All spinal cord injuries are different. How they affect intimacy and sexual function-and how people will react to the change-varies. Because of this, you need to make your own observations and evaluate your experiences to understand your changes in sexual function and how to best deal with them.
After a spinal cord injury (SCI), how you look and what you are able to do changes. An SCI may also affect how your sexual organs work. These changes often result in frustration, anger, and disappointment, all of which can strain a relationship. People with SCIs may wonder if they will be able to maintain the relationship they are in or develop new ones.
But being intimate means more than just having sex. Your interests, ideas, and behavior play a greater role in defining you than your appearance or your ability to have sex. A relationship depends on many things, including shared interests, how you deal with personal likes and dislikes, and how you treat each other.
The most important thing in a relationship is how well you communicate. Talk to your partner. Be honest about how the SCI has affected your sexual function and how you feel about it. Always keep in mind that people with SCIs can have relationships and marry, have an active sex life, and have children.
Desire and sexual arousal
Usually, men and women are sexually aroused through two pathways: direct stimulation of the genitals or other erotic area or through thinking, hearing, or seeing something sexually arousing. In men, this usually causes an erection, and in women it causes lubrication of the vagina and swelling of the clitoris. An SCI can affect either of these pathways and may change a person's physical response to arousal. Most people remain interested in sexual activity after an SCI, although the level of interest may decrease.
Many men with an SCI resume sexual activity within about 1 year of the injury. Men who are able to have an erection may find that the erection isn't rigid enough or doesn't last long enough for sexual activity. Some have retrograde ejaculation, in which semen goes into the bladder instead of out through the penis.
Women may have some, or complete, loss of vaginal sensation and muscle control. Both men and women can achieve orgasm, although it may not be as intense as before the SCI.
Your sex life will probably be different after your spinal cord injury, but sexual intimacy is still possible and encouraged. Your rehabilitation center may have a counselor or other health professional who specializes in sexual health after an SCI. He or she may be able to help you and your partner with these issues.
Treating sexual problems
Always talk to a doctor familiar with SCIs before using any medicines or devices. Discuss the location of your injury, possible side effects, and any other medical conditions you have.
You also need to watch for autonomic dysreflexia, which causes sudden very high blood pressure. If not treated promptly and correctly, it may lead to seizures, stroke, and even death. These complications are rare, but it is important to know the symptoms and watch for them.
Men who can't get an erection can use the treatments for erection problems (erectile dysfunction). These include:
- Phosphodiesterase-5 inhibitors (PDE-5 inhibitors) such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). But PDE-5 inhibitors can be dangerous for certain men.
- Medicines you inject into the penis, such as alprostadil (Caverject) and papaverine (Pavabid).
- Medicine you insert into the penis, such as alprostadil (prostaglandin E1).
- Vacuum devices, which help blood flow into the penis.
- Penile implants, which are rigid or semirigid cylinders implanted into the penis.
- Vibrators made for men.
For information on the treatment of erection problems, see the topic Erection Problems.
Women who have problems being aroused and have little or no vaginal lubrication may use:
- Sildenafil (Viagra), a medicine used to treat erectile dysfunction in men. It can also help women become aroused.
- A vibrator.
- A water-based lubricant, such as Astroglide or K-Y Jelly. Do not use oil-based lubricants.
Both men and women can use sensual exercises that you do with your partner to find areas of your body that react to stimulation.
Fertility in men
Most men with SCIs have poor sperm quality and have trouble ejaculating. To have children, men with SCIs can use penile stimulation to obtain sperm for assistive reproductive technologies. Vibrators are available that are specially made to induce ejaculation in men with SCIs.
Vibrators can damage your skin. Use them carefully if you don't have feeling in your penis.
If vibrator stimulation isn't successful, rectal probe electroejaculation (RPE) is an option. In this procedure, your doctor inserts an electrical probe into the rectum to stimulate ejaculation.
Fertility in women
An SCI usually won't affect a woman's ability to get pregnant. You may have a brief pause in your menstrual cycle after an SCI. But after your period returns, you will probably be able to get pregnant.
If you do want to get pregnant, make sure to be aware of the special medical, psychological, and social issues involved in an SCI pregnancy. Work with doctors who understand these issues. Common concerns and complications during pregnancy include:1
- Urinary tract infections (UTIs), which increase during pregnancy in women with SCIs. Your urine should be tested frequently.
- Pressure sores. The extra weight of pregnancy puts greater pressure on the skin and may increase the risk of pressure sores. Be sure you perform skin exams regularly.
- Mobility devices. The weight gain of pregnancy may mean that you need to change the type of mobility device you use. You may also have to change your transfer technique.
- Lung function. Women with damage higher on the spinal cord may have reduced lung function. Ventilator support may be needed.
- Autonomic dysreflexia. During labor, the symptoms of this condition may be the same as those seen in uterine contractions. Anesthesia should be used during labor to prevent this serious condition.