Speaking Desire: Marin County Sex Therapist Reveals How to Navigate Sex with Injury, Disability

By: Dr. Denise Renye

Despite the lack of representation in the media, people who are injured or disabled also have sex. (And if your sex goal is orgasm, sex with an injury or disability also raises the issue of what, exactly, is an orgasm. It might not be what you think.) As an online sex therapist, I have seen how shame or fear of being a “burden” can silence individuals who are injured or disabled, creating distance rather than connection in their sexual encounters.

When I worked in a facility for people with brain injuries in New Jersey, I witnessed firsthand how sexuality remains a vital part of life, even amidst physical and cognitive challenges. Educating residents about sexuality and relationships was not only about sharing information but also about fostering dignity and connection. At times, my role extended to assisting residents and their partners in navigating the practicalities of intimacy, such as exploring adaptive positioning to accommodate physical limitations.

By integrating sexuality basics and pleasure-focused education into their rehabilitation journey, I helped residents reclaim a sense of agency over their sexual lives. This experience in New Jersey underscored the importance of tailoring sex therapy to honor individual needs and circumstances, a principle I carry into my work today as an online sex therapist.

As I’ve written about, it’s important to bring consciousness into the bedroom. That means having conversations about sex. Expressing not only your desires but your needs cultivates intimacy, especially if you have an injury or disability. And remember, sex should never be painful. If sex doesn’t involve pleasure, is it even sex? As an online sex therapist, my answer is “no.” Even if the act can result in pregnancy, pain is not synonymous with sex.

For someone with an injury or disability, sexual encounters can bring physical, emotional, and psychological complexities that require open communication to ensure safety, comfort, and pleasure. It’s perfectly reasonable to raise those complexities with your partner(s) because again, sex is about pleasure for everyone involved. People are not mind-readers and that means communicating what works and what doesn’t is paramount. That might mean not only expressing what feels good and what doesn’t, but also something specific such as a change in position, additional time, the need to adjust tempo or amount of lube, or specific forms of touch.

Most of us weren’t taught how to express needs and desires during intimacy, sexual or otherwise. However, voicing all of this creates a space of trust and collaboration, which can make sex more pleasurable. Speaking your needs is an invitation for deeper connection. And remember that partners are often eager to understand and adapt to your needs, but they rely on clear, compassionate dialogue to meet you where you are. If partners don’t want to adapt to your needs, that’s a different story and something that needs to be assessed if it’s working for you or not.

Injury or disability does not diminish your right to pleasure and closeness; it simply requires a willingness to reimagine what that might look like. Sensuality and sexuality thrive on creativity and exploration and you may find sex becomes even more interesting or pleasurable as you try new things or different positions.

This applies at all times, but especially when you’re injured or have a disability: Expressing your desires, boundaries, and vulnerabilities empowers both you and your partner(s) to approach intimacy with honesty and care. This practice of using your voice is an act of self-advocacy and self-love, transforming what might feel like limitations into opportunities for mutual growth and deeper intimacy.

The process may not feel easy and that’s OK. Give yourself some grace but know that on the other side of the discomfort discussing what you want and need sexually is likely a whole lot of pleasure. And that’s something available to everyone if they want it no matter their physical condition.

That said, if you find yourself struggling to voice your wants and needs during sex, as an online sex therapist, I’m happy to support you. Get in touch.