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Sexual Health & Intimacy
Quality of Life and the Meaning of Sexuality
Mitchell Tepper, PhD, MPH
Traditional measurements of quality of life (QOL) include a social
integration factor (eg, the number of friends contacted per month);
sexual health and sexual relations are not measured. Social integration
does not measure relationship satisfaction. People can be socially
integrated but still feel emotionally isolated.
According to Gill
and Feinstein,1 QOL, as defined and experienced by an individual
with a disability, was extremely important; sometimes
more important than employment, income, or functional measures.
In a study by Johnson and colleagues,2 32 participants out of 126
who were assessed 1 year after their injury consistently gave low
satisfaction ratings to love and sexuality: a topic not even addressed
in the conventional questionnaire about community integration.
The authors concluded, "To understand quality of life, more
information on private activities, including intimate relationships
and sexuality, may be needed."
Another important element of
QOL ignored in traditional measurements is spirituality.3 A colleague
recently told me he believed sexuality
and spirituality were two different and unrelated things. He said
sex is of the flesh and spirituality is something else. I disagreed.
My perspective is based on the philosophy, history, science, medicine,
psychology, and human experience of sex. An important emergent
theme from my research on pleasure and orgasm in people with spinal
cord injuries (SCI) is what I call connectedness.
When people are
asked about the effects of SCI on their sexual response or activity,
they responded that they no longer felt the
same or "normal." Diminished sensation, lack of escalating
arousal, and an inability to orgasm made masturbation as well as
sex with a partner seem pointless, reaffirmed unexpressed beliefs
of asexuality, and led to feelings of "why bother?"
There
was a need to be with a trusted sexual partner for safe sexual
exploration and peak sexual experience, including pleasure and
orgasm. The most pervasive reasons were the excitement gained from
pleasing or satisfying a partner, feelings of connectedness or
complementary sexual energies, and identifying sex with a sense
of intimacy and as an expression of love rather than a pleasurable
release. These findings led to my theory on sexual pleasure and
orgasm in people with SCI: the ability to experience orgasm in
people with SCI is the culmination of a process of sexual self-discovery
that is haphazard and reflects how they learned about sexuality
before their injury.
SEXUAL SELF-DISCOVERY
This process of sexual self-discovery includes
reestablishing a sexual relationship with oneself and others in
the context of a
changed body, changed life, and changed interpersonal relationships.
This process unfolds over time with the ability of participants
to move from what they described as "sexually devastated" after
injury to "ecstatically orgasmic" years later.
When people focus
their attention on the details, they miss the essence of the
phenomenon. Looking only at the physical, they miss
the reflection on a spiritual level. Spiritually, humans yearn
to feel as one with another. When they are at one with another,
they feel whole, that what they have to offer has value, and
they feel desirable and worthy of love. CONNECTEDNESS
Three elements generate euphoria, ecstasy, and bliss.
Being "timeless," one
is in the moment, not comparing to past experience or focusing
on future expectations. Being "egoless," one becomes
one with his or her partner or the universe, not an individual
limited by physical disability or negative thoughts. Being in the "natural
state," described by the Indian religious leader Bhagwan
Shree Rajneesh, "The unreal is lost; the facade, the face,
are lost; the society, the culture, the civilization are lost.
You are part of nature, as trees are, animals are, stars are. You
are in a greater something: the cosmos." You are connected
to the universe.
" All I know is that I am miserable"
A wife wrote to me in desperation
asking for help for her husband who had sustained a SCI a year
after they were married.
"He said that he pretty much is not interested in sex anymore" (Avoidance). "I
try to be understanding and assure him that to be even cuddled
or for him to hold my hand and talk a bit would be wonderful, but
he refuses to even do that" (More avoidance). "He does
not touch me at all" (Disconnection). "When I go up
to even hug him good-bye he pushes me away as soon as he can" (Anger). "I
have begged him to go to marriage counseling with me to get help
but he refuses" (Arrogance). "This has gone on for
years and to be honest I feel like I am going to go insane. His
refusal to even try to work on our problems has made me resentful
and I have stopped even trying" (Created a barrier to human
relationships). "I live in one part of the house and he lives
in the other and we don't spend time together at all without
fighting. I just don't know what to do anymore. All I know
is that I am miserable." This marriage ultimately ended in
divorce.
Common reactions to loss associated with acquired disabilities
include avoidance, anger, a loss of sense of self, and an inability
to let go of the past and move on. Ego, arrogance, avoidance,
anger, and complaints are all barriers to establishing a sense
of connectedness
that is central to healthy sexual relationships. Where does the
answer lie?
If disconnection and factors that result in disconnection are barriers
to intimate sexual relations, and intimate connected relationships
are important to QOL, where does the answer lie?
According to Ray
Stubbs, author of The Essential Tantra, sensuality, sexuality,
and spirituality begin within. Barriers to these experiences
during sex include concentrating too much on performance and
not enough on sensations, judging others, making comparisons
with the
past to invalidate the present, and focusing on expectations
instead of the richness of the moment. Allowing, rather than
striving,
is the key to acknowledging that the medical model of sexual
relating does not bind us. THE ART OF LOVING
What balances the physical and spiritual is
the artistry of love richly detailed by Erich Fromm in his 1956
book, The Art of Loving.
Whipple and Komisaruk4 define love as "having stimulation
that one desires." This definition encompasses having an
emotional bond with a person for whom one yearns, as well as having
sensory stimulation that one desires. They concluded, "The
better is our understanding of love, the greater is our respect
for the significance and potency of its role in mental and physical
health."
CONCLUSION
Spiritual aspects of sexuality transcend the physical
and the knowable. In a spiritual sense, the meaning and purpose
of sexuality can
be conceived as a means of connection.
In an ideal world, humans
learn to love others and themselves without input from their
genitals, without any pressure from outside sources
to perform sexually or to be physically perfect. They learn about
sex and sexuality from family, schools, and religious institutions
that reinforce the concepts of intentional love, understanding
and valuing uniqueness, acceptance, and connectedness. Without
input from the genitals, it becomes easier to see the emotional
and spiritual aspects of sexuality.
If pleasurable sexual sensations
are introduced from the genitals, this gives positive reinforcement
experienced through the body
and appreciated in the mind. The physical and pleasurable aspects
of sex become important and provide added joy to the emotional
and spiritual.
If the pleasurable genital sensations were taken
away, one would experience great loss. Yet, the emotional and
spiritual aspects
of sexuality still exist, from which we relearn ways to experience
physical pleasure. Just as we learned to experience pleasurable
sensations from our genital experience we can learn to experience
pleasure from other parts of the body, both physical and
energetic. We learn truth from the greater culture that sex is
purely
about pleasure in the genitals. When that focus is missing,
we learn
another truth about sexuality.
Mitchell
Tepper, PhD, MPH, is founder and president of The Sexual Health Network
and www.SexualHealth.com.
References
- Gill TM, Feinstein AR. A critical appraisal of the
quality of quality-of-life
measurements. JAMA. 1994;272 (8):619-626.
- Johnston M, Nissim EN, Wood K, et al. Objective and subjective handicap following
spinal cord injury: interrelationships and predictors. J Spinal Cord Med. 2002;25(1):11-22.
- Ogden G. Integrating sexuality
and spirituality: a group therapy approach
to women's sexual dilemmas. In: Kleinplatz P, ed. New Directions in
Sex
Therapy. New York, NY: Brunner-Routledge; 2001:322-346.
- Komisaruk BR, Whipple B. Love as sensory stimulation: physiological consequences
of its deprivation and expression. Psychoneuroendocrinology. 1998;23(8):927-944.
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