Living With a Spinal Cord Injury
Intimacy and Fertility
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 take part 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. 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.
All SCIs 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 the changes in sexual function and how to best deal with them.
Treatment
There is little research on treating sexual function in SCIs.2 For men who cannot achieve an erection, the same treatments that are used for erection problems (erectile dysfunction) may be used. These include:
- Phosphodiesterase-5 inhibitors (PDE-5 inhibitors) such as sildenafil citrate (Viagra), vardenafil (Levitra), and tadalafil (Cialis). PDE-5 inhibitors can be dangerous for certain men.
- Medicines you inject into the penis, such as alprostadil (Caverject) and papaverine hydrochloride (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.
For information on the treatment of erection problems, see the topic Erection Problems.
A vibrating device can also help men obtain an erection.
Always talk to a doctor familiar with SCIs before using any medicines or assistive devices. You should discuss the location of your injury, possible side effects, and any other medical conditions you have. You also need to watch for autonomic dysreflexia, a syndrome in which there is a sudden onset of excessively high blood pressure. If not treated promptly and correctly, it may lead to seizures, stroke, and even death.
Women may have difficulty being aroused and have little or no vaginal lubrication. You can work with your partner to find areas of your body that react to stimulation. A vibrating device may also help. Lack of lubrication can result in problems such as vaginal tearing or pain during intercourse. If this is a problem, a water-based lubricant such as Astroglide will help, but do not use oil-based lubricants.
Both men and women can benefit from counseling, talking with each other, and sensual exercises. Your sex life will likely be different after your SCI, 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.
Fertility
Men with SCIs usually have difficulty fathering a child. Most men with SCIs have poor sperm quality and have trouble ejaculating.2 To have children, men with SCIs can use penile stimulation to obtain sperm for assistive reproductive technologies.
Stimulation can be done with a vibrator (penile vibratory stimulation, or PVS). Vibrators are available that are specially made to induce ejaculation in men with SCIs. Vibrators can damage your skin. Use them carefully if you do not have feeling in the penis. If PVS is not successful, rectal probe electroejaculation (RPE) is an option. In this procedure, your doctor inserts an electrical probe into the rectum
to stimulate ejaculation.
SCIs usually do not affect a woman's ability to have children.2 Most women have a brief pause in their menstrual cycle after an SCI. But after their period returns, they usually can have children. It is important for women who are sexually active after an SCI to use effective birth control if they do not want to get pregnant. Women with SCIs who want to get pregnant should be aware of the special medical, psychological, and social issues involved in an SCI pregnancy. And they should work with doctors who also understand these needs. Common concerns and complications include:3
- Urinary tract infections (UTIs), which increase during pregnancy in women with SCIs. Your urine should be tested frequently.
- Pressure sores. The additional weight of pregnancy puts greater pressure on the skin and may increase the risk of pressure sores. Be sure you perform skin exams regularly.
- Lung function. Women with damage higher on the spinal cord may experience reduced lung function. Ventilator support may be needed.
- Autonomic dysreflexia. During labor, the symptoms of this condition may be the same as seen in uterine contractions. Anesthesia should be used during labor to prevent this serious condition.
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| Author: | Shannon Erstad, MBA/MPH | Last Updated: February 18, 2009 |
| Medical Review: | William M. Green, MD - Emergency Medicine Nancy Greenwald, MD - Physical Medicine and Rehabilitation | |
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