Brian Chavez's life changed forever on a spring day in 2005 when he fell six stories from a building and suffered a spinal cord injury, leaving him a paraplegic.
"I was physically unable to do a lot of things for that first year," said Chavez, now 38. In addition to being unable to walk and perform everyday tasks as easily as he was able to before his injury, Chavez also had to face another harsh reality.
"I was thinking I was never going to be able to have sex again," he said.
After a lot of experimentation with a variety of different positions and sexual aids, Chavez discovered one product that helped make sex easier and more pleasurable: the IntimateRider, a swing chair designed to help with motion and positioning during sex.
Chavez, who has a girlfriend, says being able to have sex has been "liberating." Other people with disabilities as well as experts who work with them say products like the IntimateRider do much more than just make sex easier. By making the physical act possible, these products can also improve a person's psychological well-being by strengthening relationships and raising self-esteem.
"Anything that improves intimate life together is good for a relationship," said Stanley Ducharme, a psychologist and sex therapist at the Center for Sexual Medicine at Boston University School of Medicine. "If you don't have a good intimate life with your partner, it's very easy to drift apart and there's probably going to be some difficulty."
Ducharme also said that maintaining a relationship can be especially challenging for those with disabilities.
"Just keeping a relationship is a major issue. Often, they require a lot of care and that adds a lot of stress."
"The line between caregiver and partner/lover can get blurred, and many times people who are in a demanding caregiving role see his or her partner as something other than a sexual partner, or may be too tired physically or emotionally for sex," said Kelly Ace, a private consultant who is also affiliated with The Sexual Health Network, an organization that provides information and resources on sexuality.
Experts also say that many disabilities can make a person unable to perform sexually, whether it's due to the actual disability or certain medications. This inability to perform can make people with disabilities feel bad about themselves.
"There are all sorts of feelings involved in low sexual self-esteem, such as feeling you're not a good lover and you're not able to give your partner pleasure," said Mitchell Tepper, founder of The Sexual Health Network. Tepper, like Chavez, also suffered a spinal cord injury.
Low sexual self-esteem can lead to depression, which can be compounded by the depression a disabled person may be experiencing as a result of his or her injury or medical condition.
"When a disability happens there's a huge adjustment and there can be major depressions. People's lives have changed in all kinds of ways," said Ducharme. "Depressions can last for years depending on the ability of person to handle those kinds of changes."
In addition to depression and low self-esteem, experts say many people with disabilities must confront stigma and discrimination. Men and women who aren't in relationships before their disability may also find it difficult to find a partner willing to look past it, or may meet people who simply pity them and aren't interested in a romantic or sexual relationship.
"It's difficult to understand people's motives, and you may wonder if you're being seen for who you really are," said Ace.
Ace also said many ofveterans return physically and psychologically damaged.
"The person who went off to war isn't the person who came back, and that puts a huge strain on relationships."
Despite the many challenges people with disabilities face, sex can be a savior for many of them.
"Pleasure is protective against stereotypes and other negative messages," said Tepper. "One good sexual relationship can boost your whole sense of self and image and protect you against all these other things."
"The people who do the best physically in terms of having a successful sexual relationship are those who can sort of get stimulated in parts of the body where there's still sensation, and who can kind of think broader than just having intercourse," said Ducharme. "If you can rid of old views of sex and look at it in terms of getting emotionally connected with another person and getting stimulated in ways other than intercourse, those are the people who are the best adjusted."
"There's an appreciation there's a greater need," said Ace. "We're seeing it more with the aging population. There are a lot of chronic illnesses and physical disabilities."
"I wouldn't say they're more numerous," said Ducharme. "They are expensive and many people with disabilities are unemployed or on a fixed income. They don't have the money even for Viagra."
But Ace added that even if cost is an issue, people can look at these products and get ideas on how to adapt items in their own homes to perform similar functions. She also believes they're becoming more popular.
"Having as much functionality as possible is a goal for all of us," she said.
For people like Brian Chavez, products like the IntimateRider have made it possible to move beyond their disabilities.
"One thing that will always hold true is that life must go on, and being intimate is one of those things that has to prevail at some point in time," he said.