8.4. Functional Abilities and Positioning
Content in this section is intended for adult (age 18+) educational purposes. United Spinal Association bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. Contact the external site for answers to questions regarding its content. Information about a therapy, service, product, or treatment does not imply endorsement and is not intended to replace advice or directives from your healthcare provider. There is always a risk with any type of sexual activity, speak with your healthcare provider about options to maximize your safety.
Functional mobility describes the ability level of specific actions or movements. Within the realm of therapy, this can include movement from one place to another, movement of objects, and ambulation. Functional mobility is impacted by the level of spinal cord injury and can be modified or adapted during sexual activity to compensate for a limited range of motion. Occupational and physical therapy can provide individualized education on positioning and mobility for sexual activity. Refer to your health care provider for more information.
Proper positioning during sexual activity can improve access, stability, comfort, and relieve pressure for those with limited strength and mobility. Creatively exploring sexual positioning with your partner can help you find what works best for you and your partner. The use of positioning aids and adaptive devices can help limit spasticity, discomfort, or fatigue for those with SCI/D.
Persons with tetraplegia may require a care attendant to assist before sexual activity. Preparation may include transfers, dressing/undressing, positioning, sexual aid preparation (toy maintenance, placement), hygiene, etc. Before engaging an assistant in preparation activities, there must be honest and open communication with your caregiver regarding comfort levels, limitations, skills, and training.
The following resources discuss specific positions and positioning aids.
- Sex and Paralysis Video Series
Dr. Mitchell Tepper, a sexuality educator, counselor, and wheelchair user, has created a video series devoted to sexual activity positioning for SCI/D.
- Spinal Cord Injury BC is a team of sexual health clinicians and specialists in Vancouver, BC providing specialist sexual health services, education, and research in British Columbia, Canada. They provide numerous resources regarding sexual health including
— PleasureABLE is a sexual device manual for persons with disabilities, covering topics of sexual health, positioning, and devices.
Exploration of sexual positions can start in your wheelchair. Before any sexual activity, make sure your brakes are locked, use anti-tipping bars if applicable, and positioning the chair by a wall for stability can be helpful. If in a power chair, turn your joystick off. Check the weight limit restrictions for your chair before sexual activity.
Other considerations for improving positioning in a wheelchair:
- Using the tilt function on power wheelchairs for easier access to genitals and pressure relief
- Removing armrests and lateral thigh supports may provide options for sexual activity in the chair with a partner but individual function and safety should be considered.
In the bedroom, sexual activity can be facilitated using positioning aids (pillows, wedges, straps, slings, etc.). Many cushions and wedges have removable cases that are washable between uses. Positioning pillows underneath and around areas of the body can relieve pressure to sensitive areas and improve stability for those with limited trunk strength and sensation. Foam wedges and positioning aids can be used for those with insufficient balance, providing a firmer surface to perform sexual activities. The resources above provide some examples.
Sex furniture, also known as erotic or intimate furniture, can increase pleasure while facilitating positioning. Several options can be found on the 8.5 Sexual Aids page.
Shower chairs are used by some for support during sexual activity in the bathroom. Things to be mindful of while in the shower/tub are the weight restrictions if using shower chairs. Wet surfaces are slick and can be hazardous and shower/tub space can be limited so that positioning may be difficult.
*References found on page 8.6 Resources and References within this chapter