Following a spinal cord injury, sex will inevitably change, become difficult and often become impossible. Traumatic spinal cord injury results in a vast array of functional and nonfunctional changes in the body ranging, from loss of motor and sensory functions to changes in hormone levels. The nature and level of injury are major factors determining the retained level of sexual function in SCI (Spinal Cord Injury) patients. Immediately after the injury, both men and women lose the reflexive sexual response. Some patients may achieve some level of arousal with manual stimulation if the sacral spinal cord and peripheral nervous system are intact. This presents in the form of an erection in men and vaginal lubrication in women. However, in most cases the quality of the arousal remains significantly impaired, short lived and usually does not achieve a satisfactory goal – either orgasm or ejaculation – in both groups of patients.
Post-Spinal Cord Injury Sex For Men
Post-Spinal cord injury sex for men is usually possible, although the nature of the sex will be changed. The ability to regain erection is better preserved as compared to ejaculation. Whereas 95% of patients experience ejaculation problems, around 80% somewhat recover some level of erection after 2 years post-injury. There are three types of erection possible after a spinal cord injury:
- Psychogenic
These types of erection are triggered by thoughts of having sex, commonly provoked auditory and visual stimulations, - Reflexogenic
These are triggered by direct stimulation of the penis and are enabled by intact or impaired sexual reflexes - Spontaneous or Nocturnal
Which happen on their own, usually at night.
Which of these underlying mechanisms causes erection in spinal cord injury patients is related to the nature and severity of the injury. Even though achieving orgasm from post-spinal cord injury sex is less common in men than in women, some men may achieve a satisfactory level of orgasms. However, the quality of their orgasms may be different.
The impact of hormones on post-spinal cord injury sex
Hormonal changes play a vital role in determining the quality of remaining sexual functions in both women and men. Sexual arousal is significantly altered by higher levels of stress hormones and inflammation. Many men experience significantly reduced testosterone levels, which affects the overall quality of arousal, erection, and orgasm. In women, the extent to which sexual hormone blood alterations correlates with their sexual dysfunctions following spinal cord injury is still debated. The area is less well researched than in the case of men, largely because women make up a lower percentage of spinal cord injury patients. Similarly, many female patients continue to menstruate, ovulate and be able to reproduce so there may perhaps be less impetus for research.
Other factors at play
Despite female SCI patients being less studied in relation to sexual function, investigations have shown that physiological and psychological factors, such as body image, have an impact on sexual function, possibly more so than hormonal factors.
Needless to say, impaired mobility has an impact on sexual function, as with any phsyical activity. The challenges of establishing proper positioning are an impediment to intercourse, as is limitation of upper body function. The physical exertion and movement can cause postural hypotension and similarly a number of other autonomic dysfunctions can come into play, making sex impractical.
Needless to say, impaired mobility has an impact on sexual function, as with any phsyical activity. The challenges of establishing proper positioning are an impediment to intercourse, as is limitation of upper body function. The physical exertion and movement can cause postural hypotension and similarly a number of other autonomic dysfunctions can come into play, making sex impractical.
What can be done?
Epidural spinal cord stimulation may improve the quality of sexual function in both men and women, by improving many of the above-mentioned factors. Chiefly, by improving autonomic functions, cardiovascular functions, and blood pressure levels patients can better enjoy sex. Similarly, by improving mobility, sex becomes more feasible. Many patients treated at Verita Neuro reported improved and satisfactory levels of erection, with some patients regaining the ability to ejaculate.
References
- Drench ME. Impact of altered sexuality and sexual function in spinal cord injury: a review. Sex Disabil 1992;10(1):3–14
- Kreuter M et al. Sexuality and sexual life in women with spinal cord injury: a controlled study. J Rehabil Med 2008;40(1):61–9
- Kreuter M et al. Sexual adjustment and quality of relationship in spinal paraplegia: a controlled study. Arch Phys Med Rehabil 1996;77(6):541–8
- Siosteen A, Lundqvist C, Blomstrand C, Sullivan L, Sullivan M. Sexual ability, activity, attitudes and satisfaction as part of adjustment in spinal cord-injured subjects. Paraplegia 1990;28(5):285–95
- Biering-Sørensen F, Sonksen J. Sexual function in spinal cord lesioned men. Spinal Cord 2001;39(9):455–70
- Ramos AS, Samso JV. Specific aspects of erectile dysfunction in spinal cord injury. Int J Impot Res 2004;16Suppl. 2:42–5
- Sipski ML, Alexander CJ, Rosen R. Sexual arousal and orgasm in women: effects of spinal cord injury. Ann Neurol 2001;49(1):35–44
- Kennedy S, Over R. Psychophysiological assessment of male sexual arousal following spinal cord injury. Arch Sex Behav 1990;19(1):15–27
- Tsuji I, Nakajima F, Morimoto J, Nounaka Y. The sexual function in patients with spinal cord injury. Urol Int 1961;12:270–80
- Alexander CJ, Sipski ML, Findley TW. Sexual activities, desire, and satisfaction in males pre- and post-spinal cord injury. Arch Sex Behav 1993;22(3):217–28
- Dahlberg A, Alaranta HT, Kautiainen H, Kotila M. Sexual activity and satisfaction in men with traumatic spinal cord lesion. J Rehabil Med 2007;39(2):152–5
- Charlifue SW, Gerhart KA, Menter RR, Whiteneck GG, Manley MS. Sexual issues of women with spinal cord injuries. Paraplegia 1992;30(3):192–9
- Jackson AB, Wadley V. A multicenter study of women's self-reported reproductive health after spinal cord injury. Arch Phys Med Rehabil 1999;80(11):1420–8
- Sipski ML, Alexander CJ, Gomez-Marin O, Grossbard M, Rosen R. Effects of vibratory stimulation on sexual response in women with spinal cord injury. J Rehabil Res Dev 2005;42(5):609–16
- Teal JC, Athelstan GT. Sexuality and spinal cord injury: some psychosocial considerations. Arch Phys Med Rehabil 1975;56(6):264–8
- Fisher T, Byfield MG, Brown TT, Fiedler I, Laud P. The profile of sexual health needs of individuals 12 months after spinal cord injury. SCI Psychosoc Proc 2001;14(1):5–11
- Lombardi, G., Mondaini, N., Macchiarella, A. and Del Popolo, G. (2007), Female Sexual Dysfunction and Hormonal Status in Spinal Cord Injured (SCI) Patients. Journal of Andrology, 28: 722-726.
