Talking about potentially embarrassing issues is difficult in any relationship. However, talking about these topics can make people with disabilities feel even more vulnerable: How do we know when to bring "it" up? What will we say? How will our partner react?

These are all common questions that many of us have asked ourselves when we are in romantic, sexually related situations. Fortunately, a little preparation -- and a sense of humor -- can make talking about sensitive topics a little easier.

A Common (Embarrassing!) Problem
Bowel and bladder accidents during sexual encounters are one of the most frequently discussed topics among persons with certain physical disabilities, such as spinal cord injuries or spina bifida.

The reality is that an individual may experience the release of urine or feces during sexual situations. Although this can be an uncomfortable topic to discuss with anyone, discussing it with a sexual partner can feel like the end of the world.

However, there is hope. Many couples have communicated successfully about this topic and have gone on to enjoy satisfying sexual relationships. Try these tips for handling this type of situation:

• Initiate the conversation before the sexual interaction takes place. Talk about it after a nice dinner, when both of you are relaxed.
• Start the conversation by stating this situation is very difficult to talk about, which will let your partner know you feel vulnerable.
• Talk about ways to handle a bowel or bladder accident during sex. State that you typically try to empty your bladder and bowels prior to sexual activity, but that you also keep towels, urinals, bedpans and handi-wipes nearby.
• Diffuse your conversation about this difficult topic with a little humor -- it will put you both at ease.

Even though many people with disabilities do feel comfortable with the appearance of their bodies, many others do not. Many people will go to great lengths to hide their bodies, such as wearing clothing that covers up their arms and legs or only undressing in the dark. While it can be hard to manage these personal feelings, there are some ways to deal with these issues in yourself and with your partner.

• Look at yourself in the mirror, and get to know what your body looks like. If you wear a prosthetic, look at your body with it on and off. Aim to get more comfortable with the way that you look. When you become more comfortable with your body, your partner will also feel this same sense of ease.
• Talk with your partner about your discomfort with your body's appearance. He or she may wonder why you feel uncomfortable -- your partner may be more accepting of yourself than you are!
• Test your partner's reaction by sharing one part of your body's appearance. When your partner gives a favorable reaction (as will surely be the case), you may feel increased comfort with taking more off! People often end up feeling better about their bodies when they realize their partner finds them incredibly attractive.

Even though keeping the lights on may seem obvious, it may be helpful to communicate this information directly to your partner prior to sexual play. Having sex with the lights on can be erotic and exciting, but very different for those people who are not used to engaging in sex in this manner.

The need for this discussion may not be as critical if you are being sexual with a partner who is also deaf or hearing impaired. That is, your common experiences may create an understanding in which this does not need to be discussed.

However, if you do need to have this talk, consider the following:

• Find a way that feels right to you to launch this discussion. If it is important to you, talk about the fact that you like to communicate during sex and that leaving the lights on is the only way this can be accomplished.
• Use humor -- you may want to lead with, "You know, those of us who lip read do it with the lights on!"
• Practice with kissing before you engage in further sex play. "Making out" with the lights on can help familiarize your partner with being sexual in this type of environment.