Hesperian Health Guides

Possible problems during sex

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HealthWiki > A Health Handbook for Women with Disabilities > Chapter 7: Sexuality > Possible problems during sex


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Pain during sex

Sex should not hurt. Sometimes the pain is due to a woman’s disability, but often there are other causes. Sometimes a woman feels pain when a man’s penis, or a partner’s fingers or hand, enters her vagina. This can happen when:

  • her partner enters her too soon, before she is relaxed and her vagina is wet enough.
  • she feels guilt or shame, or does not want to have sex.
  • she has an infection or growth in her vagina or lower belly.
  • she has had her genitals cut or stitched together (female genital cutting or infibulation).

Some women with tight, spastic muscles, and some women with spinal cord injury, may find it painful for anything to enter the vagina. If so, try to find another way to have sex that brings pleasure for both partners.

Dry vagina

Sex can be painful if the vagina is too dry. When a woman is sexually excited, her vagina usually becomes wet. This is natural. But sometimes a woman’s disability makes it less likely for her vagina to become wet. This can happen to many women, but especially to some women with rheumatoid arthritis and spinal cord injury.

A common way to make the vagina wetter is to take more time with sex, so that the body makes more of its own wetness. You can also use a lubricant to make the vagina slippery so the skin will not tear.

IMPORTANT! If a latex condom is used during sex, do not use oil, petroleum jelly (Vaseline), butter, mineral oil, or lotion to make the vagina wetter. These can make the condom break. Use a water-based lubricant, such as KY Jelly, with a condom.

Painful muscles and joints

a woman sitting in a large basin of water.

Sometimes a disability, such as arthritis, will cause a woman to have pain when she moves around more than usual. If this happens to you, heat can help ease pain. Use cloths soaked in warm water on painful or swollen joints, or take a warm bath before you have sex. This can help your body relax so you enjoy sex more. If you use medicines to help your pain, try taking them at a time of day that will help you feel good when you are getting ready to have sex.

Muscle spasms

When a woman with a disability such as cerebral palsy or a paralysis becomes sexually excited, her muscles may suddenly get tight (muscle spasms). A muscle spasm is not dangerous or harmful, unless it goes on for a long time. You do not need to stop having sex. Sometimes, pressing gently on the tight muscle can help ease the spasm. Sometimes, gently stretching the muscle can also ease the spasm. But do not pull on the muscle or try to break the spasm. If you take medicine to prevent muscle spasms, it may help to take the medicine before having sex.

Bladder and bowel care

It is best to pass stool and urine before having sex. Also, if a leg bag is used to collect urine from a catheter, make sure it is empty. To avoid bladder and bowel accidents during sex, it may help to not drink or eat for a short while before sex.

If a urine catheter stays in all the time, it can be taped or tied out of the way during sex. Make sure the tube does not get bent or twisted. It is also possible to take out a fixed (Foley) catheter for up to 4 hours. But before you do this, great care must be taken to prevent infection. Usually, it is best to leave the catheter in during sex.

If a woman removes her catheter during sex, she will likely pass urine during sex. Because of the catheter, her bladder is not used to holding urine inside and urine will leak out. There is also a chance she will pass stool during sex. Keep a cloth or towel close by to catch the urine or stool if this does happen.

It can help to discuss the possibility that this may happen ahead of time with your partner. This is a difficult subject, and every woman will talk about it differently. Some women treat it like any other part of life. Other women use humor and find a way to laugh about it.

IMPORTANT! A condom can tear or break when it rubs against a catheter. To help prevent this, use a water-based lubrication jelly on the outside of the condom or inside the vagina.
IMPORTANT! During sex, some women with a spinal cord injury can get sudden high blood pressure with pounding headaches, flushed or red skin, or a fast heartbeat. This is called dysreflexia and can be a serious health problem. To help prevent this, make sure you pass urine and stool before having sex.
a tired-looking woman sitting and holding a walking stick.

Feeling too tired

Your disability may sometimes make you feel tired for much of the day. Or you may take medications that make you feel tired. This can make you less interested in having sex. Try to have sex at the time of day when you feel the least tired. If that is not practical, ask a health worker if it is safe to take your medicine at a different time of day.

If you get tired easily, or your muscles are not very strong, you may also find it easier to have sex more slowly or gently, becauseit will take less energy.

If you are feeling too tired for passionate sex, you can still find ways to give your partner pleasure, and you can ask your partner to caress you. Often, a loving touch can reduce a woman’s pain and help her sleep better. It can also bring great joy to her and to her partner as well.

Lack of desire

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Many things can cause a woman to feel less desire or pleasure from sex. Some of these things may come from a woman’s disability, and some may come from other reasons. You may feel less desire if:

  • you are tired from hard work, from not eating enough, from a new baby, or from your disability.
  • you have a partner you do not like or who treats you badly.
  • your disability causes you pain and it hurts to move.
  • you feel badly about your body or ashamed about your disability.
  • you are depressed or feel very sad most of the time.
  • you have been hurt or forced by someone in the past to have sex.
  • you are afraid of becoming pregnant or of getting a sexual infection.


When a woman lacks desire, her body makes less of its natural wetness, and she may need to use lubrication so that sex is not painful.

If you lack desire for sex, try imagining the things that give you sexual pleasure. Sexual thoughts and fantasies can help you see yourself as a woman who has desires. They can also help you build excitement, which can make your vagina wet and help you enjoy sex more. Fantasy can be something you think about alone or something you share with your partner.