Sexuality after spinal cord injury
People with SCI may employ a variety of adaptations to help carry on their sex lives healthily, by focusing on different areas of the body and types of sexual acts.
[14] By two years post-injury, 80% of men recover at least partial erectile function,[15] though many experience problems with the reliability and duration of their erections if they do not use interventions to enhance them.
[15][21] According to the American Spinal Injury Association grading scale, an incomplete SCI is one in which some amount of sensation or motor function is preserved in the rectum.
[10] Men with complete SCI report sexual sensations at the time of ejaculation, accompanied by physical signs normally found at orgasm, such as increased blood pressure.
[26] One proposed explanation for orgasm in women despite complete SCI is that the vagus nerve bypasses the spinal cord and carries sensory information from the genitals directly to the brain.
[10][25][28][29] Women with complete injuries can achieve sexual arousal and orgasm through stimulation of the clitoris, cervix, or vagina, which are each innervated by different nerve pathways, which suggests that even if SCI interferes with one area, the function might be preserved in others.
[17] The body's physical arousal response (vaginal lubrication and engorgement of the clitoris in women and erection in men) occurs due to two separate pathways which normally work together: psychogenic and reflex.
[21][27] These erections may result in the absence of psychological arousal when the penis is touched or brushed, e.g. by clothing,[43] but they do not last long and are generally lost when the stimulus is removed.
[46] The main barrier to sexual activity that people with SCI cite is physical limitation; e.g. balance problems and muscle weakness cause difficulty with positioning.
[17] As many as 95% of men with SCI have problems with ejaculation (anejaculation),[15] possibly due to impaired coordination of input from different parts of the nervous system.
[64][65] Cytokines, immune proteins which promote an inflammatory response, are present at higher concentrations in semen of men with SCI,[65][66] as is platelet-activating factor acetylhydrolase; both are harmful to sperm.
[64] Although female fertility is not usually permanently reduced by SCI, there is a stress response that can happen immediately post-injury that alters levels of fertility-related hormones in the body.
[72] Considerations exist such as maintaining proper positioning in a wheelchair,[43] prevention of pressure sores, and increased difficulty moving due to weight gain and changes in center of balance.
[74] For women with injuries above T6, a risk during labor and delivery that threatens both mother and fetus is autonomic dysreflexia, in which the blood pressure increases to dangerous levels high enough to cause potentially deadly stroke.
[87] Although satisfaction among men who use them is high, if they do need to be removed implants make other methods such as injections and vacuum devices unusable due to tissue damage.
[92] Reports of efficacy with PVS range from 15 to 88%, possibly due to differences in vibrator settings and experience of clinicians, as well as level and completeness of injury.
[21] Both PVS and electroejaculation carry a risk of autonomic dysreflexia, so drugs to prevent the condition can be given in advance and blood pressure is monitored throughout the procedures for those who are susceptible.
[55] Education includes information about birth control or assistive devices such as those for positioning in sex, or advice and ideas for addressing problems such as incontinence and autonomic dysreflexia.
[57] Longer-term education and counseling on sex after discharge from a hospital setting are especially important,[99] yet sexuality is one of the most often neglected areas in long-term SCI rehabilitation, particularly for women.
[100] Health professionals must be sensitive to issues of sexual orientation and gender identity, showing respect and acceptance while communicating, listening, and emotionally supporting.
[102] Frequently, partners of injured people must contend with feelings like guilt, anger, anxiety, and exhaustion while dealing with the added financial burden of lost wages and medical expenses.
[105] Caregivers help the child and family prepare for transition into adulthood, including in sexuality and social interaction, beginning early and intensifying during adolescence.
[109] Given the importance they place on sexuality and privacy, adolescents may experience humiliation when parents or caregivers bathe them or take care of bowel and bladder needs.
They often change their sexual practices, moving away from genital stimulation and intercourse[5] and toward greater emphasis on touching above the level of injury and other aspects of intimacy such as kissing and caressing.
[19] Other factors that enhance sexual pleasure are positive memories, fantasies, relaxation, meditation, breathing techniques, and most importantly, trust with a partner.
[121] Difficulties adjusting to a changed appearance and physical limitations contribute to reduced frequency of sexual acts, and improved body image is associated with an increase.
Partners of injured people often feel out of control, overwhelmed, angry, and guilty while having added work related to the injury, less help with responsibilities like parenting, and loss of wages.
[57] Negative societal attitudes and stereotypes about people with disabilities like SCI affect interpersonal interactions and self-image, with important implications for quality of life.
[3] Another common belief that affects sexual rehabilitation is that sex is strictly about genital function; this could cause caregivers to discount the importance of the rest of the body and of the individual.
[150] Female beauty standards propagated by mass media and culture portray the ideal woman as non-disabled: as one fashion model with a SCI commented, "when you have a devastating injury or disability, you're not often thought of as sensual or pretty because you don't look like the women in the magazines.
