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Rehabilitation Institute of Chicago: LIFE Center

Spinal Cord Injury: Sexuality

Reviewed June 2015
Author: Diane Rowles , MS, ACNP, BC, CRRN
Nurse Practitioner
Rehabilitation Institute of Chicago
Details...
A spinal cord injury is a life–changing event. It can affect the ability to function in many ways, including sexuality and intimacy. The way you feel about sex and the ability to have sex is very important, but is different for every person. It also holds different levels of importance to people at various times in their lives.

The extent to which sexual functioning is affected by spinal cord injury depends on the level of injury and whether the injury is complete or incomplete. Men and women are affected differently.
• Generally, the more incomplete the injury, the less change in function.
• For men, the main changes are in sensation (or feeling); getting erections (hard); and ejaculating (producing sperm).
• For women, the changes are in sensation and the ability to lubricate (get wet).

It is not unusual for people with spinal cord injury to have questions about sexuality. A nurse, doctor, psychologist and other health care provider will talk about sexuality issues during a rehabilitation hospitalization and will be able to give specifics for each patient. Patients should also feel free to ask questions. After discharge from a rehabilitation hospital, patients should seek information from their outpatient rehabilitation team or primary health care provider. Many resources available on this subject.

Sexuality for Men
Both the area of an injury and the degree of injury affect sexual functioning. The two areas in the spinal cord that are most related to sexual functioning in men are T11–L2 and S2–S4.

The center at T11–L2 controls psychogenic erections (those stimulated in the brain when fantasizing) and release of fluids. The center at S2–4 controls reflexogenic erections (those stimulated by masturbating, rubbing the inside of the thigh, a full bladder and when catheterizing) and ejaculation (the release of semen). Normally, messages traveling along the spinal cord and to the brain work together. After an injury to the spinal cord, however, messages are disrupted.

If there is an injury in the cervical or high thoracic area in the spinal cord, the messages passed from the brain to the T11–L2 center are affected. Erections are less likely to happen by looking at sexy pictures, etc., but more by touching or rubbing. How long these erections last and how firm they become are different for all individuals. If the injury is below the T11–L2 area, it is possible that the nerves in the T11–L2 area will be working and erections can occur as they did before the injury. Again, the firmness and duration of the erection differs from person to person.

Fertility is another area that may be affected by spinal cord injury. The ability to ejaculate will depend on the location of the injury. Also, the number and movement of sperm may be less, which influences fertility. The only way to measure the quality of male sperm is to have a laboratory test.

Sexuality for Women
The major effects of spinal cord injury on sexual functioning for women is are the loss of sensation and the ability to lubricate. If lubrication is a problem, a water–soluble, non–lanolin, over the counter product such as K–Y jelly can help. Avoid Vaseline or petroleum products.

Following spinal cord injury, some women do miss cycles of menses (periods). Menses almost always return in the first few months to first year. It is important to know that even without periods, ovulation may be occurring and pregnancy is possible.

Women with spinal cord injuries are able to become pregnant and carry to term, but, depending on the injury, there may be additional concerns:
• Increased difficulty in transferring;
• Problems with bladder management and urinary tract infections;
• Higher risk of autonomic dysreflexia for women with injuries above T–6.

All of these medical conditions can be managed with good care. If pregnancy is being considered, get more information and ask questions from your doctor and medical team.

All women should continue to receive annual gynecological exams and health maintenance after a spinal cord injury. This includes breast exams, mammograms, and pap smears.

Tips for Men and Women

Planning for Caregiving
In planning for help at home, consider what effect this will have on a relationship with your caregiver. If it is the person with whom you have sex, discuss whether it is realistic to be both caregiver and a lover. For many partners, doing care is not a problem, but for others it is. If doing care will put stress on the relationship, consider hiring someone to help with showers and bowel programs, or having another family member perform that part of care.

Enjoying Intimate Time
When planning to spend quality time with a sexual partner, it is important to prepare yourself, your partner and your surroundings. Whatever makes you feel good is important. Some ideas include: dimming the lights, burning candles, playing soft music and touching. Setting the mood will improve the experience and make it more enjoyable.

There are many options for sexual enjoyment. Talk to your partner about what feels good and what does not. The loss or changes in sensation mean it may take time to get used to new feelings in certain areas of the body. There is no way for a partner to know what feels good and what does not unless you are open and discuss how you feel.

Talk with your partner about what feels good and encourage them to touch where you have sensation. As you experiment, you may find that there are areas of increased sensation on your body. Frequently, they are at the nipple line, the back of the neck (including behind the ears), and at the shoulders. An additional area, especially for people with injuries at the thoracic level, is a band just above the level of injury. Frequently, this is a very sensitive area that can be stimulated. The amount of genital sensation will depend on the spinal cord injury and the return of function and sensation.

Your partner may have a fear of hurting you or causing pain. Assure him or her that you are fine and will tell them if something causes any problems.

Positioning
Popular places to have sex are in the wheelchair where spasms are usually better controlled and hand and arm function is better and in the shower where the sensation of water feels good.

If you have spasms, it is important to either position in order to increase the use of the spasm to help with movement, or, if the spasms are too severe, adjust positioning to stop them from interfering. Try different positions until finding one that is comfortable and works best. Consider the amount of energy it will take to keep the position and what will allow the most movement. Some people find lying on their back allows for more energy for sex since less energy is used to support their weight. It also leaves the hands free to help with stimulation.

Orgasm
Many people with spinal cord injuries say that orgasm is different, but that it does occur. You may want to discuss this further with your medical team and with other persons with a spinal cord injury. Orgasm is frequently described following a spinal cord injury as a “psychological response,” or a “mind thing”– just as enjoyable, and sometimes even better.

Practicing Safe Sex
Regardless of any disability, it is important to practice safe sex. Safe sex means using a condom to prevent the spread of disease or knowing your partner has not been exposed to a disease.

Contraception
There are many types of contraception available, but some may not be suitable after a spinal cord injury due to risk of complications. A nurse or physician will be able to give you information on the best method.

Medications
Review medications with your health care provider to see if any affect sexual functioning. Some medications may make it harder to get an erection or get wet. If spasms are making it harder to have sex, take medications 30 minutes to one hour before having sex. If you want to use spasms to help with positioning or stimulation, take medications after intercourse instead.

Bladder and Bowel Function
The nerves that enervate the bladder and bowel are at the same level as the sexual functioning centers on the spinal cord. Because nerves are so small and close together, sometimes when one nerve is stimulated, the neighboring nerve may be stimulated as well. If the bladder and/or the bowel are full during intercourse, there is a possibility of having accidents. So, it is important to catheterize and perform a bowel program to empty the bladder and bowel before intercourse.

For people using an indwelling (Foley) catheter, the catheter may be left in or removed for intercourse.
• For women choosing to leave it in: tape the catheter out of the way (most frequently it is taped up to the abdomen or hip) making sure that the urine can drain.
• Men should run the catheter along the side of the penis and cover with a condom, making sure that the urine can drain.
• If choosing to remove the catheter, have a new one ready to put in afterward. Remember that if a catheter is left out for long, urine is building up and may cause autonomic dysreflexia.

Autonomic Dysreflexia
If autonomic dysreflexia occurs, stop and be sure to check bladder and bowel to make sure that both are empty. If it continues to be a problem during sex, discuss options with your doctor.

Please remember that your medical team is able to give more information and specific suggestions including what to expect. No matter what, each person needs to try different options to find what works best.

The Rehabilitation Institute of Chicago offers sexuality services for men and women with disabilities. For information call 312.238.1000.

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