Spinal Cord Injury
Many people with spinal cord injury (SCI) are able to have a
satisfying sex life and to have children. Two important factors determine how
sexual function is affected when the spinal cord is traumatically or otherwise
injured:
1) The level of the injury.
The higher the level of the injury (towards the head) the higher
the function of nerves and muscles lost. Quadriplegia involves paralysis and loss
of sensation in both arms and both legs. Paraplegia, which is usually due to
injury at a lower level of the spinal cord, involves only the legs, while parts
of the upper torso and the arms have normal sensation and muscle function.
2) The degree of spinal cord injury.
Injuries range from incomplete to complete, depending on whether
some parts of the spinal cord escape from injury. Following incomplete injury,
sensation and muscle activity can remain intact in areas that would be affected
following a complete injury. Incomplete SCI often allows several sexual
functions and responses to remain intact.
Possible changes in sexuality following spinal cord injury
Some of the physiologic changes (loss of sensation and muscle
function in certain areas) following SCI are transient and most pronounced
immediately. Only after several weeks can the full impact of the injury to the
spinal cord be determined.
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Women may experience 3-6 months without menstruation,
after which the cycle usually normalizes and fertility is preserved. Even
during irregular or lacking cycles a woman can remain fertile. |
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Depending on the level and degree of SCI, erectile function
and ejaculation in men, and the ability to experience orgasm in both sexes
may or may not be disturbed. |
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Many people with loss of sensation in their genital area due
to SCI are able to develop erogenous zones in other areas of the body where
sensation has remained intact. Caressing of these areas can cause sexual
feelings and pleasure. |
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Several of the treatment options for erectile dysfunction
are also available for men with SCI, including injections of prostaglandin E1
into the penis; vacuum pumps; and oral medication (Viagra). |
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Women with complete SCI often retain their ability to
achieve orgasm. If vaginal lubrication is decreased, water-soluble
lubricants (K-Y jelly, Astroglide, etc.) sold over the counter in most
pharmacies can be used. |
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If you have an indwelling catheter, it can be taped out of
the way in women, and men can fold it back over the penis, and cover both
penis and catheter with a condom. |
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Even though mobility and sensation may be affected following
SCI, many couples are able to adjust their lovemaking to the new
circumstances and resume a satisfying sex life. |
Fertility & pregnancy
The best method of birth control depends on whether the woman’s
hand strength and/or sensation in the genital area is affected. She may find it
difficult to manipulate diaphragms, cervical caps, female condoms, and
contraceptive sponges. Birth control pills containing estrogen may not be
recommended due to their increased risk of causing thrombophlebitis (blood clots
in leg veins) after a SCI. Levonorgestrol implants surgically placed under the
skin of the arm can be used as a long-term contraceptive method. The male condom
also may be an appropriate choice of contraception.
Fertility in men with SCI is often affected by ejaculation
problems, lower sperm count, and decreased sperm motility. Several techniques
are available for harvesting semen from men unable to ejaculate. Many men have
been able to procreate after a SCI.
Women with SCI who wish to become pregnant should discuss the
potential problems associated with pregnancy and their management with their
gynecologist. Many women with SCI have been able to have children.
References
Bancroft, J. (1989) Human sexuality and its problems. Churchill
Livingstone, ISBN: 0-443-03455-9
Crenshaw, T. L. & Goldberg, J.P. (1996) Sexual Pharmacology.
Drugs that affect sexual function. Norton, ISBN: 0-393-70144-1
Milsten, R. & Slowinski, J. (1999) The sexual male. Problems
and solutions. Norton, ISBN: 0-393-04740-7
Sipski, M.L. & Alexander, C.J. (1997) Sexual function in
people with disability and chronic illness. Aspen Publishers, Inc., ISBN:
0-8342-0886-5
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