Can paraplegics have sex?" Shashank Pandey, 27, a paraplegic, took seven years to ask his doctor this. He was 20 when a spinal injury left him paralysed from the waist down.
"The question had been playing on my mind ever since, but I always dismissed it. I was too shy to ask," he says.
Eventually, he mustered the courage. And the answer he received has encouraged him to seek a partner.
Pandey is in a minority. Many tetraplegics and paraplegics in India are still embarrassed to discuss sex-related issues, even with their doctors. As a result of inadequate information, many don't reach sexual maturity and are haunted by misplaced fears of rejection and impotence.
"Sex is between our ears," says Shivjeet Singh Raghav, a 55-year-old quadriplegic. A peer counsellor at New Delhi's Indian Spinal Injuries Centre (ISIC), Raghav has been wheelchair-bound after he suffered a spinal injury in college. "I still feel attracted to women just as I did before. Sex is equally about your partner, and his or her happiness," he adds.
There are challenges, of course. Finding a partner can be more difficult. And the differently abled have to resist the way abled people desexualise them. But educating oneself and one's partner, and seeking guidance and counselling, can help.
After recovering from the trauma of the accident, patients are confronted with questions about their own sexuality. With little information available at fertility hospitals, many end up feeling frustrated and trapped. They feel embarrassed to talk, and hospitals don't always disseminate correct information.
"Less than a dozen centres in the country are equipped to deal with fertility and sexuality needs of differently abled patients," says Dr Dinesh Suman, urologist at ISIC.
ISIC trains patients to explore their sexuality by following a partner-centric approach. 'You can't feel it, but your partner can,' is what patients are often told here.
"It's not just an act. It involves communication, emotions and harmony between the couple," says Raghav. "We help patients overcome their fears by training them to live out their sexuality."
Fears range from no bladder or bowel control, impotency to performance anxieties. Some fears are also psychological, especially among younger men. They want the same level of intimacy as before the injury, and get frustrated when that doesn't happen. "We advise patients to not over-do anything. They must face reality and act accordingly," says Raghav.
"It is also critical that partners and spouses understand an injury's psychological impact. So we supply them with information to save them from embarrassment," he adds.
Starting a family
"Spinal injuries have no ill effects on reproductive health. Women can conceive normally through fertility treatments," says Dr Rachna Sharma, a gynaecologist at ISIC. "As they have no sensations, they do not experience labour pains. We operate on them in the 37th week."
Dr Sharma helps about a dozen differently abled women conceive every year.
Babies born to a differently abled woman may be a little underweight. But that's all. For men, time is of the essence.
"A spinal injury disrupts the nerves, which in turn influences male virility. Couples should try to conceive at a younger age, using medicines and assistive gear," says Dr Suman.
Adds Raghav: "We need to rise above misinformation and stigma, and give them the respect and dignity they deserve."