Sex, Intimacy and Spinal Cord Injury

Sex and intimacy are an integral part of the development and experience of all people. Today, there is more information than ever for people with spinal cord injury (SCI) and paralysis who have questions about what their sex and intimate life will be like post-injury. It’s a common question from both men and women: can I still have a healthy sex life after SCI?

The answer is yes, but it’s important to ask questions and get informed to understand what is different about sex, fertility, and intimacy for people with SCI.

Although it is true that after spinal cord disease or injury both men and women often face physical and emotional changes, the good news is that there are many people living with SCI who are enjoying healthy and satisfying sexual lives.

Let’s Talk About Sex

Having sex after spinal cord injury is a lot like having sex for the first time all over again. People who approach sex with an open mind and a willingness to experiment to find out what works and doesn’t work after their injury tend to have the most success and reported satisfaction.

You may not have a strong desire for sex when first injured, but your desire will likely increase over time as you learn to manage self-care and understand your body after injury.

Emotional Impact: SCI may also impact how you think and feel about yourself. Some people may initially feel less desirable after SCI, but it’s important to remember that loss of movement or sensation does not change the fact that you are a desirable sexual being. You are more likely to feel desirable and want to fully express your sexuality if you understand your body and feel comfortable with yourself and your personal identity.

Physical Impact: Loss of muscle movement, sense of touch, and sexual reflexes often occurs after spinal cord injury (SCI). How this loss affects arousal, orgasm, and fertility depends on your level of injury and whether your injury is complete or incomplete, so it’s important to speak to your doctor about your particular injury and how it may impact sex and intimacy from a physical standpoint.

Remember that sexuality is about everything you are and not just about physicality. It’s your personality, your preferences, your communication style, your emotional needs, and, of course, the physical act of sex. Open communication with your partner about your fears and needs is essential as you explore all the different ways you experience sex and intimacy together.

Sexual Arousal and SCI

Sexual arousal is the body’s response to your desire for sex. This includes an increase in heart rate, blood pressure, and breathing rate, and can include an increase in blood flow to the genital area. People without SCI are usually aroused through two pathways:

  • Reflex pathway – Arousal that occurs in response to sensual touching.
  • Psychogenic pathway – Arousal that occurs from psychological sexual sensations such as sexual thoughts, sights, smells, or sounds that turn you on sexually.

For people with SCI, one or both of these pathways may be blocked, but most people with SCI can be aroused by sensual touching. The more sensation you have in the area between your belly button and upper outer thigh, the more likely you are to be aroused by sexual thoughts, sights, smells, or sounds.

For men who can’t get physically aroused after SCI, changing medications may help. Often times spasticity medications, pain medications, or antidepressants are contributing factors.

For women, oral sex may help increase vaginal lubrication enough for penetration. Using a water-based lubricant is another option.

Most men can get an erection with sensual touching and medications like sildenafil, tadalafil or vardenafil. Be sure to talk to your health professional about these medications and other options, such as a constricting ring, vacuum suction device, or a surgically implanted penile prosthesis.

Sex and Communication

If you have a sexual partner from before your SCI, you may have questions and concerns about how to talk with your partner about the ways your sexual relationship will change. If you are developing a new relationship after SCI, you may have thoughts about how to communicate your sexual needs, particularly with someone who doesn’t have experience with SCI.

Here are some tips to help you communicate openly and honestly with your sexual partner:

  • Know your body. Take time to ask questions and understand how your body might change after injury. It can take time to understand how your body works, and what gives you pleasure.
  • Keep an open mind. Be open to trying many different approaches to sex after SCI. Take the time to figure out what each of you finds pleasing and exciting. What you did before your injury may work for you. If not, you and your partner can be creative and open to exploring new ways to find sexual satisfaction. This involves self-awareness and possibly self-exploration to get a clear sense of what you want or need sexually.
  • Keep talking. Talking about sex can be difficult, so you will want to communicate in a way that makes both you and your partner feel comfortable. Some couples find it helpful to write down their needs. The goal is to talk about any issues or concerns and work together to solve problems and resolve concerns.
  • Listen. Healthy communication requires give and take. Listen to your partner’s needs, just as you would like your partner to do for you. Listening to your partner can help resolve issues in a way that satisfies both partners. Remember, your partner will likely have questions and concerns as well, and expressing to them that you are open and receptive to listening is essential.
  • Be honest. Sexual relationships are also about give and take, so it’s important to be honest with yourself and your partner about what is working and what isn’t. This will help your partner feel comfortable expressing the same things back to you. By establishing a ground rule of loving honesty, you will both grow and learn together.
  • Be patient. Couples commonly need time to get comfortable with each other. You will likely experience a few setbacks. For example, there may be issues with bowel, bladder, and spasticity. However, you and your partner should be able to manage issues as you continue to communicate, listen, remain flexible, and approach yourself and your partner with patience and loving-kindness.

Let’s Talk About Fertility

Many people with SCI have questions about fertility. While it’s important to speak with your healthcare professional about your situation, men and women of all levels of injury have had children post SCI.

If you don’t want to have children, it’s important to use a safe form of birth control as well. Condoms are generally considered the best choice for both men and women with SCI.

Fertility and Men

Some men with SCI can get their partners pregnant through sexual intercourse, but many men cannot. Because male sexual function depends on both voluntary and involuntary motor control, most spinal cord injuries impede fertility to some extent. The problem is not sperm quality or even sperm production. Instead, the issue is that men with SCI often struggle to get or retain erections. Working with a fertility specialist can help identify the exact problem, which enables you to develop a plan to move forward. Because everyone is different, it’s important to speak with your doctor, fertility specialist and/or urologist to determine the best course of action.

Fertility and Women

It is possible for women with spinal cord injury to become pregnant through intercourse and carry a baby to term. Spinal cord injuries rarely directly affect women’s fertility, though women may briefly cease ovulating after an injury. As long as a woman is able to have intercourse, she can often still get pregnant, but everyone is unique and it’s important to speak with your physician and a fertility specialist familiar with SCI to get all the information you need.

Let’s Talk About Intimacy

Intimacy is about all forms of sexual expression, not just the act of intercourse. People with SCI may need to explore with their partners to find out new ways of expressing love and intimacy. Intimacy plays an essential role in how we feel about ourselves and how we relate to others. With intimacy, an emotional connection is just as important as a physical connection. Intimacy ranges from hand-holding, kissing and hugging, to touching/pleasuring each other in the bedroom.

There are many parts of your body that can be aroused and provide a pleasant sexual response. These areas of the body are called the erogenous zones and are not limited to the genital area. Using all of your senses can also be helpful. Instead of focusing on what isn’t working, try experimenting with new and exciting forms of touch and sexual expression.

Most problems have a solution, and professionals who know about sexuality and issues of SCI are your best option. They can provide you with accurate information and confidentiality answer your questions. If you have questions or concerns about sex and intimacy after SCI, try the following:

  • Talk to a doctor or nurse about medical needs.
  • Consult an occupational therapist or physical therapist who may be helpful in suggesting equipment needs.
  • An experienced counselor, psychologist, social worker, or sex therapist can usually help individuals and couples work through relationship problems and identify other helpful resources.

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