Sexuality After SCI
Since a spinal cord injury (SCI) affects virtually every system of the human body, many people who sustain SCI have serious concerns about how their injuries have affected their ability to participate in and enjoy a sexual relationship. This document attempts to address some of the more common questions that arise on the topic of sex after a SCI. It also directs the reader to additional sources of more specific information.
Sexual function in humans is controlled by parts of the central nervous system (CNS), particularly the brain and spinal cord. Interruption to the CNS through injury to the spinal cord will therefore have some effect on sexual function. The extent to which sexual function is impaired, however, depends on a variety of factors including the level of injury, the severity of damage to the spinal cord, and whether the individual is male or female.
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At only the most basic level, a female's ability to engage in sexual activity is less likely to be affected by SCI, by virtue of the way the female body is constructed. A woman is often able to have intercourse as easily after SCI as before, although additional lubrication may be needed to avoid chafing and to make the act of intercourse easier to initiate. Alternative positioning of one's body may have to be considered as well.
While certain aspects of female sexual functioning may be changed after SCI, the ability to conceive, carry and give birth is usually not impaired. Birth control is an issue of great interest to women in general and the woman with an SCI has additional reasons to be concerned. Unless a woman develops sensitivity to latex, her male partner's use of condoms may be the easiest method of birth control. Using foam, the sponge or a diaphragm and jelly is still possible, but women with quadriplegia may now find this difficult, if not impossible. While only a few assistive devices are available to help perform these tasks, a woman's partner may wish to assist or even perform these tasks, helping to make the responsibility for birth control a shared function.
Other methods of birth control, such as IUD's, the pill and Norplant, should only be used with great caution after consultation with an experienced gynecologist or physiatrist. Both SCI and the pill are known to cause vascular complications in certain individuals and one may contraindicate the use of the other. IUD's are particularly worrisome because a lack of sensation or inability to check its positioning may cause a woman to be unaware of slippage or puncture. Slippage may decrease the effectiveness of preventing a pregnancy and a puncture can be life threatening.
Many women are concerned about their ability to have children following a SCI. Although there may be precautions to guard against complications such as autonomic dysreflexia, most women are able to bear children following a SCI. A competent physician who is experienced in labor and delivery with women with SCI is essential when contemplating having children.
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For males, the situation of sexual functioning is a little more complicated. Some men are able to achieve erections quite easily, while others can achieve erections occasionally and some are unable to achieve erections at all after a SCI. Two basic kinds of erections are possible. Psychogenic (the kind of erection that occurs as a result of having sexy thoughts or by looking at erotic pictures) and reflexogenic (erections that occur as a result of direct physical stimulation of the penis or surrounding area).
There are several ways to achieve an erection after SCI. Vacuum-Induced Erections employ tubes with a vacuum pump that, when placed over the penis and activated, pulls the air out of the tube often causing blood to inflate the penis. A band is then placed around the base of the penis to maintain erection. Most urologists suggest this method as a first step as it is the least invasive of the available procedures. Another option is the Injected Vasoactive Drug. A very fine needle is used prior to sexual activity to inject a prescribed dosage of medication into the base of the penis. The extremely fine needle causes little or no discomfort. The drug causes the blood vessels in the penis to enlarge, thereby stimulating an erection that can last from 15 minutes to an hour or more, depending on the dosage injected. Some potential side effects include bruises and erection for a dangerously long period of time. The cost per injection can range from $10 to $20 depending on the medication used, and insurance coverage may be available.
Penile Implants, or penile prostheses are sometimes considered. This procedure is extremely invasive as it involves surgical implantation of a rod or an inflatable tube into the penis. Inflatable implants have several chambers that are filled with fluid to achieve erection and are then emptied following intercourse. The pump, chambers to be filled with fluid, and connecting tubes are all implanted. Semi-rigid implants consist of two implants made of a flexible material that causes a permanent rigid state. The penis can be bent against the pelvis when not engaged in intercourse.
Although the level and severity of injury may give some indication as to how likely a man is to be able to have erections, the best way to find out for yourself is to get to know your body and learn how it reacts to certain situations. Your doctor can give you more information about whatever physiological limitations may exist, but you and your partner need to explore your body's response to sexual situations. Although talking about sexual function is sometimes difficult, complete and open communication between partners is the best way to explore sexual possibilities available to you after injury (just as it was before injury, by the way!)
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As with other basic physiological functions after a SCI, sexual sensations can also be altered. Some of the nerves you once counted on to provide pleasurable feelings in sexual organs and other erotic areas of your body may no longer be working as they did before injury. Some people retain specific sexual sensations in the genital areas, while others notice they are diminished or absent. However, many others have reported heightened sensations in different parts of the body - the neck, earlobes, arms or other areas of skin. Many people who have sustained a SCI have indicated that their total enjoyment of the sexual experience after SCI is as good as, if not better than, their pre-injury sexual experiences. Necessity in many cases encourages them to concentrate on "holistic" sexual experiences rather than on genital-specific sex. Many individuals report that they can still achieve climax although frequently not in the same way as before their injury. Again, the best way to find out your own likes, dislikes and needs is exploring them openly with a willing and loving partner.
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A key component of sexuality is how one perceives one's body. A person who is able to see themselves as attractive and desirable is far more likely to engage in a healthy and satisfying sex life. Some people experience issues of lowered self esteem and a resulting poor self image following a spinal cord injury. As a person with SCI adjusts to a new physical reality, it may be difficult to change self perceptions to accommodate the injury in a positive way. There are several books and videos that address the concepts of body image and sexuality. People can find these books, in conjunction with candid conversations regarding sex, self image and their body, to be helpful as they search for different ways to express sexual feelings.
One common misconception following a spinal cord injury is that a single man or woman will never find a life partner, or that an existing partner will leave a relationship due to the complications of an injury. This is not the case. The divorce rate following spinal cord injury is only slightly higher than in other populations, and thousands of people have been married and begun families after a spinal cord injury.
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Many couples experience issues relating to sexuality that may or may not require the services of a qualified counselor or sexual therapist. While open communication between partners can often resolve many sexual issues, a therapist can sometimes assist in the transition issues following SCI. The American Association of Sex Educators, Counselors and Therapists (AASECT) has a list of qualified and certified professionals (see resource listings).
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The issues relating to sexuality are not exclusive to the heterosexual population. People who have incurred a SCI and who are homosexual or bisexual experience the same feelings of separation from their peers as their heterosexual counterparts. Changing perceptions of one's body coupled with a lack of forums to meet others in similar situations can be devastating. The burden of experience of being a member of a discriminated group may often increase. Information is available through several organizations including the NSCIA Resource Center and ABLETOGETHER (see resource listings).
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Sexual devices are still considered a taboo subject in modern society. In reality, they can often be an effective tool in exploration and towards achieving maximum sexual satisfaction. The key to the purchase and use of any type of sexual toy or device is acceptance of varied sexual desires and frequent and honest self exploration or communication between sexual partners. The Xandria collection offers a catalogue specifically for persons with disabilities (see resource listings).
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Coalition on Sexuality and Disability, Inc.
The American Association of Sex Educators, Counselors and
The Sex Information and Educational Council of the U.S.
The Xandria Collection
NSCIA, 7/96 NSCIA would like to thank Dan Casady, Thom DeLilla and Robert Oates, M.D., for their help in preparing this fact sheet. This Factsheet is offered as an information service and is not intended to cover all treatments or research in the field nor is it an endorsement of the methods mentioned herein. Any information you may have to offer to further update this Factsheet would be greatly appreciated. The National Spinal Cord Injury Association Resource Center (NSCIRC) provides information and referral on any subject related to spinal cord injury. Contact the resource center at 1-800-962-9629.
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