Introduction

Sexuality is an important element in our health, including our mental health. It is one of the functions whose purpose is to keep our system alive and healthy. On the level of sexuality we are all very vulnerable, and when we are ill we may have to meet our sexual needs in a new way, affected by our changing body image.

Fortunately we can find new resources, fantasy and powers of regeneration, so that we can continue to live a full life.

Here, we shall only discuss ways of facilitating the technical aspects of intercourse through control of spasticity; that is muscular rigidity. We shall not touch on the mental aspect in this context, although it is an inseparable part of sexuality. The more a couple tell each other about their feelings and guide each other as they caress, the more enjoyable and exciting their lovemaking will be.

We can make intercourse possible, either by consciously using the muscular rigidity of spasticity, or by decreasing it. This is regardless of which partner is spastic and which the active one. The results are anyway better when spasticity is controlled.

Most MS patients suffer from rigidity in extension. The degree may vary, but in lovemaking the major drawback is rigidity of the legs and lumbar region in extension (also in flexion).

To help relaxation, we suggest positions that are easy to hold and in which the muscular weakness possibly associated with rigidity is least detrimental. By caressing one another and using inventiveness to prolong the foreplay stage of lovemaking, the often strenuous phase of intercourse can be eased.

By trying out different positions for intercourse, you may be surprised to find many new, stimulating and less tiring ways of making love in addition to the accustomed ones.

Physiotherapists
Taina Vahtera
Annaleena Viramo-Koskela

The first stages of lovemaking

It's best to begin lovemaking in a relaxed way, caressing gently to relax (open) the legs. It is especially important to use relaxing caresses and plenty of time, as rigidity prevents you from achieving and controlling the positions for intercourse. Some good ways of relaxing:

Using the body weight

• Your body's weight and warmth will relax your partner's muscular rigidity. Sit or lie on your partner when caressing.


• When massaging, press your hands vigorously against your partner's body to press it onto the base on which you are lying.


• Change your position so that the body's centre of gravity changes (e.g. from one side to the other.).

Stroking and caressing

• Caresses feel best on bare skin.


• Light stroking with the fingertips may help you to find the tensest areas, where the stroking can be more vigorous. Slow, calm, progressive movements relax most effectively.


• In numb areas you can try using a firmer hand. If one spot is oversensitive, move on to another area. Try it out on your own body if you want to check the strength of the stimulus..

Kissing and the role of the mouth in foreplay

• Caressing with the mouth often succeeds even if the hands are disturbingly clumsy due to disorders of fine motor co-ordination or numbness. Caressing the breasts, abdominal area, pelvic area, thighs and genitals with the mouth and tongue prepares your partner for intercourse and reduces muscular rigidity. Moreover, in this way you can shorten the time spent in the tiring position for intercourse.


• When kissing, the partners can change roles. For example, the one being kissed can move while the one kissing remains still.


• Gentle movements relax most in kissing too. Concentrating on the most sensitive parts (for example, those mentioned above), following your partner's reactions and listening to his or her feelings will help you along.

Massaging

• Massage painlessly, avoiding over-sensitive spots, with wide motions in areas where it feels good.


• Massaging the back, lumbar area and buttocks relaxes your partner in a pleasant way.

Rhythmical movements

• Rhythmical movement is beneficial in all functions. Repeat the same movement several times. Push your hands repeatedly towards your partner's shoulders. At the same time your weight will shift backwards and forwards in the pelvic region, rocking back and forth as you sit on your partner.


• If your partner is lying on his side, you can roll him gently back and forth, changing the place where you grip him.


• You can develop different variations yourself, but the main thing is to be gentle and unhurried. The most enjoyable ways of caressing can best be found by talking about it with your partner.


• By trying out different places, you can add interest and variety to your lovemaking (e.g. out-of-doors, in water, in the kitchen, in the car).


• Oils and various ointments feel pleasant and may make it easier to learn massage, to caress and may also help in the actual intercourse.


• Rubbing oil or ointment into the body after a shower is a pleasant way to relax.


• Many people find spasticity is considerably reduced after a shower or sauna. But everyone is individual in this too.

The temperature of the water or sauna, and the length of time spent bathing, affect people in different ways.

• You can make it easier to hold a position by using a duvet or pillow, for instance.

Incontinence

The incontinence often associated with spasticity may disturb intercourse. Even having a full bladder may increase spasticity. Emptying the bladder before lovemaking will help. If you empty the bladder then, no more than a few spoonfuls of urine will have time to collect.

If this small amount escapes, it will probably not disturb lovemaking. Talking to your partner about it often solves the practical problems.

Good positions for lovemaking

• The woman tries to keep either one or both legs bent.


• Changing the position helps to keep you relaxed.


• The degree of spasticity is affected by small details, like the position of the ankle or the neck.

Controlled spasticity

A woman who has difficulty in bending her legs will find it easy to stay in these positions during intercourse. The idea is that the woman should try to keep one or both legs bent. The couple should try gently, while caressing each other, to bend the woman's legs.

In the positions shown, it is also easy for a man with rigidity in extension to make love. Lying on the back increases rigidity, and this can be alleviated by keeping the chin near the chest (by placing a high enough pillow beneath the head) and supporting the bent knees, for example with pillows.

Bending the legs makes it easier to open them, which makes intercourse easier, especially for the man. The degree of spasticity is affected by small details such as the position of the ankles or the neck.

You can only find the right position by trying, but it is extremely important by relaxatibg. It is no use trying to force yourself into a certain position and stay in it. Instead, try another position if it feels easier. Changing position also keeps you relaxed. You can, for instance, start lying on your stomach and end up sitting in your partner's lap.

A sitting position suits both men and women. Pillows can be used, for example, under the woman's knees or between the calf and the thigh. You can find the easiest and most comfortable position for making love by trying out different movements and positions of the legs. The man and woman can support each other, for instance, by the shoulders or hips, so that neither can fall back unintentionally. Leaning against a wall also helps you to keep your balance.

A sturdy chair is a great help both for men and for women with spasticity in extension. The best type of chair is one with no arms, but absolutely stable. You can also try a shower stool or even the lavatory seat, especially if you suffer from incontinence.

It is good to remember that the shower and sauna are also suitable places for making love.

You can support yourself with your hands on his chest, shoulders or hips and support yourself on the man's knees

Hold on with your hands to one or both knees and push the chair near the wall so that it cannot fall over

Both partners' knees should be sufficiently bent (try different angles)

When the man is on his knees, the woman can help him to keep his balance by pressing her own legs against his hips. In this position, she can also guide the man's movements in the way she wishes.

The positions shown on this page are suitable, particularly for spasticity that causes flexion of the muscles. You can help to hold the positions by using cushions and duvets.

Only by trying out can you find the right position and angle for intercourse.

To get to this position, you can start caressing, for example, on all fours. The woman then, by pushing backwards with her hips, gradually sits on the man's lap

This position is very good for a woman because she can rest her feet on the floor, and the man's position at the same time prevents her legs from closing. The man should use something soft, like a cushion, under his knees

These positions may suit a woman who has difficulty in bending her legs. You can use a coffee table or a table that is stable enough so that the woman can safely relax.

While lying on her back, the woman can rest her legs on the man's hips or the man can support the woman's legs on his body using his hands. See the previous page for how to support the woman in a half-sitting position. When the woman is on all fours, the man can pull her back by the hips towards himself. In this way the woman's centre of gravity remains behind. This prevents spasticity from increasing, and the legs from straightening.

Staying on all fours is easier if you support yourself on your elbows, which relaxes the shoulders and neck.
It is also easy to shift to lying on the stomach, with the woman underneath. The man can also go between the woman's legs, or the woman can bend one knee to the side. This makes it easier for the man to caress her stomach and breasts.

When lying on her back, the woman's position is usually well supported and relaxed if one leg is suitably bent.
Getting the legs bent usually requires a sufficiently long period of foreplay (such as massaging, caressing, changing positions and so on).

These pictures show different positions with bent knees. The woman can support either one or both knees with her hands, holding either the crook of the knees or the top of the calf.

The woman can lift both legs onto the man's back, so that they support each other, for example with the ankles crossed.

The woman can also lift one leg onto the man's shoulder or let it slip into the crook of his arm, which makes it easier on the hip joint. This position is easiest to keep if the other leg is kept relaxed on the base.

A relaxed, well supported position, where only a small movement is needed is easiest to reach when lying on the side. These positions are good for both men and women.

It is worth trying different versions, as in the pictures.
The woman can bend her body forwards, so that the angle at which the hips meet can be varied. The man can change the position of his leg, for example so that the leg is on top of the woman. The weight and warmth of his leg against her hip may help to relax her.

When the man and woman are facing each other, the weight of the woman's leg relaxes the man's pelvic area. By changing the position of her leg, the woman can make intercourse easier. As shown above, the length of the upper body affects the angle at which the hips meet.

"The heavens held their breath.
And we succeeded."

Eova Kilpi (Finnish writer)
Approved by the [Finnish] Center for Health Education for 1991-1994