Questions and concerns about sex after spinal cord injury (SCI) are extremely common, but sadly they’re often neglected in long-term rehabilitation. However, the good news is that women with SCI are able to rediscover their sexuality, and can still enjoy rewarding sex lives. Through understanding potential problems, and solving them together with their partner, women with SCI can start to feel like they again live a normal and comfortable life. So, with that in mind, how can women start to rediscover sex after SCI? Let’s find out.
The impact of spinal cord injury on sexual function
Sex is one of many natural processes that gets disrupted by SCI. During the initial healing phase, reflex sexual arousal can be absent, and a number of women with SCI can experience a pause in their normal menstrual cycle1. In addition to the innumerable physical and psychological difficulties SCI can have, sexuality can often appear low down on the priority list.
With time, however, most women will want to reconnect with their sexuality, regardless of the level of their spinal cord injury. Yet, it’s important to understand that every spinal cord injury is unique, and that the nature and level of the injury may influence reflexogenic arousal, psychogenic arousal, or both2. For instance, reflexogenic arousal refers to the vaginal lubrication that occurs in response to genital stimulation, as a reflex through the spinal cord — without involvement of the brain. In contrast, psychogenic arousal refers to vaginal lubrication occurring as a result of thoughts and fantasies.
Should either of these method prove troublesome for you, a simple waterbased lubricant such as KY jelly is a good solution to difficulties with arousal — making penetration easier and preventing trauma to the genitalia. All women with spinal cord injuries, regardless of level or completeness, are able to experience orgasm. However, some may find it more difficult to achieve than others, and it may feel slightly different, too. If this is the case, it’s important to know that the physical aspect of sex has never been the sole focus of female sexuality; emotional connection plays a just as important role. Women with SCI are not only capable of giving and receiving pleasure, they are still able to experience intimacy, and actively participate in romantic and sexual relationships.
One of the simplest ways to get around any potential hurdles is to simply talk with your partner, making sure you’re both completely at ease and comfortable; easing any stress levels you may have.
Women and their partners are also encouraged to consult with doctors and therapists regarding their sexual needs and challenges3. For instance, resuming with sex after spinal cord injury requires considerations about fertility and family planning.
Those who desire birth control are advised to consult with a healthcare professional about their options. Condoms are frequently the top choice, as intrauterine devices are often less suitable for women who have reduced pelvic sensation. What’s more, the oral contraceptive pill may carry increased risks in women with reduced mobility4.
Additionally, bladder and bowel accidents are common concerns when it comes to having sex with a spinal injury. Couples should discuss these issues and how they will react if an accident does happen, however there some very simple preventative methods you can implement. Women who intermittently self-catheterise should empty their bladders before sex, and may wish to refrain drinking a lot of fluid before sexual activity, for example. Women with indwelling catheters should secure the catheter without kinks before having sex, too, and avoid heavy meals before sexual activity as this can be helpful in preventing bowel incidents.
You should also consider exploring different sexual positions for their suitability and safety — something your gynaecologist will be able to help you with. When trying new positions however, avoid putting weight or abrasion over pressure sores and ulcers, and always check your skin for
chafing or wounds. Consider the use of your pillows, too, as this can help with any pain and spasticity — both very common problems with SCI.
You should also familiarise yourself, and your partner, with the signs and symptoms of autonomic dysreflexia, which may be triggered by sexual activity, as well as other complications like infection. Essentially, autonomic dysreflexia is acute and uncontrolled hypertension, which can be life-threatening. It usually occurs at a neurologic level of SCI at, or above, the sixth thoracic vertebral level (T6), and if left untreated it can cause a multitude of other problems. However, do not let this in any way put you off rediscovering sex, as your doctor will go through this with you step by step and make you fully aware of the dangers. It just something to consider.
Redefining sexuality after spinal cord injury
All humans are sexual beings, and spinal cord injuries do not change this fact. After initial rehabilitation, many people with spinal cord injury actually report that sexuality is among their top priorities. The desire to resume sexual activity may be driven by a need to feel closeness, intimacy and pleasure, or by a desire to fulfill your partner’s needs. Yet, many people worry that they will not be able to keep their partner and maintain a relationship after SCI. They feel so guilty and frustrated that they insist on terminating the relationship so that their partner can go find someone ‘able-bodied’. Single women with SCI may wonder if they will ever be able to meet someone and initiate a serious relationship or get married.
It is important to remember, however, that any successful relationship is based on open and honest communication. Women with SCI, whether they are in a relationship or wanting to start one, should discuss their sexual concerns and desires with their partner or prospective partner. It is normal for one or both parties to have doubts or questions, and emotional intimacy is fortified if these issues are discussed freely.
Self-esteem and body image are critical components of sexuality, and as a woman with a spinal cord injury, you may find yourself having to redefine your own perceptions about your body and your attractiveness. Relearn your body, and what gives you pleasure — whether that be emotional or physical. Accepting one’s body and embracing one’s sexuality are best achieved through exploration, both alone and with your partner5. You may still have varying degrees of sensation in many of your erogenous zones, and due to neuroplasticity, you may discover new sensitive areas of your body that lead to arousal and pleasure. The use of other senses like vision, sound, and smell, as well as breathing and relaxation techniques, are all ways of enhancing pleasure.
Open discussions about sex, desire, and fantasy combined with gentle touching and experimentation can lead to powerful sexual experiences where you and your partner learn to approach sex far more holistically than a genital focused, climax focused activity. You may actually find that you appreciate these sexual experiences more than the one’s you had before the injury.
If you need any more advice on rediscovering sex after spinal cord injury, please let us know and we’ll put you in touch with a Bard nurse. They will be more than happy to lend their support, advice, and expertise.
For more information on sex and SCI, then just pop across to our Learn section. Alternatively, our Bard nurses are more than happy to have a chat, all you need to do is get in touch.
1 "Sexuality following spinal cord injury Spinal Injuries Scotland." (2015) Accessed: 6th July 2016
2 Hess, Marika J, and Sigmund Hough. "Impact of spinal cord injury on sexuality: broadbased clinical practice intervention and practical application." The journal of spinal cord medicine 35.4 (2012): 211218.
3 Lombardi, G et al. "Sexual rehabilitation in women with spinal cord injury: a critical review of the literature." Spinal cord 48.12 (2010): 842849.
4 “Sexuality and Reproductive Health in Adults with Spinal Cord Injury: A Clinical Practice Guideline for HealthCare Professionals.” The Journal of Spinal Cord Medicine 33.3 (2010): 281–336
5 "Sexuality for Women with Spinal Cord Injury United Spinal Association." (2012). Accessed: 18th May 2016<http://www.spinalcord.org/resourcecenter/askus/index.php?pg=kb.page&id=1579>