A spinal cord injury can affect male and female sexuality and fertility. Depending on the level and completeness of the spinal cord injury, the extent of the impaired sexual function varies.

The most common issue for male sexuality after an SCI is whether they can maintain an erection. There are three main situations.

• In men with complete lesions above the S2-4 reflex centre (upper motor neuron, UMN), the sacral reflexes are intact, and reflex erections are retained but are often unpredictable.
• Men with complete lesions below or involving the S2–4 reflex centre (lower motor neuron, LMN) lose reflex erections. Still, they may be able to achieve psychogenic erections, but it’s hard to sustain.
• Men with low cord (mixed) lesions between the sympathetic (T11–L2) and parasympathetic (S2–4) spinal centres may retain both types of erections.

The alteration in ejaculatory function after an SCI is another issue, which includes two situations in general.

• Men with complete (UMN) lesions above the emission centre (sympathetic T11–L2) retain only about a 5% chance of achieving reflex ejaculation without intervention.
• Men with complete (mixed and LMN) lesions below the emission centre (sympathetic T11–L2) may retain the ability to achieve seminal psychogenic emission (often precocious) with associated partial orgasm.

59% of women reported at least one sexual dysfunction after spinal cord injury. Meanwhile, women are more prone than men to depression and psychological disorders after a spinal cord injury, which adversely affects their sexual functioning. Moreover, the sexual changes in women after an SCI may include the following:

• altered sexual desire and arousal
• changed genital sensation
• altered vaginal lubrication
• altered vaginal accommodation, satisfaction, pain and orgasm

Fertility in women usually returns with the first period:

• Having SCI does not affect the ability to conceive naturally.
• When it comes to contraception, condoms may be the easiest method.
• Certain aspects of pregnancy, like routine monitoring, will be different in people with SCI because there is a higher risk for secondary complications of SCI during pregnancy. Women with SCI should be assessed in high-risk pregnancy units to determine their risks.

When it comes to fertility, men with SCI may be reduced. The reduction level depends on the injury level and whether the injury is complete or incomplete.

The reduction in fertility happens because:

• A sustained erection may not be achievable
• The injury impaired ejaculation.
• And it reduces semen/sperm quality and motility.

There are many methods to improve the sexual function and fertility ability in people with SCI. We have had a professional page to cover these issues. Please to access to the factsheet for sexuality and fertility for more information.

References:

1. Queensland Spinal Cord Injuries Service (QSCIS) (March 2020). “Sex and Fertility following Spinal Cord Injury (SCI)” (PDF). 2020
2. Sandra Lever, Grace Leong (2017). “Sexuality following spinal cord injury” (PDF). 2017