Dear Patrick: I’m an attendant for a paraplegic man. He needs to be catheterized a few times a day, so I go over to his apartment and take care of that, make his meals, take care of his service dog, etc. Lately he has had a friend—a very attractive female friend—staying in the spare bedroom of his apartment. I suspect they are actually boyfriend and girlfriend. But I can’t figure out how they could possibly be having sex. What would a young, healthy woman see in a man who can’t even walk?
Dear Put Off: As an attendant for a paraplegic person, you are part of a medical team that provides for his intimate care. I don’t know if anyone has explained to you that being part of that team puts certain requirements on you for protecting his confidentiality and his privacy. You have an obligation to care for him the same way that a doctor would, not judging his private life, and making sure that no one else outside of his home ever gets any information about him that would allow them to judge him, either.
But before you can protect someone’s confidentiality or privacy, you have to be the kind of person who doesn’t make any judgments yourself. Let’s ask ourselves why you might be put off by the thought of a man with a spinal cord injury wanting to have a girlfriend or just simply have sex. Were you aware that even if a man has a spinal cord injury, he can still sometimes have erections? He may not have much (or any) sensation in his genitals, and in fact these erections can feel like a spasm that is rather painful. But they do indicate that on some level, the ability to function sexually is the very last thing that nature allows to leave our bodies. Nature protects and guards our sexuality, making sure that we have that potential as long as we have any life at all in our bodies.
There are a lot of reasons why people who are disabled still want to be sexually active. The most popular reason is because they still have a libido or a desire for sex. Even if you had a broken leg, you might still want to go running, go with your friends on a hiking trip or snowboarding, or you might want to just climb a tree for fun. Deaf friends of mine used to go to punk rock concerts because they liked the way the bass music made their bodies feel, and they enjoyed dancing. Blind people are curious about color and art, and still want to read and understand literature. The need to communicate with each other is a very deep human instinct. That drive to be close physically, to touch and be touched, to enjoy the acceptance and beauty of another person’s body, and to feel that they love to look at and touch us, is something that any adult can relate to, regardless of their strength or other physical abilities.
Sometimes the desire to have sex is based on romance. People who are disabled do fall in love, you know, and it’s not unheard of for that love to be returned. Some of the smartest and kindest people I know are disabled, and I wouldn’t be at all ashamed to be lovers with a person who needed to use a wheelchair to get around. It’s just never happened yet—mostly because so many people in wheelchairs live with their families, and if they are gay, they don’t get to express that part of their lives. (Now, there is a whole other topic to blow your mind.) Sometimes it’s just about lust or loneliness—not wanting to be the only body in that damn bed. These are all emotions I’m sure you have felt.
The bottom line is that just because you are this man’s attendant, you don’t have a right to know if he is having sex with his female roommate or not. If the two of you know each other well enough to be friendly, he might volunteer that information. But it would not be professional for you to ask. You should continue to treat him and her politely, as a guest in their home. We usually get to know a lot of other things about people in the process of making friends with them before we share information about sex. Some friends never talk about who they are doing or why or how.
But as an attendant for physically challenged people, I think you should know that folks with spinal cord injuries have sex in all the different ways that they can. Humans are creative creatures. They may need their partner to take a lead role in positioning their body so they can enjoy physical closeness or embracing. They might engage in oral sex or use toys like vibrators. Sometimes the partner uses her hands to touch both herself and her male lover or she may perform oral sex. If he’s able to get an erection, she may be able to have sporadic intercourse with him. But (as you probably know) people who are paraplegic have a lot of trouble with urinary tract infections (UTIs), so it’s important to use condoms; UTIs are really hard to get rid of when you are getting catheterized more than once a day.
You may not agree with me, but I want to suggest that what is important about making love is not the specific technique people use, but the way that they feel about each other. A lover who is tender and gentle, one who admires and wants you, and one who understands you on a deep level, is wonderful to be with, even if all he or she can do is smile at you while the two of you kiss. Desire requires a lot of finesse with technique to keep the heat going, but love only requires the focus of two people on each other.
I hope this has taken some of the “squick factor” out of your job and perhaps opened a window or two into more compassion for your client. If not, it might be better if you quit and allowed somebody else to become his attendant.