Men's Health & Tips: January 2009

Sex with Multiple Partners

Where Do All of These Body Parts Go?
Before the printing press existed to print pornographic literature, or the camera to take lewd pictures, or camcorders, phones, computers, and so on, men and women still found ways to enjoy elicit pleasures. The most common was to have more than one sexual partner. Some cultures, such as parts of the Middle East, gave this act official sanction by allowing men to take more than one wife, which probably took half of the fun out of the practice.

To some degree, adultery in ancient times was more forgivable than today. Some marriages arranged by parents worked, and some didn’t. If someone got stuck with a sexually incompatible partner or one whom he or shehated — and especially because divorce was almost nonexistent — it’s easy to understand why some people looked for greener pastures.

The lure of adultery
The statistics about how many people commit adultery may not be reliable, but you don’t need statistics to know about something that takes place under your very nose. Incidences of adultery abound all around us, be they among the rich and famous whom we read about in the news, or among our neighbors and co-workers whom we hear about through the grapevine.

Cheating comes in all different forms, from the man who goes to a prostitute while on a business trip, to the woman who sees an old boyfriend every Wednesday afternoon, to adulterous couples who see more of each other than they do of their respective spouses. But, whether quickies or lifelong affairs, all cheating tears at the bonds of marriage.

One recent development that has impacted this type of behavior is the risk of disease.

Nowadays, I find that more and more people try to patch up their marriages and work things out simply because they fear the health consequences that fooling around on their spouses can bring. To the extent that people try to have better sex with their spouses, I applaud this movement. Nevertheless, I do wish that it had arisen in greater part because of the spread of knowledge about good sexual functioning rather than out of fear of disease.

Wife swapping, swinging, and group sex
Of course, not all sex that married people have outside their marriage involves cheating. Some couples make the conscious decision to have sex with other people.

Some couples bring a third person into their bedroom, be it a man or a woman, which is called a ménage à trois.

Sometimes two couples get together and trade partners, which is called wife swapping. (I think that the fact that it’s not called husband swapping is significant, but more on that in a minute.)

Sometimes a larger group of regulars meets in someone’s home to exchange partners, which is called swinging.

And sometimes a group of strangers just gets together, usually at a club, and has sex with anyone else who happens to be there, which experts label group sex and people used to call an orgy.

All of these activities grew in popularity in the late 1960s and early 1970s. I believe this practice mostly resulted from the development of the birth control pill, which allowed people to have sex without the risk of pregnancy. But this type of behavior has been going on for a long time (for example, the notorious Roman orgies or the scenes depicted in Angkor Wat, the temple in Cambodia), and the behavior will never totally disappear.

Throughout this book I say that sex becomes better as the couple learns to communicate on a higher level and further their relationship. So why do people want to have sex with people they barely know? What’s the attraction?

A little bit of exhibitionism and voyeurism lives inside us all. Some people are appalled at those feelings and do the best they can to hidethem, while others enjoy giving into them, and you can certainly do that at an orgy.

Another attraction is the promise of strong visual stimulation that comes from watching new partners or other couples engage in a variety of sexual activities.

How fulfilling are these exchanges sexually? For many men, to whom visual stimuli are very strong, these scenes can do a lot for their libidos. On the other hand, many women need to concentrate to have an orgasm, and these situations aren’t conducive to their sexual functioning. Therein lies theanswer as to why the practice is called wife swapping — because men usually derive the most pleasure from these situations and push their wives or partners into them.

Although the men are usually the instigators, I’ve seen situations where they’ve also been the ones to most regret having started their wives on this path. As Phil and Betty found out, wife swapping can cause unexpected emotions and unintended results.

Betty and Phil
Betty and Phil were married for about five years when someone Phil knew at work — I’ll call him Gary — invited him to go to a wife-swapping party. Phil was very eager to go, but Betty wasn’t. He kept begging and pleading, and eventually she consented, but she kept to herself the real reason that she had said yes. Betty had met Gary at the company Christmas party and found herself attracted to him. She would never have acted upon that

attraction, or at least that’s what she told me, but when Phil begged her to go to the party, she decided that maybe the chance to be with Gary was an opportunity not worth passing up.

In fact, Gary had caught Betty looking at him, which is why he asked Phil to join the group in the first place. Naturally, when things started getting hot and heavy at the party, Betty and Gary gravitated toward each other and wound up having sex. Phil had sex with someone at the party and then went looking for his wife. When he saw her going at it with Gary, he at first dismissed it, but after a while he started feeling jealous. This jealousy affected his ability to have a second erection, and so he became really upset. On their way home, Phil lashed out at Betty, who fell back on the argument that going to the party had been his idea.

Eventually Phil’s jealousy calmed down, and he started fantasizing about the party. When the next one rolled around, he decided that they should go. Betty tried to talk him out of it, but he swore up and down that he wouldn’t be jealous, and so they went.

I’m sure that you can guess the ending of this story. Betty came to me to see whether I could help her repair her marriage, and I did try. But it was really too late. Gary aroused much stronger sexual feelings in her than Phil did, and because she and Phil had no kids, she finally decided that she’d prefer to spend the rest of her life with Gary.

So, while Betty did find the experience of wife swapping pleasurable, her focus all along was really on one man, Gary, and not having sex with a variety of different men. I think that many women who enter into this scene have similar experiences to Betty’s. Even if, initially, a woman does have sex with a lot of men, she doesn’t necessarily have to be sexually aroused for that to happen. Eventually, however, she fixes her focus on another man, not her husband. And then, when her husband realizes this, the trouble begins.

Of course, couples for whom swinging works out don’t go to see a sex therapist such as myself, so perhaps this sort of lifestyle works for more people than I know. But I’ve seen enough people who’ve had problems with these situations to know that the risks to a marriage are great. You see, the libido is very strong, but it’s also easily satisfied. There’s no such release as an orgasm for jealousy. Jealousy is the type of emotion that tends to build and fester over time, and that usually spells trouble. The only advice I can give you now is to keep thoughts about group sex as your fantasy and don’t try to live them out.

Male Changes in Sexual Capability

Some people may say that the phrase “sex in the golden years” is simply putting a positive spin on a mostly negative issue. Others may even say that the phrase is an oxymoron because they think that as soon as people get their first Social Security check, sex goes out the window.

I must be honest with you and tell you that experiencing negative aspects of sex as you grow older is common. After all, many other physical attributes begin to grow dimmer, so why should your sexual apparatus remain perfectly fit? And, in fact, it doesn’t. But not all the aging factors that relate to sex are negative. And let me make one thing absolutely clear: You can continue having sex right up into your 90s.

This article addresses the ups and downs of sex and the aging process — menopause, soft or nonexistent erections, and more freedom to make love when the mood strikes.

Every woman goes through menopause and, although every man does go through certain changes, the results aren’t always the same. Some men merely have a decrease in their sexual prowess, which I get into in a moment, while others become impotent. Obviously, impotency is a serious problem, but it doesn’t have to spell the end of a sexual relationship.

The spirit is willing, but the penis is weak: Fewer psychogenic erections
Let me begin with the early symptoms of a man’s aging in regards to sex. A younger man can have an erection merely by thinking about something that turns him on, called a psychogenic erection. He sees an erotic photograph or thinks of the last time he and his wife made love and, voilà, his penis becomes hard and erect.

As a man grows older, a time may come when he can no longer have an erection merely by thinking about something sexy. Now, this change doesn’t happen overnight. He still has psychogenic erections for a time, but they become fewer and fewer and need more and more stimulation to take effect. Then, at some point, they stop altogether.

Does this spell the end of his sex life? Absolutely not! (Unless, of course, he doesn’t realize what has occurred.) The following sections provide options for achieving an erection and maintaining a healthy sex life for years to come.

Responding to a woman’s touch
When a man can’t achieve an erection by his thoughts alone, his partner can help by touching him. By stroking a man’s penis with her hands, a woman provides the stimulation he needs to have intercourse.

Some men know that they can still get an erection because they masturbate to relieve their sexual frustration, but they refuse to touch themselves in front of their partners to get an erection. So these men have very useful information, but refuse to share it with their partners.

I encourage you to talk to your partner about what you need. Yes, you’ll have a period of awkwardness to get through, but would you rather never have sex again? Because your penis no longer is a reliable indicator of when you want to have sex, you’ll need to develop a new set of signals that tells your partner that you’re interested in having sex. The signal can be anything from whispering a certain phrase in her ear to strutting around in a goofy pair of boxers. Just be sure your partner knows the signal, too!

The lack of an erection doesn’t mean you don’t want to make love. If you tell your partner you’re interested, and she shares that interest, your partner simply needs to stimulate your penis with her hands (or mouth) to help you get an erection.

Oral sex: Always an Effective Solution for Older Man

As a man gets older, he may require greater amounts of stimulation to get an erection. Some men find that oral sex works better than the use of hands. If your wife has always been willing to perform fellatio, you have no problems. If she has never performed fellatio, however, then problems can occur. Not only may she feel disgusted by the idea, but if she feels that she is being forced into performing oral sex, she may be more resentful about having to start.

I get many letters from widows who face this problem. A woman’s sex life with her husband may have dwindled slowly over the years, and both partners had become used to it. But then, after her husband passes away, she meets a man who isn’t interested only in companionship — he wants to have sex with her. The problem is that he can’t have an erection all that easily and requests oral sex. The woman is in a quandary. At her age, men may be hard to find, so she doesn’t want to lose his companionship because of the oral sex issue. And because she knows that so many other widows would be happy to do whatever an interested man wanted done, she feels she doesn’t have a lot of leverage in this area. So she writes to me and asks what she should do.

This question is tough for me to answer. On the one hand, I don’t believe that anyone should do anything under pressure. But if the alternative is to lose the man and be lonely, that option’s no good either. I usually suggest a compromise, which is to have the woman try oral sex.

Maybe she won’t find fellatio so horrible after she gets used to it. She may even learn to like it. Don’t be surprised by that, because I do get women who report exactly that turn of events to me. Or maybe she’ll hate fellatio and have to give up on this man. But it’s worth a try.

Impotency: Don’t ignore it; bring it up

Just as a man’s inability to have a psychogenic erection comes on slowly, so does the onset of impotency. An impotent man first finds that his erections become softer and don’t last as long. At some point, he can’t have an erection at all. Impotency is the second most common type of erectile dysfunction (ED).

Until the advertisement campaigns for drugs to treat ED arrived on the scene, many men were too ashamed to ask their doctors about problems with impotency. They just figured that sex for them was over. But since the development of drugs, such as Viagra (sildenafil), to treat ED, that attitude has changed dramatically. But while Viagra, or one of the other such pills, may solve the problem, the medication brings up other issues about communication with one’s spouse.

You should always check with your physician about impotency, especially if you take any kind of medication. Different medications have different side effects. Sometimes, if you complain to your doctor about problems with impotency, he or she can put you on a different type of drug, and the impotency will go away. Impotency may also be an early indication of circulatory problems, so by reporting problems with your erections to your doctor, you may end up preventing a serious health issue.

These ED drugs don’t work for every impotent man. Some men who are on certain heart medications aren’t allowed to take them. And others have physical problems too severe for even one of these drugs to help. But if a man is just not able to have an erection any longer, that doesn’t mean that he can never perform sexual intercourse again. Medication isn’t the only solution to impotency; a variety of implant devices are available to allow a man to have erections whenever he wants them.

A benefit of aging: No more premature ejaculation
Many men who suffer from premature ejaculation (when a man ejaculates before he wants to) when they’re younger find that, as they age, that particular problem often goes away. If their wives really enjoy intercourse, this can signal the start of a whole new phase of their sex lives.

The Psychological Bonuses
The effects of aging go beyond physical changes for both partners. Their attitudes about sex may change for the better as well.

When two people first get married, their libidos are so high that they make time for sex even if time is short. As the years go by, and particularly as children arrive on the scene, finding time for sex can become more difficult. And in these days when both men and women are in the workforce, not only is time often in short supply but energy is as well.

In the so-called golden years, time suddenly grows in much larger supply. The kids are out of the house (I hope), and even if both partners aren’t fully retired, in all likelihood they’re not working full time. These changes allow the couple to make love at various hours of the day, and in various places — not just at night in the bedroom with the door locked.

Making love in the morning isn’t only advisable because it adds variety. The male sex hormone, testosterone, is at its highest level in the morning; if a man has problems with impotency, they are least likely to show up in the morning. Also, after a good night’s rest, energy levels may be higher.

Just as during any other period in your relationship, the more effort you put into better lovemaking during your golden years, the more you get out of the experience.

Same-Sex Relationships

Sexual arousal is a very personal matter. Each of us has a different set of interests that excite us sexually. But there are also some broad strokes that cover larger groups of people. One of those applies to people who become aroused by people of the same sex. They are not in the majority, but because the smaller strokes that color our personal arousal truly define us, no matter what overall group we fall into, we are all equally human and deserving of respect. This article explains sexual orientation, talks about how a person reveals his or her orientation, and lists the different ways homosexuals engage in sex.

Considering Sexual Orientation
Homosexuality is when men or women are sexually attracted only to others of the same sex as themselves. (Hetero means different, and homo means the same.) Which one you are — heterosexual or homosexual, that is, straight or gay (male homosexual) or lesbian (female homosexual) — is called your sexual orientation.

What determines sexual orientation?
I’m often asked why some people desire to have sexual relations with members of their own sex instead of with the opposite sex. From the letters I get, I know that many people believe that homosexuals choose the homosexual lifestyle over heterosexuality. They think that a gay person makes a conscious choice at some point in his or her life to be gay, and so they also believe that gay people can just as easily change their minds and switch to heterosexuality. Of course, the implication is that they should change back to the more “normal” sexual orientation.

The truth is that we don’t know for sure the etiology of homosexuality — the reasons that some people are gay while most others are not. However, current scientific research leans toward the idea that people are born with the capacity to be either gay or straight and that the environment may have some influence as well. In spite of the research done on the subject, scientists have not found any conclusive results.

For many years, homosexuality was defined as a mental illness, and treatment was aimed at restoring “normal” sexuality. It wasn’t until 1973 that the American Psychiatric Association recognized that homosexuality wasn’t a mental illness. Here is what modern science has to say about homosexuality: Research with twins has demonstrated that a genetic component to homosexuality exists, but genetics isn’t thought to account for all cases.

Anatomical studies of the brain have shown some apparent structural differences between homosexuals and heterosexuals, but to date this research, while continuing, is still speculative.

Although humans have been contemplating the issue for eons, we still can come to no conclusion about what determines sexual orientation. All we know is that homosexuality among men and women has existed for as long as history has been recorded, that homosexual lifestyles are no more likely to disappear than heterosexual ones, and, as far as I’m concerned, that homosexuals should be treated with the same respect as every other human being.

Keeping religion and government out of the bedroom
Is knowing why some people live a different lifestyle important? In a perfectly open society that attached no consequences to one’s sexual orientation, knowing what caused different sexual orientations may not be important. But, because some people in our society publicly advocate that homosexual men and lesbians be prevented from — or even punished for — living their lifestyles, I think that understanding the reasons behind homosexuality is relevant.

You see, if gay people have a choice in their lifestyles, then some can perhaps legitimately argue that society should try to control how they live. (Some lesbians say that they chose lesbianism for political reasons, but that subject is beyond the scope of this book.) Society singles out a number of different modes of behavior to restrict. Some think that because we ban things such as prostitution and sex with minors, we could also ban homosexuality. Sodomy (a term that refers to anal sex but can also include oral sex) was illegal across the country for many years and is still outlawed in some states.

But what if sexual orientation is beyond our choice? What if we’re born with our sexual orientation and can’t change it? Should society pass laws forbidding homosexuals from having sex if that’s the only way that sex is pleasing to them? And the other question is, do we want the government telling us what to do in our bedrooms, no matter what our sexual orientation?

Now, as a Jew, I know that the Bible specifically bans homosexual acts, and therefore many believers in the Bible consider homosexuals to be sinners. The problem with relying on the Bible is that so much of what it says is open to interpretation. For example, just a few pages from where the Bible bans homosexual acts, it admonishes us not to wear clothes made from different types of cloth. How many of us follow that regulation? Some religious denominations, such as the Episcopalians, voice support for homosexual priests despite these Biblical injunctions. Many Christians also support our armed forces despite the fact that one of the Ten Commandments says “Thou shalt not kill” and Jesus instructed his followers to turn the other cheek. The only thing we know for certain is that we are all here on this Earth together.

In America, we believe in the separation between church and state. Believers in the Bible are certainly free to stop themselves from committing certain sexual acts, but under the U.S. Constitution, their beliefs don’t confer on them the right to force others to believe or behave as they do.

Although gay sexuality may not fit the mold used by most people, I believe that we shouldn’t criticize gays for behavior over which they may really have no control, and which doesn’t harm anyone anyway. Nobody forces anyone to be gay, and neither should anyone force someone not to be gay.

Behaving responsibly, no matter what orientation you are
What two consenting adults, whatever their sexual orientation, do in the privacy of their home is their own business. Now this doesn’t mean that I give blanket absolution to every form of homosexual behavior. For example, I believe that some of the activities that take place in public areas, like at gay bars and bathhouses, go too far — especially in this era of AIDS.

Homosexuals are as capable of responsible sex as are heterosexuals — and they’re just as capable of irresponsible sex as well. Considering that heterosexuals have a 50 percent divorce rate and often have multiple sexual partners over time, expecting homosexuals to be any different by picking one partner and staying with him or her for a lifetime is unreasonable.

A person in either lifestyle should make a serious effort to form a relationship before having sex. And all sexually active people — gay and straight — should employ safer sex practices.

Where does bisexuality fit in?
There are a few areas in my field where the jury is still out. I’ve already mentioned one of these, the G-spot orgasm. Another is the issue of bisexuality. There is no doubt that there are people who have sex with both the opposite sex and their own sex. What is open to question is whether this is a permanent state or a transitional one. Now, to people who consider themselves bisexual at any given point in time, it will seem as if this is how they will always feel, and yet research has shown that some bisexuals do end up becoming either heterosexual or homosexual. By the way, I’m not talking about who their specific partner is at the moment, but rather how they feel on the inside. Someone could never have had sex with a person of the same sex, say, but still feel the attraction.

Some people label themselves as bicurious, meaning that they want to try sex with both sexes, and may even have done so, but haven’t made up their mind as to their sexual orientation. What gives me pause about this concept is that there appears to be some peer pressure with regards to this, so young people are engaging in sexual acts just to be thought of as cool, rather than because they are really unsure of where they stand. Because I strongly believe that you should only have sex with someone with whom you share a romantic relationship, and because having sex with multiple partners incurs risks, I would urge you not to experiment simply out of curiosity.

Just as we don’t know everything there is to know about homosexuality, we also can’t close the books on bisexuality either. I hope that one day conclusive research will be done on the remaining open issues so we can help people to not only understand, but accept people’s various sexual orientations. Determining Your Orientation: What Turns You On I’m sure that many heterosexuals are reading this chapter out of curiosity, and that’s great. Some straight readers may even get turned on by reading about gay sex, which may confuse them. They may suddenly start to wonder whether they themselves are gay. So, before getting to the sexual part of this discussion, I’d like to familiarize you with the very beginning of the process — uncovering your sexual orientation. Getting excited by reading about homosexual sex, or even having fantasies about engaging in sexual relations with a member of your own sex, doesn’t mean that you’re gay. A homosexual definitely knows whether he or she is attracted to members of their own sex, and that identification doesn’t come because of an occasional gay fantasy. In addition to gay fantasies, a common occurrence among young teen males is to sexually experiment with another male. This experimentation may take the form of masturbating together, or actually masturbating each other.

This may occur among females, too. This type of behavior doesn’t usually go any further than that. Again, sexual experimentation among teenagers is pretty common and doesn’t indicate any homosexual tendencies.What does indicate that a young person is actually a homosexual? The best indicator of homosexuality is if you can get sexually excited only by thinking about having sex with someone of your own sex (even if you have sex only with members of the opposite sex).

Revealing Your Sexual Identity
Sexual orientation goes beyond just engaging in sexual acts. A person’s sexual identity will cover a broad range of areas, some of which may because by sexual orientation, or may simply be a way of fitting in with others in a group. Is being a football fan primarily a straight man’s hobby, or having a flair for fashion primarily a gay man’s interest? I don’t know the answers, but I do know that some people behave in particular ways so they can blend in with their chosen community. So sexual identity affects many aspects of a person’s life, including sexual behavior, sexual attraction, affection, safety, socialization, and so on.

Living in the closet
Saying that someone is in the closet has a range of meanings. Basically, the phrase refers to someone who doesn’t openly admit that he or she is gay. Some people who get married, have children, and spend an entire lifetime living with and regularly having sex with a member of the opposite sex are really not heterosexual at all. To get excited, these people have to fantasize about having sex with a member of their own sex.

People who appear to be openly heterosexual may actually lead clandestine gay sex lives in several different ways:

Some people visit gay bars when the opportunity presents itself, go to areas where gay prostitutes are known to hang out, or merely masturbate while looking at gay magazines.
Some people lead a gay lifestyle only when in the presence of other gays, but put on a front of being heterosexual in other settings, such as at work or school.
Some people may never actually engage in any form of gay sex, but, nevertheless, deep down inside, are gay.

Many of these people, especially in today’s more liberal atmosphere, do end up “coming out of the closet” at some point in their lives. Others box themselves in so tightly that they just don’t feel that they can survive the revelation, and so they hide their homosexuality for their entire lives.

Coming out
Before 1969, few gays publicly revealed their sexual orientation (also called coming out), but a riot in New York — caused by a police raid of a gay bar called The Stonewall — politicized many gays and started what was called the Gay Liberation Movement. This movement insists that those in society treat the homosexual lifestyle the same as the heterosexual one, and that people give gays rights equal to those of everyone else. Since then, federal, state, and city legislatures have passed many laws that give gays much more freedom than they once had to practice their lifestyles. Nevertheless, many members of our society still frown on gays — oftentimes, including the people who are closest to gays: their families.

Coming out to family and friends
The adolescent years are never easy for anyone, but they’re certainly a lot more difficult for gay young people. Not only do gay teens have to confront their own emerging sexuality, which is different from that of most of their peers, but they must then face the rebuke that their sexuality often brings from their immediate families. Revealing one’s homosexuality is never easy — for young or old — but the process can be particularly difficult for teens, who are dependent on their families and have not yet established their own private lives with their own place to live and a job to provide financial support. In fact, the rates of suicide for young homosexuals are much higher than for heterosexuals of the same age, in great part because many can’t cope when faced with rejection from their families.

No two families react the same way when a son or a daughter comes out of the closet.

Some parents may have suspected their child’s homosexual orientation for a while and learned to accept it, so they have a general sense of relief that the subject is out in the open.

Other parents react very negatively, upset that many of their expectations for their child — the traditional heterosexual marriage followed by grandchildren — have suddenly disappeared. They may also react negatively, in part because they feel that their child’s homosexuality reflects badly on them (and the way they raised that child) in the eyes of the rest of the family as well as friends and neighbors.

In some families, the reaction is split, with one parent accepting the son or daughter’s announcement and the other going so far as to cut off all contact.

Teens should understand that being a parent isn’t easy, and because the expectations of most parents are turned topsy-turvy by the announcement that their child is gay, it’s normal for them to have some mixed emotions in the beginning. Getting past those feelings and working with your parents, and perhaps a counselor, to rebuild family unity is the key, and I don’t believe that you can help do that without some preparation. If you’re forewarned about how your family may react, and have been told ways to handle these reactions, you’re much more likely to end up being accepted by your family.

The most important advice I can give to those of you who are gay and who haven’t revealed your sexual identity to your family is to immediately find a counselor who has worked with other gay people facing this problem to give you. The counselor’s experience in this area can be invaluable to you in obtaining the best possible results from your circumstances.

Coming out to the world
Most gay people come out to a potential sex partner first. That experience itself can be very scary. What if that person turns out to be straight? Rejection is always traumatic, but especially if the other person is actually repulsed by the offer, as a straight person approached sexually by someone of their own sex often is.

Eventually, most gay people meet others who share their lifestyle, and the support that they get from others helps them to then declare their sexual orientation to their families and friends. One new way of discussing the topic that is helping many teens come out are Internet chat rooms. Using this method of communication, teens can find out about the gay lifestyle without having to reveal their own identity until they’re ready to do so.

Coming out in your profession or on the job can be much more risky. Openness about one’s sexual orientation doesn’t always translate well in the business world. Because of this, many gay people who don’t hide their status at home are very careful about whom they tell at the office. Some companies won’t hire a homosexual simply because of the strain that a potentially HIV-positive person may put on their health benefits program. In other cases, some employers are becoming less tolerant of their homosexual employees, either because of their own fear of AIDS or because of a concern that their other employees may react negatively. Even though this discrimination is often illegal, it doesn’t stop it from occurring, no matter how abhorrent.

This on-the-job discrimination against homosexuals can backfire in the battle against AIDS. For appearance’s sake, a gay employee may avoid forming a relationship, which forces him or her into the dangerous world of anonymous sex, where the risk of getting and spreading AIDS is so much higher.

Because a gay person can never know exactly what the outcome of his or her coming out will be, the decision is always a heavy burden. If everything goes right, gay men and women may feel as though a tremendous weight has been lifted from their shoulders because they no longer have to lead dual lives. On the other hand, if they end up losing contact with certain family members and friends or losing their job, many people may find the loss a heavy price to pay for admitting their true identity.

Coming out when you’re married, with children The gay man or woman who marries someone of the opposite sex and also has children faces a double burden if he or she decides to reveal a different sexual identity. In addition to his or her own suffering, his or her partner and children undoubtedly suffer tremendously.

Although the gay person certainly feels a sense of loss at leaving the spouse and children, the gay person will likely eventually blossom within the gay community. However, for the partner who is left behind, the grieving process can be worse than that caused by the death of a spouse. That person now has not only lost a spouse, but has also had his or her own sexual worth badly damaged. The partner whom they loved, and whom they thought found them sexually attractive, may have never actually felt that way. This realization comes as a crushing blow. (However, some women are relieved to know that they were being rejected for reasons that had nothing to do with them as individuals.) Straight spouse support groups can help people come to terms with their thoughts about themselves and their gay spouses. Still, many abandoned spouses end up facing their loss alone.

These negative consequences don’t result from the gay people making a bad decision by coming out. Rather, I believe that these gay people make a bad decision when they marry in the first place. By allowing society to pressure them into leading a lifestyle that doesn’t suit them, they end up causing many other people a lot of pain and suffering later on — in addition to the suffering they endure themselves while leading a life not truly their own.

Outing by others
Some people within the gay community believe that all gay people should reveal their homosexuality. These people sometimes act on this belief and reveal the secretly gay person’s sexual orientation to the world at large in a process called outing.

I am totally against outing. I have seen the pain and suffering that gay people go through when they freely decide to reveal their true selves, and nobodyhas the right to force someone else to undergo that process.

Finding support
Not long ago, left-handed children were forced to learn to write with their right hands. Society has since learned to accept lefties, and in some endeavors, such as sports, many lefties actually have an advantage.

I hope one day we will feel the same way about gay people that we feel about lefties. The pressures that our society puts on gays to keep their sexuality hidden causes untold damage. And the guilt for this lies not on gay people, but on all of us for trying to force them into adopting a false sexual identity.

Although everyone focuses on the AIDS crisis among homosexuals — and the disease certainly has had a horrible effect on this population — at the same time, gays have been building networks to help each other live more satisfying lives. They’ve organized politically, with groups such as the National Gay and Lesbian Task Force, so that in major cities with large gay communities, homosexuals have gained many, if not most, of the same civil rights as heterosexuals. Gay resorts have sprung up where homosexuals can gather without feeling different.

All of these changes have made life a lot more pleasant for homosexuals since the Stonewall incident, but far too many people still remain ignorant and discriminate against others because of their sexual orientation.

Sexual Practices among Gay Men

Homosexual men practice a wide array of male-to-male sexual activities — Many of them identical to heterosexual activities. And, in a gay relationship, the feelings of love and caring can be as strong as in any heterosexual relationship.

Because of the traumatic effect that AIDS has had on the gay community, I am listing gay sexual practices in order of their safety — a major concern for both gays and straights. I particularly want young homosexual males to hear this message about safer sex. Although the older gay population, which has seen so many of its members suffer and die, has adopted safer sex practices, reports indicate that young gay men are still flirting with danger. I can only hope that they use safer sex before it’s too late.

At the safest end of the spectrum is voyeurism; that is, watching other people have sex. This activity may be compared to straight men going to topless clubs; although, because of the atmosphere of the gay bar and bath scene, masturbation more likely accompanies voyeurism among homosexuals.

Group masturbation is another common practice in certain homosexual communities. This may either be solo masturbation done in the presence of others, or mutual masturbation, which is sometimes done in circle jerks where one man masturbates the next, who masturbates the next, and so on. Because of the dangers of AIDS, most major cities have developed J/O Clubs (the J/O stands for “jerk off” or “jack off”), which are places where gay men may masturbate together. These clubs usually have strict rules against other, dangerous forms of sex.

Frottage is the term applied to the practice of two men rubbing their bodies against each other, usually until climax. This is considered a safe form of sexual activity.

Fellatio, oral-penile sex, is considered to be the most common form of sex between men.

Because the risks of transmitting an STD are greater if one person ejaculates into the mouth of the other, ejaculating in the mouth is often avoided. Because of the leak of Cowper’s fluid, however, oral sex still has some danger to it unless the person on whom fellatio is being performed wears a condom. Kissing other body parts includes little risk, except for anal kissing, or rimming, from which many STDs can be passed on.

The most risky form of gay male sex is penile-anal sex. This is when one man inserts his penis into the anus of his partner and thrusts until he achieves orgasm. The person whose anus is being penetrated (the bottom) may also find pleasure from having his prostate and rectum stimulated in this manner. The transmission of STDs is at its highest during anal sex because the ejaculate can contain the viruses. Because the rectal lining is often torn or abraded during this sexual practice, the viruses then gain easy access to the bloodstream.

The use of condoms is a must for safer penile-anal sex; although, because of the amount of physical activity, condoms are more likely to break during anal sex than during vaginal sex. So, even with a condom, anal sex remains a risky activity.

Marriage between Same-Sex Partners
Although our society condemns gay people for being promiscuous, it also puts roadblocks in front of gays who want to make a commitment to each other. Many people want to limit the concept of marriage to the union of a man and a woman. Because I want to wish a healthy life to all human beings, I believe we must encourage all people, including gays, to form long-term relationships.

Sex When You’re Physically Disabled

Saying that terrific sex is possible and desirable for people with physical disabilities isn’t the same as saying it’s easy to come by.

Perhaps the most difficult part of sexuality for many people with disabilities is finding a partner. Some people who were once physically fit and had a partner lose that partner after they become disabled. No one can say whether losing a partner is worse than not having one in the first place; both are very, very difficult circumstances. If the disabled person’s partner does leave, adding an emotional loss to the physical one, this combination can prove unbearably painful.

Finding a partner
Persistence and open-mindedness are the most important characteristics for a person with disabilities to have in finding a partner. You have to learn to have faith in the fact that some people decide whom they want to have as a partner based on the inner person, not a person’s physical attributes or financial well-being. These individuals can look beyond physical problems because they fall in love with others based on who those people are as human beings.

For such a person to discover the inner you, you must allow your inner being to shine through. This isn’t easy. Often people with disabilities tend to hide themselves in shame or to cover their weaknesses with anger. Although these two common responses are quite understandable, you must let as many people as possible see the real you, the happy you, the sensitive you, the sexy you. Then, hopefully, you’ll find a partner.

Some people who become the partner of a person with disabilities are themselves disabled and may even have the same disability. But if you act unpleasant and make it especially difficult for someone to love you, then whether the person you meet has a disability or not doesn’t really matter. There are many wonderful people to whom a disability isn’t an impediment to opening up their heart, but that doesn’t make them want to spend time with a self-absorbed grouch.

Most disabled people have to struggle every day just to get by, so I know that you possess plenty of strength and courage. I also know, however, that giving up on something long-term, such as finding a partner, is easy to do when just getting down to the street is an effort. But you can’t let yourself give up. You have to persevere because finding someone to share your life with is a goal worth every ounce of determination you put into realizing it.

One benefit to showing your bright side is that, even if you never find a partner with whom to form a loving and sexual relationship, you will certainly make new friends. People can’t help but be attracted to a sunny disposition.

If you smile, if you give people compliments, if you tell a funny joke, if you give them a big hello, they will respond positively. On the other hand, if you have a sour face, if you mumble, if you complain, you will turn people off.

Many of you may be saying, “But I have a disability — I have enough troubles. Why do I have to reach out? Why do I have to be the first one to smile?”

Well, you know what? I give the exact same advice to a physically able person who wants to find a partner. Your disposition does play a role in attracting others, and just because you have a good excuse for feeling rotten doesn’t change the fact that negative feelings repel people. That’s just the way it is; if you want to attract people, then you have to act attractive.

Partnering the person with disabilities
Comparing pain is impossible, so I would never make a comparison between the hurt felt by those who become disabled, in whatever way, and the suffering of their partners. Nevertheless, I must acknowledge the partners’ pain. Without warning, a marriage that included a long list of activities that both partners enjoyed (such as skiing or tennis or making love on the dining room table) becomes one full of obstacles instead. Yes, the physically fit partners still have their health, but their hopes, dreams, aspirations, and fantasies can be just as damaged as those of their disabled lovers.

Sadly, but often understandably, many of these partners leave the marriage. They refuse to accept the limitations put on their lives by living with a disabled person. Sure, the world would be a great place if everyone could be heroic, but not everybody can. We shouldn’t condemn these people because we don’t know for sure what we would do if we were in their shoes.

Keeping the relationship alive
Some couples, when one partner’s health first fails, swear that they will stay together and work things out. Keeping that promise isn’t always possible, however. Sometimes the relationship ends because the healthy partner just can’t find the strength any longer to take care of a disabled partner and still manage his or her own life. In other cases it ends because the disabled person places too many demands on the partner with too little consideration.

No matter how difficult having a disability is, a person with physical challenges must be willing to give his or her partner a hand. Yes, you may have lost certain faculties, but you have to be willing to exercise the ones you still have to your fullest.

Because this is an article about sex, let me address that particular subject. If a man has an accident and, as a result, loses his ability to have erections, his wife doesn’t have to spend the rest of her life sexually frustrated. If he can still move his fingers, if he can still use his tongue, if he can hold a vibrator, he owes his wife sexual fulfillment. If the man abandons his wife sexually while at the same time asking her for all sorts of other help, then she may not be able to bear all those burdens. The same holds true for a disabled woman who withholds sexual favors.

An inspiring man
On one of my television programs, I interviewed a man who was quadriplegic, and he was willing to talk on national television about the great sex life he had with his wife. He did the best that he could with what God left to him, and he had a very successful marriage.

He is definitely inspirational, and thankfully he is not alone. Many people with physical disabilities have great sex. Coming Home, a 1978 movie (now out on DVD) about a soldier who returns from Vietnam in a wheelchair, offers a moving example of how sexual and sexy the relationship of a disabled man and a healthy woman can be. A disability doesn’t have to put an end to a couple’s sex life, although it will almost definitely mean that they will have to put more effort into seeing that the fires do keep burning brightly.

If the healthy spouse of a disabled person who refused to engage in any sex came to me, I wouldn’t necessarily advise that person to stay in such a marriage. I may feel bad saying it, but I just might have to say that the healthy person has to think of themselves too.

You should also remember that, besides sex, many other things form the glue that keeps a loving partnership together. You have to tell your partner how much you love him; you have to thank her for putting in the extra effort that your disability may cause; in short, you must nurture your entire relationship if you are going to have a successful marriage.

If you and your partner face a disability, I can’t recommend too strongly that you speak to your doctor about sexual functioning. These days, medical help is available. For a man who can’t have an erection, Viagra (sildenafil), penile implants, or Caverject (alprostadil) injections may be effective. In the case of spinal injuries, the man may not feel an orgasm the same way he used to, but he may be able to have an erection, ejaculate, and feel pleasure from the experience. If your doctor doesn’t have the information you require on this subject, be advised that facilities exist that have helped disabled men with their sexual functioning, and make an effort to contact the one nearest you.

I also recommend that you see a sex therapist or marriage counselor — in particular, one who has experience working with disability issues. Both you and your partner may have worries and fears that play a role in your sexual functioning — maybe even a bigger role than the actual disability. You both need to talk these problems out, and rarely can a couple accomplish this communication without professional help. The same is true of strains other than sexual ones, which can tear at your relationship. Undergoing such trials is never easy, so don’t be ashamed to seek help in overcoming them.

Sex After You’ve Had a Heart Attack

When most people hear the term disabled or physically challenged, they immediately think of someone with an affliction that you can easily see, such as a person who is in a wheelchair, who uses a cane, or who signs instead of speaks. Not every ailment is visible, however, and one of the most common problems that affects sexual functioning is a heart attack.

Overcoming fear
You may have heard rumors of famous men who died because of a heart attack while in the throes of passion. I can’t attest to the truth of any of these stories. But I can tell you that, for the average person who suffers a heart attack or undergoes heart surgery or even has angina, problems with sex almost always result. Not that these people don’t want to have sex, but they’re afraid. They worry that, as a result of engaging in intercourse or having an orgasm, they will trigger another heart attack — this time, a fatal one.

This isn’t an absolutely foundless fear, but studies show that the increased risk is really minimal. For healthy people, the risk of having a heart attack after sex is about 2 in a million. For people with heart conditions, that figure rises to 20 in a million. Even though the number increases by tenfold, you can see that the risks remain very small.

Certainly, for a time after you’ve had a heart attack, your doctor will forbid you from having sex. And just because the doctor gives you the green light doesn’t mean that you will feel ready. It doesn’t take much to make a man lose his ability to have an erection, so you can imagine that the fear of provoking a heart attack can certainly cause impotence. For women, the usual problem is anorgasmia, the inability to have an orgasm, and it is equally understandable that a woman who normally gets little enjoyment from sex may be reluctant to participate in the act.

The best treatment for fear of sex after a heart attack is reassurance from your physician or cardiologist. I believe that this reassurance should take place in the hospital while you are still recuperating. Sexual performance is almost always a concern of someone who has had heart problems, and having your fears alleviated as quickly as possible can help speed up your recovery. If you need further tests to determine what you can and can’t do, then, by all means, you should get them. No doctor should consider the loss of sex as no big deal because it is a big deal — not only for the patient, but also for the patient’s partner.

By the way, the patient may not be the only one who suffers from impotence or anorgasmia. The partner, who is just as afraid of causing a crisis with his or her lover’s heart, can also suffer. The partner may need just as much reassurance as the patient.

One way to overcome the fears associated with sex is to make masturbation the first step and slowly work your way up to intercourse. You can also perform masturbation on your partner so he or she doesn’t have to be sexually frustrated during your recovery.

It may not all be in your head
Fear isn’t the only factor that can cause impotence. Vascular problems usually accompany heart problems, so — because a man’s erection results from blood flowing into the penis — sometimes the impotence a man experiences after a heart attack has physical rather than mental causes.

Angina, shortness of breath, and palpitations are problems associated with heart conditions, and, although they may not be deadly, they can certainly put a crimp in your sex life. Very often these symptoms show up after you’ve had an orgasm, when your heartbeat is on its way down. Now, if you get an angina attack (a sharp pain in the chest area) every time you orgasm, these attacks won’t improve your desire for sex. Here, again, you should consult with your physician or cardiologist. Don’t be ashamed to ask specific questions. Your doctor may have suggestions that will help you have a relatively normal sex life, and you have every right to find out.

What can you do?
Here are some specific tips that may help you if you have heart trouble.

If you have a heart condition, don’t engage in sexual activity when you’re angry or under a lot of stress. At these times, the heart already beats faster, and sex would only tax its abilities even more.
See if your doctor can prescribe drugs such as calcium channel blockers or beta blockers for you. These drugs can make sex easier on your heart.
Some heart patients decide for themselves to take their heart medication, such as Inderal (propranolol) or nitroglycerin, before having sex, thinking that they can prevent heart troubles.
Do not attempt such techniques without first checking with your physician. (Propranolol is used on a schedule, so taking it out of schedule can be risky.) Men suffering from impotence may consider taking Viagra or another drug used to treat erectile dysfunction. This can be deadly, however, so don’t ask for a prescription from another doctor without first checking with your heart specialist.

The medications that are prescribed for heart conditions, such as beta blockers, antihypertensives, and diuretics, can cause sexual functioning problems of their own. Sometimes your doctor can prescribe alternative medicines that will still be effective without getting in the way of your sexual functioning, so ask questions of your cardiologist.

Both the medical profession and the patients share the responsibility for the lack of communication between them. Some cardiologists gloss over the sexual aspects, but many times the patients are simply too shy to discuss their sexual problems with their cardiologist. This embarrassment especially holds true for older people, who form the biggest proportion of heart patients. They may believe that, at their age, sex isn’t important. But sex is important,and it can play an important role in your recovery. Don’t ignore sexual problems; speak out.

I believe that consulting with a sex therapist who is trained in working with people with heart ailments is also a good idea. Sex therapists aren’t shy about speaking to you about your sexual functioning, and, if necessary, they can act as an intermediary and speak to your doctor to find out exactly what sexual activities you can perform safely.

Sex When You Have Diabetes

Diabetes is a disease in which the body doesn’t properly use or produce sufficient amounts of insulin, which is a hormone needed to process sugar and starches. This disease has many side effects and can be deadly. Diabetes currently affects 7 percent of the population, and sadly the number of people with diabetes grows every day.

One of the side effects of diabetes in men can be impotence. The fact that so many people know about this possibility means that many men who are diabetic suffer needlessly with impotence. In these cases, the impotence is caused not by the disease, but by the anxiety they feel.

If you’re a diabetic having problems with your erections (either a softening of the erections or no erections at all), I suggest that you visit a sex therapist for several reasons:

The therapist may be able to help restore some or all of your lost functioning, if the cause isn’t physical.
Even without a firm erection, sexual enjoyment and ejaculation can still be satisfying. A therapist can help you explore these possibilities.
You should visit this sex counselor with your spouse because she may need reassurance that you are having these problems because of the disease, not because you no longer find her attractive or have taken an outside lover.
You should also consult with your doctor because some products on the market may be able to restore your ability to have an erection, chief among them Viagra. If you’re not a candidate for Viagra or one of its competitors, then a penile implant may be the solution you require.

Drugs that can affect your sex life
Many drugs have side effects that pertain to your sex life. The following is a list of drugs that can affect various sexual functions. Take note: These drugs will not affect everyone the same way, but if you are taking one or more of these drugs and you notice that it is affecting your sexual functioning, speak to your doctor about it. The doctor may prescribe a different drug, or perhaps a different dosage, which can restore your sexual functioning. Drugs that have been on the market for a long time are more likely to affect your sexual functioning because when pharmaceutical companies first developed these drugs, their main concern was treating the symptoms involved. Only later, as these companies tinker with the dosages, have they eliminated some of the negative side effects.

Drugs that can affect sexual desire (names in parentheses are generic names):
Antihypertensives, antidepressants, hypnotics, antipsychotics, ulcer medications, birth control pills, and antianxiety drugs such as Aldomet (methyldopa), Anabuse (disulfiram), antihistamines, barbiturates, Catapres (clonidine), estrogens (used in men to treat prostate cancer), Inderal (propranolol), Librium (chlordiazepoxide), Lopressor (metoprolol), Serpasil (reserpine), TADs (tricyclic antidepressants), Tagamet (cimetidine), Tenorim (atenolol), Thorazine (chlorpromazine), Trandate (labetalol), and Valium (diazepam).

Drugs that can affect ejaculation:
Aldomet (methyldopa), anticholinergics, barbituates, Catapres (clonidine), Dibenzyline (phenoxy-benzamine), estrogens, Ismelin (guanethidine), Mellaril (thioridazine), MAOs (monoamine oxidase inhibitors), Serpasil (reserpine), thiazide diuretics, Thorazine (chlorpromazine), tricyclic antidepres- sants, and selective serotonin inhibitors, such as Prozac, Zoloft, Paxil, and Celexa.

Drugs that can affect erections:
Adalat (nifedpine), Aldomet (methyldopa), Antabuse (disulfiram), anticholinergics, antihis- tamines, Banthine (methantheline), barbiturates, Calan (verapamil), Cardizem (diltiazem), Catapres (clonidine), digitalis, Dilacor (diltiazem), estrogens, hydroxyprogesterone (for prostate cancer), Ismelin (guanethidine), Isoptin (verapamil), Librium (chlordiazepoxide), Lithonate (lithium), MAOs (monoamine oxidase inhibitors), Mellaril (thioridazine), Procardia (nifedpine), Serpasil (reserpine), Tagamet (cimetidine), Thorazine (chlorpromazine), Trecator-SC (ethionamide), tricyclic antidepressants, Valium (diazepam), and Verelan (verapamil)

Drugs that can affect orgasm in women:
Aldomet (methyldopa), anticholinergics, Catapres (clonidine), MAOs (monoamine oxidase inhibitors), tricyclic antidepressants, and selective serotonin inhibitors, such as Prozac, Zoloft, Paxil, and Celexa.

Diabetic women can also suffer from diminished sexual functioning. The intensity of the orgasmic response is sometimes lessened, and she may develop a greater need for increased manual or oral stimulation of the clitoris to have an orgasm. Again, a sex therapist can help you deal with these symptoms.

Sex and People Who Are Mentally Disabled or Ill

Some people with mental disabilities, such as Down syndrome, have only the intelligence of a child. Many people believe that these people should be treated like children with regard to all of their abilities. They believe that these adults should be “protected” from sex the way we protect children. As a result of such policies — especially if the person lives in a group setting — family or staff make an effort to eliminate any form of sexual interest or expression from these people’s lives. They get no privacy and aren’t even allowed to masturbate.

In many cases, this restrictive attitude toward sex conflicts with reality because, although a person’s mental level may be stuck in childhood, physically, he or she goes on to become an adult. The men have erections, nocturnal emissions, and a fully developed libido (sex drive) with all the attendant sexual desires. The woman’s sex drive also can develop fully, and physically she will have to adapt to having her menstrual periods.

Although, for some mentally impaired individuals, sex education can be limited to teaching them not to undress or touch their genitals in public, many others would benefit from learning about safer sex practices and how to handle a relationship.

Because the degree of mental proficiency differs for each individual, how much they should be taught, and how much freedom regarding sex they should get, depends on the individual. Some mentally disabled people marry and have children; for others, such activities aren’t appropriate.

Anyone — parent, relative, or caretaker — dealing with a mentally disabled person who reaches adolescence can’t ignore sex. As the mentally disabled person grows up physically, his or her hormones kick in, causing a variety of changes, such as the growth of pubic and underarm hair, breasts, and so on. Just as with average teenagers, someone must teach mentally disabled teenagers that these changes are normal. Girls must learn to use a pad or tampon. Boys must be told about wet dreams. Both sexes have to understand the sexual feelings that they are starting to have. Both have to learn about masturbation and that they should do it in private.

Another point to consider is companionship. Everyone needs companionship, and so people pairing off is only natural. Sometimes that companionship develops into a romance, and then a sexual relationship. Some institutions allow this activity to take place, making sure that contraception is used, while others do not. But even keeping men separated from women can’t ensure that sexual contact won’t take place.

The best approach is to offer all mentally impaired people sex education so they can learn to deal with this aspect of their lives. They will benefit from it, and so will those who take care of them. We can’t deny people who have mental impairments the right to fulfill the same needs the rest of us have, and so we have an obligation to help them learn as much as they can absorb.

While some people are born with a mental disability, far more people at some point in their life encounter a mental illness, such as depression, which affects 19 million people in the United States. I encourage anyone who suffers from a mental illness to seek treatment from a mental health professional. Most of these therapists will ask patients about any effects their condition has on their sex life. If someone with a mental illness is encountering sexual difficulties because of their illness and their doctor doesn’t ask about it, they shouldn’t hesitate to bring up their concerns. Sexual functioning is an important part of life, and if help can be offered (which may simply be a change in medication), such remedies should be explored.

Sex and People Who Are Living in a Long-Term Care Facility

Just as people who take care of the mentally disabled must accept the sexuality of those under their care, so must those people who tend to any person who is permanently living in an institutional setting, including those with chronic disabilities and the elderly who are in nursing homes. For the vast majority of these people, whatever disabilities they do have, sexual dysfunction didn’t place them in the facility.

Individuals living outside of their homes deserve respect for both their sexuality and their privacy. If they need the door closed to masturbate, caretakers shouldn’t disturb them. Many times, people confined to a nursing home form romantic relationships. In these cases, I believe that facilities should designate dating rooms, with clear “Do Not Disturb” signs, so residents can enjoy their companionship in whatever way they see fit. Remember, even if a couple doesn’t have intercourse, the pleasure of touching each other, hugging, or kissing is intensified if the couple is permitted to be alone.

In some cases, a couple can’t have sex without assistance. In these instances, I advocate that the staff should be trained to help disabled individuals enjoy the benefits of sex in much the same way that the staff is trained to help these people bathe or use the restroom. Sex isn’t only for the young and beautiful, but for everybody, and this assistance should be provided in a nonjudgmental way.

To create an environment where healthy sexual relationships can flourish in these settings, the staff must receive the necessary counseling to handle such issues just as competently as they give other types of care. Because of our society’s values, helping people to have sex doesn’t always come naturally, but I believe that, given the proper guidance, we can make our institutions a little warmer than they are now by including as much loving as possible.

Uncompromising Compromised Sex
In all probability, sex for a person with disabilities or a medical condition will involve some compromises. Not every position will be possible; maybe even some very basic sex acts, such as intercourse, are impossible. Those limitations don’t mean, however, that the two people having sex can’t derive a lot of pleasure from their activities. The important thing is not to look at your sex lives as limited, but to try to make the most of the sexual performance that you can have. Discuss your situation with your doctor to find the full range of what is possible for you.

Remember that sex isn’t just orgasms. The pleasure that comes from making love (and here, I think, using that term is very important) comes also from touching each other, kissing each other, and caressing each other.

The human body and the human spirit are amazing things. Very often, the body of a disabled person compensates for one loss through the development of other senses. A blind person may find that his or her sense of hearing has improved considerably. A deaf person may develop a keener sense of smell. And so people with disabilities may well find that the parts of the sex act that are available to them become exquisitely pleasurable.

For this reason, you should never give up. Try to enjoy sex to whateverextent you can and make sure that your partner enjoys it, too. You may find that you gain as much enjoyment as any nondisabled person does and, by fully appreciating the sensations that you do have, maybe even more so.