A spinal cord injury (SCI) can affect intimacy, both physically and emotionally. The injury may result in changes in relationships, sexual activity and the desire for sexual activity, and the ability to have children.

After an SCI, how you look and what you are able to do changes. You may use crutches or a wheelchair and may not be able to participate in all the activities you did previously. You may also feel less of a person sexually: your SCI may have affected how your sexual organs function. 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 be able to develop new ones.

It is important to understand that being intimate means more than just having sex. Your mind can be sexually stimulating to others, and your interests, ideas, and behavior play a greater role in defining you than your appearance or your physical ability to have sex. What makes you unique is your view of the world and how you choose to live. All of this may be more important in a relationship than your ability to have sexual intercourse. Remember that a relationship depends on many things, including your shared interests, how you deal with your personal likes and dislikes, and how you treat each other.

The most important factor in a relationship is how well you communicate. If you are in an intimate relationship or are seeking one, be honest about how the SCI has affected your sexual function physically and how you feel about it. Always keep in mind that people with SCIs are attractive, have relationships and marry, have an active sex life, and can father or bear children.

Desire and sexual arousal

Both men and women remain interested in sexual activity after an SCI, although the level of interest appears to decrease after the injury. Most men with an SCI resume sexual activity within 1 year of the injury, although how often they have sex decreases.²

Usually, men and women are sexually aroused through two pathways: direct stimulation of the genitals or other erotic area (reflex arousal) or through thinking, hearing, or seeing something sexually arousing (psychogenic arousal). In men, this usually results in an erection, and in women, lubrication of the vagina and swelling of the clitoris. However, an SCI can affect either of these pathways, and people with an SCI may or may not have a changed or absent physical response to arousal.

Men who are able to achieve erection may find that the erection is not rigid enough or does not last long enough for sexual activity. 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 of the same intensity as before the SCI. Men will sometimes experience retrograde ejaculation, in which semen is ejaculated into the bladder, not through the penis.