The Ultimate Guide to Sex and Disability (35 page)

If you aren't going to use a condom for oral sex, then you should try to avoid getting semen in your mouth. This isn't totally protective, as pre-cum can also have germs in it, but it does reduce your risk. Do not brush your teeth right before sex because it can cause little scratches in the gums that might let in viruses. Some people suggest rinsing your mouth with an antibacterial mouthwash afterward, but there is no evidence that this works.

EASY-ON CONDOM

There is a new condom called the EZ-On. This condom is made of nonlatex material and is unique because of the way it can be put on. Each condom comes in a cardboard disk that offers you something more to hold on to while you slide the condom on a penis or dildo. The design is also unique because you can slide the condom on either way (with most condoms there is a wrong way to slide it on and it won't roll down correctly if you don't do it the right way). This condom has two main drawbacks. First, at the time we wrote this it was not available in the United States. It is currently only available in Canada and Europe. Second, the condoms are very expensive (usually $3 each). For more information about this condom you can visit the company's website at www.mayerlabs.com.

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How to Use a Condom

Condom use goes against the environmental "reduce, reuse, recycle" idea. We'd like to see people using more of them, and they should never be reused.

Putting on a condom can get tricky if both partners have difficulty using their hands. It takes quite a bit of manual dexterity to open a condom packet and put on a condom. In chapter 4 we discussed negotiating with attendants about putting on condoms. After we describe how to put a condom on with your hands, we will describe a way someone can put one on with their mouth.

Condoms should be put on before the erect penis gets near the partner's genitalia. Condoms come individually wrapped, in little plastic or foil packets. They have an expiration date on them and should not be stored in hot places (like a back pocket or wallet).

Open the packet, being careful not to tear the condom with your teeth or fingernails. Pull the condom out, but don't unroll it yet. Make sure the condom is the right way up. This means you can see the rolled-up part, it isn't tucked inside the condom. Squeeze the tip of the condom so there is no air in it (which makes room for semen). Most condoms have a kind of nipple at the end for this, although a few brands don't. If you want you can put a couple of drops of lube inside the condom (this will increase sensitivity). With the tip squeezed, hold the condom against the top of the penis. If the penis is uncircumcised, pull back the foreskin. Unroll the condom all the way down to the base of the penis. There might be some condom left rolled up. It's always a good idea to use extra lubricant with condoms. This will reduce the chances of a condom breaking and also increases sensitivity.

If you can't use your hands, and your partner can't either, you can try the mouth trick. Obviously the person attached to the penis can't do this, the partner has to. It can be tricky and you need to be careful with your teeth. Practicing a few times with a dildo, cucumber, or banana may be reassuring. Some condom packages are easier to open than others. Because the tiny rectangular packages might be harder to remove the condom from, you might want to start with the square packets instead. If you

can get the condom in your mouth, suck it into place with the reservoir tip facing your throat. Have your lips or teeth closed enough so that the rolled edge doesn't go into your mouth—this is definitely not worth suffocating for. Use your tongue to press the tip toward the roof of your mouth behind your top teeth, so you are squeezing the tip against the back of your teeth and keeping air out of it. Using your lips and mouth, slide the condom onto the head of the penis or dildo. If you can, use your neck muscles to push the condom down onto the penis or dildo. If not, maybe your partner can move his penis toward your mouth. Once the condom is on a little, you can try to use a different part of your body to further roll the condom on. You don't need as much manual dexterity for this, so you might be able to use your hand, or your forearm or tongue.

Removing a Condom

Taking off the condom is as important as putting it on. If neither of you can use your hands, it may be best to pull out before or during ejaculation. If one person can get their hand around enough of the penis to hold the condom on, then you can wait until after ejaculation. A condom will fall off a flaccid penis, so it is important to withdraw the penis right after ejaculation before it becomes soft. Hold the condom at the base of the penis with your thumb and forefinger in a ring. Pull the penis out and move away from your partner. Either person can help with this. Slide the condom off and tie the end of it. If you can't tie it, have a plastic bag handy to throw it in right away. Don't flush it down the toilet. Don't let the condom or the penis touch your partner's genitals. Wash the penis before letting your genitals touch again.

If a condom comes off or breaks during vaginal or anal penetration, get the condom out right away. The partner shouldn't douche. Men might be able to protect themselves a bit by going to the bathroom and peeing and washing their genitals. A broken condom is a good reason to get STI testing. For women who are not otherwise protected against pregnancy, emergency contraception is available that can be taken up to seventy-two hours after intercourse, although the sooner it is taken, the better.

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Dental Dams

Used by dentists during oral surgery, dental dams are thin squares of latex that can also be used to provide a barrier during oral/vaginal and oral/anal contact. Many sex educators recommend using dental dams, but no one knows how often they actually get used in real life. There is no good answer as to whether they should always be used for cunnilin-gus. The risk of transmission of HIV in this activity is lower than for fellatio or for penetrative sex, but other STIs can be transmitted fairly easily through cunnilingus. Because analingus also carries a risk of transmitting intestinal parasites, dams are a good idea. Dams can be tricky to use because they don't stay in place themselves and require a hand to hold them there. Some companies sell "dam garters" that you can wear to hold a dental dam in place. If you'd rather not pay for something like that, you can try cutting holes in your underwear and wearing them with a dam in place. People also sometimes use household plastic wrap instead of spending money on dental dams. It is not certain whether this is an effective barrier, but if you are using plastic wrap be sure to use regular wrap and not the microwaveable kind (which is more porous and less effective). With any sort of barrier, using some lube on the vulva under the dam will increase sensation. Dams and other barriers should not be reused. There are now nonlatex dental dams available for people with latex sensitivies.

Gloves

For any penetration play involving fingers and orifices you can use gloves. They are always recommended to cover a finger or fingers going into the anus, but they can also be used if someone knows they have HIV or an STI and their partner will be touching their genitals. Cuts or sores on the hands can increase the risk of transmitting HIV or hepatitis in either direction, and gloves can prevent this. Even if neither partner has an STI, gloves are a great way of keeping things clean and smooth (hangnails, small cuts on the fingers, and rough nails all get smoothed out when you put on a glove). The most common gloves available are latex gloves. People with latex allergies have several options. Two options are

gloves made from vinyl and gloves made from a material called nitrile. Both provide protection and are still thin enough to transmit sensation.

Safety with Sex Toys

As with anything else, sex toys can be misused and have unpleasant or dangerous effects. In the allergy section in chapter 9, and later in this chapter, we talk about the materials that sex toys are made of. There are other safety considerations also.

Sex toys used for penetration may be harder than a real human being. They can have rough edges or seams that can cause cuts. Taking your time, using lots of lube, and paying attention to what you are feeling are all important.

If you have decreased sensation, then you need to be even more cautious. Use lots of lube. You may want to start off with a toy that is smaller than what you think you want, and then move up in size as desired.

My girlfriend is a para and does not have a lot of sensation in her genitals. Once we tried a cheap dildo that didn't even look like a penis but had all these ripples so we thought it would do the trick. Because my girlfriend doesn't have sensation below the waist, she wasn't able to tell me that she was uncomfortable. We got a little excited and zealous with the dildo. Afterwards though, she told me that she didn't feel "right" for a few days. Her insides felt funny and she didn't want to use the dildo again for a while. I learned that I have to take it slow and that we might have to be more cautious if we are trying something that involves any kind of penetration.

For anal penetration, use only toys that are designed for this. A toy without a flared based can get sucked up into the rectum and will not always be easy to retrieve.

If you are going to use a cock ring, make sure that you will be able to get it off within thirty minutes, or that there is someone who can help you with this.

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Autonomic dysreflexia (AD) is a potentially life-threatening response to a problem in the body that is most likely to occur in people with a spinal cord injury at or above thoracic level 6 (T-6). It is usually triggered by a bladder or bowel problem and by labor (the "having a baby" kind of labor). It may also be triggered by sexual activity, particularly the use of a vibrator. The body identifies a problem, but there is no conscious awareness of the problem because messages to and from the brain get blocked by the SCI. Blood vessels constrict and blood pressure rises. Other parts of your body sense the increase in blood pressure and try to counteract the change by slowing your heart rate and sending signals to tell your blood vessels to relax. These signals can't get through the spinal cord lesion. Blood pressure continues to rise.

The rapid rise in blood pressure can be very serious. There are ways to deal with AD, first among them learning the warning signs your body gives you and knowing how to check yourself out. Early warning signs are flushing, sweating, and increased spasticity. That's when you should get medical attention. More serious signs, which may occur later, are blurred vision, headache, nasal congestion, nausea, and erection of body hair. Having an emergency plan is crucial. Get into a position where your head is elevated, your clothes are loosened, and your shoes are off. Make someone stay with you while you or they call for help. For more information about AD the Paralyzed Veterans of America have put together an excellent, and free, information booklet. You can contact them at 888-860-7244, or online at www.pva.org.

Allergies

We come into contact with many materials during sex—soaps, deodorant, and perfume on our partner's skin; latex in condoms, gloves, and dams; rubber and additives in sex toys; spermicides and lubricants; and even traces of food on hands.

People who have allergies should keep in mind that they may react to something during sex. People who have never had an allergic reaction

should consider this as a possible cause of pain during sex or of a rash that develops afterward.

In addition to allergies, people can have nonallergic reactions to chemicals they are exposed to. The most notable is that some people feel extreme skin irritation after exposure to some spermicidal foams or gels.

Latex Allergies

Most condoms, gloves, and dams are made of latex, as are many sex toys. Anyone who has had a lot of exposure to latex, especially to internal organs through multiple surgery or to mucous membranes through catheterization, is at a higher risk of latex allergy. People with spina bifida (menigomyelocele) often have latex allergies.

People with even mild latex allergies should avoid exposure to latex, as such allergies get worse with increased exposure to the substance.

Latex allergy can result in a rash, difficulty breathing, swelling, or even an anaphylactic reaction that can lead to death.

Condoms

At the time we are writing this book there are four brands of nonlatex condoms on the market. They provide protection from both unwanted pregnancy and STIs during penetration play. Condoms that are made from animal skin (called lambskin condoms) do protect against pregnancy, but do not provide STI protection.

Three of these condoms are the traditional male condoms. One is called Avanti and is manufactured by Durex. One is called Supra and is manufactured by Trojan. The last kind (see earlier sidebar) is called EZ-On. They are all made of a form of plastic called polyurethane. The benefit of this material is that it is very strong so the condoms are thinner than latex condoms. It also conducts temperature better than latex. However, polyurethane condoms are not as stretchy as latex condoms. For this reason the manufacturers have made these condoms a bit wider than the regular size of condoms. These condoms are still very expensive (about three times the price of latex condoms). We hope that as the market for this product increases the price will come down.

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The Trojan Supra condom is only available with a spermicidal lubricant. Because some people react to the spermicide, you may want to try the Avanti instead. If the Supra is the only nonlatex condom available to you, you could try gently rinsing it off if you have had problems with spermicide before.

The other nonlatex condom is called Reality and it is a female condom. It is shaped like a male condom, only bigger, and is designed to be inserted in the vagina prior to penetration play. It has a ring that holds it in place inside the vagina and also comes out a bit to protect the surrounding vulva. This might give somewhat more protection against HPV and herpes than do male condoms. Because they haven't been around as long, we don't have any great tips about how to