Sexuality and Fertility

Sexuality and Fertility

The key to successfully redefining your sexual identity is experimentation and open communication.

Sexual function is impaired by injury to the spinal cord. Depending on the level of injury and the degree of nerve damage sexual sensation is changed after SCI. Some people retain sensations in their genitals, others notice they are reduced or absent. Some have heightened sensations in other parts of the body. In many cases people are encouraged to concentrate on “holistic” sexual experiences rather than genital-specific experiences. Many people report that they can still achieve orgasm. It is recommended to take time to explore your own likes, dislikes and needs – don’t put pressure on yourself and over time you will learn what works and what doesn’t. The key to successfully redefining your sexual identity is experimentation and open communication. It helps to understand the anatomy and physiology of sexual function and sexual response.

Sexual health for Men and Women

Having an understanding of how paralysis affects your sexual experience is extremely important after an injury. There are a wide range of options available to both men and women, no matter the level of paralysis.

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Sexual health for women
Sexual health for men

Sexuality, contraception and fertility

Low sex drive is common among women with paralysis. There may also be a fear of bowel or bladder accidents during sex. However, you can take precautionary methods to reduce the chance of an accident:

  • Limit fluid intake if a sexual encounter is planned.
  • If you use an intermittent catheter, you should empty the bladder before sex. If you use a suprapubic or Foley catheter you could try taping the catheter tube to the thigh or abdomen to keep it out of the way.
  • Establish a consistent bowel program and consider reducing the amount you eat beforehand.
  • Be open when communicating with your partner. If you are honest with them and take precautions, the occasional accident is unlikely to stop you from having a fulfilling sex life.
  • Viagra was clinically tested by a group of women with spinal cord injuries and almost all reported that the drug stimulated arousal. In some, it enhanced lubrication and sensation during intercourse.

  • When it comes to contraception, condoms may be the easiest method. Alternatives include spermicidal gel, foam and lubricants, sponges or a diaphragm. This can be more difficult with quadriplegia so you may also like to consider IUDs, a contraceptive pill or hormone implants. Bear in mind that on top of having an SCI, contraceptive methods come with a risk of thrombosis in the legs. Check with your GP or specialist to see which one is most suitable for you. Women with an SCI are still able to conceive naturally. It may also be possible to give birth naturally, however loss of sensation in the pelvic area may prevent you from knowing that labor has begun. There are potential risks associated with pregnancy including increased urinary tract infections, pressure sores and spasticity. Autonomic Dysreflexia is a serious risk during labor for those with injuries above T6.

    Erectile function and fertility

    The most common issue for male sexuality after an SCI is whether they can maintain an erection. The nerves that control a man’s ability to have a reflex erection is located in the sacral area (S2–S4) of the spinal cord. Unless the S2-S4 pathway is damaged, most men will be able to have a reflex erection with physical stimulation. Spasticity is known to interfere with sexual activity in some people with SCI. During genital stimulation, spasticity is more likely to be increased and Autonomic Dysreflexia may occur and will temporarily cease sexual activity. In addition, ejaculation has been reported to decrease spasticity for up to 24-hours. Research shows that Viagra, Cialis and Levitra significantly improve the quality of erections and the satisfaction of sex life in most men with erectile dysfunction (ED) who have injuries between T6 and L5. If you have a risk of have low or high blood pressure or vascular disease do not take these drugs.

    Men who have an SCI typically experience a change in their ability to biologically father a child, due to the inability to ejaculate. There is a possibility of experiencing retrograde ejaculations, which semen travels in reverse, back into the bladder. The number of sperm a man produces does not usually drop in the months or years after paralysis. However, the strength of the sperm is considerably lower than able-bodied men. If this is an issue, there is still plenty of avenues to becoming a biological parent if you consult your GP or specialists for options.

    Further information

    The SCIA Resources library has gathered together a wealth of information on various aspects of sexuality. Visit SCIA Resource Library – Sexuality to access articles, books, websites and forums on topics such as sexuality, fertility, pregnancy, relationships and parenting.