The Effects of Limb Loss on Sexuality

by Richard Mooney

  The good news is that the physical consequences of limb loss almostnever prevent sexual activity. The bad news is that limb loss often bringsabout such profound changes in one's self-image and emotional well-beingthat it does damage one's view of oneself as a sexual being and it can,therefore, inhibit development of intimate relationships. Thus, theproblem, if there is one, is almost always emotional -- not physical.

  The physical consequences   When there are physical consequencesthat adversely affect intimacy, they are usually reported to be pain, fear offurther injury, and general physical debility.The presence of residual limb pain and its potential effect on intimacy--especially during the healing period--requires no elaboration. Fear offurther injury is probably related to the potential exacerbation of pain,since once the healing period is past, intimacy is unlikely to cause furtherinjury. General physical debility is another matter, however.

  Mourad and Chiu, in reporting on marital-sexual adjustment ofamputees in the February, 1974, issue of Medical Aspects of HumanSexuality, studied 12,000 new amputees. The majority of the individualsstudied (58 percent) had their amputations due to disease, of whichdiabetes and/or arteriosclerosis were predominant. The results are notsurprising. The great majority of the amputees in this group were olderand/or chronically ill. Many of the males were impotent and many of thefemales reported a complete absence of orgasmic response.

  It's important to repeat at this point, that there is much more tosexuality and physical intimacy than sexual intercourse. Pain, fear offurther injury, and chronic illness need not, in and of themselves, have anadverse effect on the numerous other avenues of sexual expression, suchas giving and receiving pleasure, sharing intimacy and affection, andcommunicating deep feelings

  The remaining 42 percent of the individuals studied by Mourad andChiu had their amputations because of tumors or trauma, and themajority of these were under forty years of age. Most of the sexualdysfunction reported by this group had its roots in emotional areas - fear,anxiety, and feelings of unattractiveness.

  The emotional consequences   Ellen Winchell, Ph.D., in her book, Coping with Limb Loss, poses the following questions:

  Dr. Winchell's implied answer is, "maybe not," and in support, she citesthe far-reaching effects of self-confidence and self-esteem in shaping one'ssexual identity.

  Altered physical appearance frequently results in lowered self-esteemamong people with amputations. They can feel "handicapped" by theirperceived inability to compete with the "normal" members of their sex fora mate. "After all, who wants a "damaged" partner?" Women who havebeen preoccupied with their appearance express fear that they are "nolonger attractive" and will neither be able to marry nor hold on to apartner they already have. They tend to feel their residual limbs are uglyand should be hidden by clothing or a prosthesis. And the notion of beingseen unclothed is so abhorrent that they cannot even contemplateintimacy.

  Not being able to participate in previously enjoyed activities, such assports or hiking can also affect one's feeling of confidence andcompleteness--especially if it is seen as likely to damage an existingrelationship.

  Real or imagined rejection by those of the opposite sex can reinforcethese feelings of inadequacy and low self-worth. Unfortunately, somepeople with limb loss do experience rejection which is attributable to theiramputation. Others, motivated by their lowered self-confidence and self-esteem imagine they have been rejected when they have not, or attributerejection to their amputation when other factors may be the actualreasons.   As Dr. Winchell points out, it is difficult for one to be loved by others ifone does not love oneself. It is unfortunate that the physical alterationthat results from amputation prevents many with limb loss from lovingthemselves.

  What is to be done?       Fortunately, most people who experiencelimb loss accompanied by the feelings of inadequacy and loss of sexualitydiscussed above, recover with the passage of time. When they are able toreach acceptance--the final stage of the grieving process--they find theirself-esteem and self confidence restored. They can think clearly aboutthemselves once again. They realize that, in Dr. Winchell's words, "Thetotality of who a person is holds far greater importance than does his orher loss of limb." They realize their brains, personality, and sexuality arenot in their arms or legs. They realize that the willingness to accept theloss of a limb shows an admirable depth of character and strength. Thosewho share the life crisis of amputation with their partners realize thatsharing the loss and recovering together can serve to strengthen theirlove and commitment to each other.

  For others, time, bravery, clear thought, and a sense of humor are notenough. Outside help is needed to restore their emotional resources. Forsome, support group participation will help. It is clearly useful to be able toshare fears and experiences with others in the "same boat." Some will seekgeneral psychological counseling, and still others will seek treatment by asex therapist.

Here are some other suggestions from Coping with Limb Loss:

Involve your partner in your recovery - It can be helpful if yourpartner can become comfortable with viewing and touching your residuallimb as early as possible. Talk with your partner about your fears andexpectations for your recovery. Laugh together. Cry together. Andrecover together.

Experiment with body positioning - Explore and discover what changesin position are necessary to restore comfort and balance during intimacy.Deciding who should be on top and who should be on which side of the bedis often sufficient accommodation.

Place less emphasis on performance - Learn that mutual pleasure ismore important than performance. Let go of societal "norms." Let go of theguilt and shame of being different. Understand that it's frequently easierfor others to accept your differences than to accept them yourself.

Realize that sexuality is more than intercourse - Give yourselfpermission to broaden your definition of sexual expression. Be creative.Experiment. Whatever works is okay.

Keep the lines of communication open - Don't make assumptions aboutintimate matters based on fear or insecurity. Open discussion ofexpectations, concerns, and physical capabilities is vital.

  As one individual with multiple amputations expressed proudly to me, "Iam unique. I am not like anyone else in the world. I've found my differentbody to be an advantage. People remember me and many doors haveopened for me because of that. I've met many stimulating people I wouldnever have met if I weren't unique. I like my body. It's the only one I'llever have. I take pains to keep it attractive by eating correctly and gettingregular exercise."

What a wonderful outlook and healthy philosophy!

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