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4 Sexual Health
Foreword
I think that if this Reference Manual was written over 20 years ago,there might not have been a section on Sexual Health, or it wouldhave looked quite different from this section. In this section we triedto canvass the issues surrounding both males and females anddiscuss options that may aid an individual with erectile dysfunction.
This section also discusses fertility issues, what types ofcontraception are most beneficial and appropriate for someone witha spinal cord injury and discusses pregnancy with a spinal cordinjury. This section reminds us that even with a spinal cord injurywe can still fulfill the dreams that we have and carry on withrelationships that we’d like to as adults.
Please remember that the information provided in this section is notmeant to offer medical advice, but to provide information that willhelp you discuss this matter with your medical practitioners, as wellas allow you to seek out more information on these issues.
Sexuality
What is Sexuality?
Sexuality is made up of both the physical and psychologicalaspects of your being. After a SCI, remember that you are still you.
Your attractive brown or blue eyes will still be attractive. Yourcharisma will still charm and your personality will still shine through.
You will still define your sexuality. After a SCI your physical functionwill be altered but your sexual desires will not be. The old adagethat the brain is the most erotic part of the body is entirely true.
After a spinal cord injury, there will be changes in your sex life, andin the way you view sex. But these changes can be positive. Manypeople state that sex became more intimate and special after theiraccident. You should remember that open communication is thekey to maintaining a healthy and active sex life, now more thanever. You will now need to talk about what feels good and what youcan and cannot do. Rediscovering your body and your partner’sbody in new ways can add to the sexual experience. Don’t be afraidto experiment and discuss things with your partner! A spinal cordinjury does not mean you have to give up your sex life; you justhave to be willing to keep an open mind.
Coping With the Changes
Male
ERECTION
An erection may be difficult to achieve following a SCI. There are
certain factors that will determine the possibility and probability of
achieving an erection, some of these being:
• The level of your injury. In most cases, a person with complete lower injuries cannot achieve erections. However, the higher theinjury is along the spine, the more likely it is that a person will beable to achieve and maintain a complete erection.
• The amount of time since your injury. The ability to achieve an erection is sometimes lessened in the beginning stages of aSCI; however, that may change during the first year after yourinjury.
• How severe your injury is. A person with an incomplete injury is more likely to be able to achieve an erection than a person witha complete injury.
Men, whether they have sustained a SCI or not, achieve one of twotypes of erections: • Reflexogenic erections are achieved through direct genital stimulation. The reflex centre is located in the lower end of thespinal cord and produces a better quality erection.
• Psychogenic erections begin in the mind as a result of some visual stimulation or as a result of a fantasy. The ability toachieve this type of erection will depend on the level andcompleteness of the injury.
Some men with a SCI may also experience spontaneous erections.
Aids for Achieving Erection
There are now numerous aids to achieving an erection. Some of
these aids include:
• Viagra (Silendafil Citrate)
Viagra works by helping allow blood to flow into the penis causing an erection; however, sexual stimulation is still necessary when • Intracavernous Injections
This involves receiving a needle of medication in the penisapproximately 20 minutes before any sexual activity.
• Vacuum Pump
A vacuum pump produces an erection by creating a vacuumaround the penis that draws blood into the penis. To maintain thiserection, a rubber ring is placed around the base of the penis.
• Urethral Suppository (MUSE)
This is a very small suppository that is inserted into the tip of thepenis approximately 5-10 minutes before any sexual activity. Arubber band is used with this instance to maintain the erection aswell.
• Penile Implants
There are three different types of penile implants; rigid, semi-rigidand inflatable. A surgeon must implant these for you, and theoperation is permanent.
In order for any treatment to be successful, it is advisable to includeyour partner in information and learning sessions EJACULATION, ORGASM, AND COITUS
The brain and the nerves in the lowest part of the spinal cord
control ejaculation. When the spinal cord has been injured, there is
a decrease in ability to ejaculate. Some men with SCI experience
what is referred to as “retrograde ejaculation” where semen travels
up into the bladder instead of out through the penis.
Many men with a spinal cord injury still experience orgasm;however, most state they are unable to reach pre-injury levelorgasm. The ability to have an orgasm is not directly related to yourlevel of injury.
Aids for Achieving Ejaculation
There are many procedures that will induce ejaculation. All of
these involve consultation with your health care provider.
• Vibrator
Has an 80% success rate. Procedure is non-invasive. There is arisk of autonomic dysreflexia.
• Pharmacologically Induced - subcutaneous injection
Injection of physostigmine includes a risk of autonomicdysreflexia and possible dizziness and hallucinations.
• Electro-ejaculation
Introduce an electric probe in the rectum to stimulate ejaculationusing a weak electrical discharge. There is a risk of pain.
• Aspiration of sperm
This is a new technique. The risk is of narrowing of the canalsthrough which sperm travels • Testicular Puncture
The collection of sperm directly from the testicle.
• Retrograde Ejaculation
Sperm ends up in the bladder and is collected, cleaned andused for fertilization. Possible risk of infertile sperm.
Female
After an SCI you may notice some gradual changes in the quality of
your orgasms, lubrications, and engorgement of nipples or vulva.
In complete SCI, vaginal secretions are affected and someliterature suggests vaginal lubricants be used. You should usewater-soluble gels; not Vaseline or petroleum jelly as they canirritate the vaginal mucosa and the chemical reaction can destroy acondom. Breathing, pulse rate, and blood pressure increases in theSCI woman just as they do in the able-bodied woman. The clitorisand labia swell in women with SCI as well.
You may find you do not have the same control over thepubococygeus muscle, which controls the flow of urine, so thismust be kept in mind during sexual activity. It is not uncommon forSCI women to have intercourse with a catheter in place; however, ifyou do remove your catheter, you must remember that it shouldonly be removed up to a maximum of 4 hours.
It is possible for a woman with a SCI to achieve a normal orgasm,
however it is commonly noted that achieving orgasm after an injury
depends on the level of your injury. Some SCI women, like SCI
men, report of experiencing “phantom orgasms” or “paraorgasms”
(please see below under Orgasm).
It is generally easier for the SCI woman to adjust to changes in theirsexual function than SCI men. Although one might think that this isbecause of a woman’s ability to accept a more passive role, manySCI woman have found they became more independent and activeas sexual partners following their injury. However, there are factorsthat can change a SCI woman’s ability to adapt to this newbehaviour, including a low self-concept and a poor body image.
Accepting yourself as a person will help you become morecomfortable with your new sexual self, and taking control wheneverpossible will only strengthen that comfort level.
It is ideal for partners to be free to use whatever activities,fantasies, artificial devices, and other sensual expressions that areacceptable and pleasurable to them. Mutual masturbation, hugging,oral stimulation of feeling areas, or any other form of pleasurablestimulations, may be included in the expression of sexuality.
Merriam-Webster’s dictionary defines an orgasm as “an explosive discharge of neuromuscular tensions at the height of sexual arousal that is usually accompanied by the ejaculation of semen in the male and by vaginal contractions in the female.” Some SCI men and women are able to experience “phantom orgasms” or “paraorgasms,” which refers to the reassignment of sexual response to other non-affected areas of the body. The University of Miami School of Medicine describes this as “a highly pleasurable fantasized orgasm (which occurs by) mentally intensifying an existing sensation from some neurologically intact portion of their body and reassigning the sensation to their genitals.” Some areas that are particularly sensitive and produce sexualarousal are called erogenous zones. Many people with SCIdiscover that areas other than the genital areas and nipples aresexually exciting when touched. Use them and also your othersenses to heighten these feelings with the help of the largest sexorgan; the brain.
Things to bear in mind:
• Autonomic Dysreflexia (AD)
Sometimes sexual activity can bring on episodes of Autonomic
Dysreflexia (please see Health and Wellness).
• Bladder Management
If you are worried about bladder control, decreasing your fluidintake prior to sex will help. Whether or not you leave in yourcatheter during sex is your choice.
• Catheter
If a catheter is worn during intercourse, it should be taped inplace and/or a condom should be worn to keep it in place. Takecare not to anchor the catheter down while the penis is still soft.
It should be allowed to slide in the penis as the erection is takingplace.
• Spasticity
Spasticity is not necessarily a hindrance when it comes to sex,as some people use it to increase pleasure or obtain erections.
Fertility and Contraceptives
Male
There is a possibility that because of your SCI, the quality and
quantity of your sperm may be decreased; however research is
currently being done to further determine this.
Artificial insemination is the introduction of sperm into the vagina orcervix by artificial means. Sperm collected by vibratory stimulationor electro-ejaculation can be used in this procedure to increase thelikelihood of fertilization.
If a couple desires children but the sperm of a male is of poorquality and cannot be used, another option is artificial inseminationwith the sperm of a donor.
Condoms are an appropriate contraceptive for men.
Female
A woman with a spinal cord injury can still get pregnant and have a
normal vaginal delivery. Because having a spinal cord injury causes
many changes in your health, some problems associated with
pregnancy are more prevalent. Some of the more significant
complications are:
• Blood Pressure – Blood pressure may drop in the second
• Urinary Tract Infections – Urinary tract infections can lead to
more serious conditions that could bring on premature labour ormay even be life threatening. Be sure to empty your bladder ascompletely as possible and have your doctor check for bacteriain your urine, even when no signs of infection are present.
• Spasticity – Some drugs taken to stop spasticity cannot be
taken while breast-feeding. Be sure to talk to your doctor if youintend to breast-feed so proper medication can be prescribed.
• Pressure sores – Increased weight during your pregnancy can
increase your chances of pressure sores. Be sure to do frequentpressure releases and skin examinations.
• Lung Capacity – SCI commonly reduces lung capacity, and
pregnancy and labour sometimes demand extra oxygen. If youare feeling short of breath, talk to your doctor, as some sort ofsupport may be necessary for you.
• Pre-term labour – While women with a SCI generally have
normal pregnancies, there is a higher occurrence of prematuredelivery. Women with a SCI experience the beginnings of labourdifferently from uninjured women but do have indication thatlabour has started.
• Delivery – Most SCI women deliver normally and do not need
caesarean section. The percentage of SCI women who delivervia caesarean section is only slightly higher than that ofuninjured women.
As a woman with SCI, your pregnancy is considered “high risk” dueto the unique complications that can occur, and you should discussthese possible complications with your physician.
There are special health factors affecting a SCI woman and sochoice of contraceptive should also be discussed with yourphysician to ensure that all risks are identified and explained to you.
Parenting
Parenting through the baby, toddler, teenage and adult years mayrequire assistive devices and adaptations to baby furniture and toyscommonly found on the market. Many individuals with a spinal cordinjury have experienced the same rewards and frustrations ofraising children as non-spinal cord injured individuals and thensome. Children tend to be more adaptive to things than we usuallygive them credit. And remember to ask for help when you need it.
Please see the local directory for contact numbers and informationon parenting.
SUMMARY
This section should make you think. Hopefully, it’s put you on the
road to realizing that you are a sexual person despite anything that
has happened to you. Whether you’re a man or a woman, know
that there is someone out there for you. Everybody has a soul
mate; someone to love and yes, have sex with, too. Thousands of
disabled people have, why not you? There’s a healthy, happy,
sexually active life just waiting for you to take it.
RESOURCES
Sexuality and Spinal Injury
http://calder.med.miami.edu/pointis/sexdrive.html
Canadian Paraplegic Organization – Life After Spinal Cord Injury http://www.canparaplegic.org/national/level2.tpl?var1=story&var2=5.00Life After a Spinal Cord Injury, 1997.
Spinal Cord Injury Information Network – Parenting and Relationships http://www.spinalcord.uab.edu/show.asp?durki=41589http://www.spinalcord.uab.edu/show.asp?durki=24429 Paraplegia News - Having Childrenhttp://www.pn-magazine.com/PN/articles/kids.htm Hammond, Margaret C. & Burns, Stephen C (Ed).
Yes You Can! A Guide to Self-Care for Persons with Spinal Cord Injury. Third Edition.
Paralyzed Veterans of America, 2000. Chapter 14 Durcharme, Stanley H & Gill, Kathleen M.
Sexuality After Spinal Cord Injury: Answers to your questions.
Baltimore: Paul H. Brookes Publishing Co., 1997.
Terms Encountered in this Section
AIDS Virus – Acquired Immune Deficiency Syndrome.
artificial insemination – The placement of a sperm sample inside the female
reproductive tract to improve the female's chances of getting pregnant.
autonomic dysreflexia – Caused by an irritation below the level of injury, it is the
sudden onset of extremely high blood pressure, which if left untreated can lead to
serious complications and even death.
cervix – The lower and narrow end of the uterus.
coitus – Sexual union between a male and a female involving insertion of the penis into
the vagina.
contraceptive – A device, drug, or chemical agent that prevents pregnancy.
ejaculation – The expulsion of seminal fluid from the urethra of the penis during
orgasm.
electro-ejaculation – Controlled electrical stimulation, usually applied to the prostate
gland with a probe, to induce ejaculation in a man who has nerve damage that prevents
him from ejaculating normally.
erection – The firm and enlarged condition of a body organ or part when the erectile
tissue surrounding it becomes filled with blood.
erogenous zones – Any area of the body especially sensitive to sexual stimulation.
MUSE – Medicated Urethral System of Erection
orgasm – The peak of sexual excitement, characterized by strong feelings of pleasure
and by a series of involuntary contractions of the muscles of the genitals.
paraorgasm – Possibly psychological transference of pleasure to a feeling portion of
the body.
penile prosthesis – Rigid, semi-rigid, or inflatable device implanted into the penis for
the purpose of attaining an erection.
psychogenic erections – Erection produced or caused by psychic or mental factors
rather than organic factors.
reflexogenic drections – Erection caused by direct stimulation of the genital area.
retrograde djaculation – Ejaculation backwards into the bladder instead of forward
through the urethra.
Spasticity – A state of hyperactivity or increase over the normal tone of a muscle, with
heightened deep tendon reflexes.
STD – Sexually Transmitted Disease
subcutaneous injection – Injection just under the skin.
testicular puncture – Puncture of a testicle, in this case, to gather sperm.
vagina – The female organ of sexual intercourse and the birth canal.
vaginal secretions – Natural vaginal lubricant secreted by women.
Viagra – (Sildenafil Citrate) Drug that increases blood flow to the penis assisting the
process of erection.

Source: http://www.geishad.org.mx/4sexual%20health.pdf