Generally, Dr. Cole says, when it comes to communicating their sexual needs, "the burden is really on the person with the disability. It may seem a little harsh to say this, but it's really their responsibility to educate their partners, to 'desensationalize' the disability so their partners can see through it to the person who's behind it. Actually, people who have disabilities do this well, because that's how they survive."

Fairly often (for instance, for many men with spinal cord injuries), erection is just not possible. In such cases, men need to learn to expand their sexual repertoire to include nonintercourse sex. (Which is actually good advice for everybody)

In some ways, people with disabilities have a small advantage here, because when there's sensory loss in one part ofthe body, some other part of the body often becomes doubly sensitive. This means there may be a highly erogenous hot spot hidden in some nook or cranny of the flesh, just waiting to be kissed or caressed.

"Also, we sometimes forget about hugging and holding and warm, tender feelings, which are a far more important part of intimacy than intercourse," says Dr. On the other hand, she adds, it's a little too easy for rehabilitation specialists to say "Well, if your penis doesn't work, just nibble on her ears." Men who have been strongly socialized to think that erections equal manhood are sometimes devastated when they can no longer get one on cue. If getting an erection is of central importance, there's an increasingly wide array of medical methods for creating an erect penis, whether it be through surgery, injections or an implant. (See "Erection Problems.") And many young men with spinal cord injuries, who can't sustain an erection or have an orgasm, can even impregnate their wives through a technique called electroejaculation (which triggers ejaculation by means of a low-voltage jolt of electricity).