. Frightened by that wrenching possibility, I drove myself to the nearest Planned Parenthood and got my tubes tied at age 27. The relief was tremendous.

I knew from the outset being with David would entail decisions many women in their twenties don’t normally consider. I knew we needed to live a forgiving climate, wherever he found work, and that the increasing amounts of care he’d require would eat the time normally given to nurturing children.

But the full magnitude of my decision is a deeply felt experience continuing to unfold. Any ideas I’d had about wrapping my fallopian tubes with tiny rubber bands and blithely moving forward were naïve.

“You aren’t having kids?” My gastroenterologist asks, astounded. I am 31, deathly ill from the steroids she prescribes.

“Do David and I strike you as good genetic material?” I ask bitterly. This line of questioning is especially annoying from a doctor.

She is taken aback. “I guess not…” Brightening. “You could adopt!”

Wearily, I agree. Adoption always pleases people: they feel good about themselves for having solved my problem.

Until I was diagnosed with Ehlers-Danlos Syndrome at 29, and learned more about my illness, I felt rather smug in my decision. My decision, my body. Then I joined the EDS society and began receiving their newsletters. Women with EDS are advised against childbearing. Fragile collagen often causes uterine rupture. A fetus carried to term means a dangerous birth. If mother and child survive these hurdles, the child inherits the disease, and whole sickening cycle turns on itself.

Suddenly this womanly body made for babies, stayed only by my liberated hand, is a defused bomb. While my peers begin carrying sleepy-faced bundles in baby slings, I am forced into a new understanding. Not my decision. My body’s, made without consultation.

My inability to bear children makes me feel damaged at the core of a previously unshakable sense of femaleness. As a woman, I am going to miss one of life’s profoundest experiences. My body will never know pregnancy or childbirth. David’s green eyes will never look at me through an infant’s face. This, that I cannot bear David’s child, is… the cursor blinks, demanding an adjective. I can’t have a child with the man I love because I am too fucking sick.

Our lovemaking brings us pleasure, intimacy, binds us. But it will never make a child, so our sexuality is something that offends some, confuses others. Disabled people are supposed to sit quietly in their wheelchairs; the barren are condemned to spinsterhood. If this sounds archaic, please read today’s newspaper for the latest plans from our new government. Policies for people like for you. Policies for people like me.

Recently we attended a small dinner party. Our friend Cal carried David up the steep steps to his Berkeley kitchen, where he served red wine in cut crystal glasses. As talk will among people in their thirties, the topic soon turned to marriage and children. “Are you guys going to have kids?” Around the dark wood table, eyes turned to us. “We can’t.” I replied.

Sarah gazed at us in the candlelight. “That’s too bad. Your children would have been so beautiful.”

The first time David and I made love, I knocked down a curtain rod.

We were in my narrow twin bed, which I’d wedged against the wall to accommodate an overflow of bookcases. I was trying to straddle him while working his cock, hugely erect, into my painfully tightened vagina, all while maintaining a calmly sexy ambiance.

Prior to this June evening in 1993, I’d been celibate for four years. There are various reasons for this protracted celibacy, but mostly I hadn’t met anyone interesting enough to fuck.

At 23, David was a virgin.

I’d never inducted a virgin before, and felt a sort of solemn responsibility to make this a warm, wonderful first time, something he’d remember affectionately once we’d gone our separate ways. That he had muscular dystrophy made me feel even more responsible to make this good for him.

The personal insecurities I’d bring to any new lover — worry over my body, difficulty with intimacy, self-induced pressure to perform — conspired to crate a less than sexy mood on my part. I was so nervous my cunt closed and dried up. My body, limber from years of dance training, refused to organize itself around my eager new boyfriend.

So there we were, him straining upward, me struggling gamely for purchase, then reaching up stupidly to grab my cream-embroidered hippie curtains. The rod and curtain fell, quietly covering us. I gave up all pretense of mood and collapsed atop my not-yet-lover, giggling.

“This never happens in the movies.”

“Nope,” he agreed.

After that, we were able to get our bodies together successfully. David then devoured an enormous snack and drove home at 3 am, looking utterly blissed out.

Eight years later, I cannot pluck sexuality from the fabric of our lives together, holding it up like a particularly colorful thread meant for your examination. In writing about sexuality and disability, other parts of my life — our life — will bleed into my story: how family, friends, the medical community, even strangers can assault your sexuality. The precarious balance between being a caretaker and a mate. How illness can rob you of your self-esteem and your libido. And how in hell you cope.

I do not propose to represent all disabled folk; I write of myself, my life and illness, and my life with David. If you are disabled, or involved with someone who is, I hope my story makes you laugh, cry, disagree, nod with recognition, and feel a little less lonely during the bad days.

If you aren’t disabled, welcome. Come see how two physically imperfect specimens are making life and love together, and how, in the dark, our differences vanish.

This is my letter to the world. May reading it enrich yours.

David has a rare form of Muscular Dystrophy called “Becker Muscular Dystrophy.” It progresses with mindless, genetic brutality. When we met, David walked and drove unassisted. Then his balance began faltering, and my mother bought him a cane. In 1998 he was hired at a Bay Area university, where the everyday exertions many of us take for granted — protracted standing, using the rest room, a meeting across the building — quickly became overwhelming. He now uses a power wheelchair everywhere but in our small apartment, which is set up with his comfort in mind. The furnishings are heavy, immobile handholds. The tables have rounded corners. Grab bars snake along the bathroom walls. We have no glass baubles or throw rugs.

His initial prognosis was poor, predicting death by age fifty. Advances in medicine have altered this, and during our last clinic visit, the doctors said two stunning words to us: old age.

A short list of the things David can do: earn a Ph.D. in American History, work in his field, handle the household finances, listen to heavy metal, be a computer geek, dress, toilet, and feed himself. He is completely sexually functional: MD does not affect the penis. He has a fine one.

I have a collagen disease called Ehlers-Danlos Syndrome. EDS has numerous manifestations, unified by hypermobile, easily dislocated joints. My skin is fragile and translucent; when I’m naked, my veins are completely visible, like blue tracery on vellum. During the years I studied dance, if a limb didn’t move one way, I simply twisted it until the desired look was achieved. Teachers and other dancers envied my eerie flexibility. But during my twenties, years of wear and tear began manifesting themselves. A rheumatologist finally diagnosed me, warning me to stop dancing before I crippled myself. Though heartbroken, I didn’t need her admonitions. The agony in various extremities sufficed. Unhappily I stopped dancing and began writing.

So here we are: a guy with limited movement, a woman who moves too much. Makes for a creative sex life.

Last night we made love in one of our favorite positions: sitting up, face to face, our legs crossed behind each other’s backs. David can sit up himself and, cradled in the safety of my legs, he can lean backward if he wishes. The position puts no strain on my painful left knee or hip, allowing me to focus on lovemaking. He leaned far back, his hands lightly resting on my torso, rocking deep inside me. Afterward I dropped backward, my head drooping over the edge of the bed. My hair, which is long and reddish-brown, nearly brushed the floor.

We studied our reflections in the mirrored closet doors. David was still sitting up, his torso and head framed by my thighs. My breasts were just visible in the bedclothes. We analyzed the composition of this sexy tableau, as if a photographer had just sidled into our bedroom. His semen began cooling between my legs.

We were perfect.