Sexual Function In Men After Spinal Cord Injury

Is it possible to be sexually active after a spinal cord injury?

A spinal cord injury (SCI) affects many areas of your life. You may have to make some changes in how you are sexually active, but you can still have a fulfilling sex life. Many people define themselves, at least in part, by their sexuality. Some people believe that sexual intimacy (closeness) means the same thing as the physical act of intercourse. Believing this and being afraid that your partner will not want you anymore can make you feel depressed. This can decrease your libido (the feeling of wanting sex and intimacy). Intimacy is different than intercourse, but both are needed for a good relationship with a partner.

What is the normal sexual anatomy of a man?

  • A man's sexual anatomy consists of the penis, scrotum and testicles, prostate, and urethra. The penis is made of three spongy cylinders (tubes) with spaces containing the erectile (erection) tissue. Blood moves into two of the cylinders during sexual excitement to produce an erection.

  • The urethra that runs from the bladder to the end of the penis is in the third cylinder. The urethra is the tube that both urine and sperm travel through to exit the body. The scrotum is a sac that hangs below the penis and contains the testicles. The testicles help produce and store sperm. The prostate gland makes semen, the fluid that sperm are in. The prostate gland circles the urethra and can be stimulated by putting a lubricated finger in the rectum.

How did my body react to sexual stimulation before the spinal cord injury?

Your senses control your responses to sexual stimulation. You may hear or see sexual things, such as images, pictures, or another person. Your thoughts and imagination (daydreams or fantasies) also help your body respond sexually. The senses of smelling, tasting, and feeling also play a part in your responses. For example, feelings travel from your genitals (sex organs) to your brain. Other feelings, tastes, and smells come from parts of your body like your skin, lips, and fingers. Your brain takes this information and sends messages back to your genitals, resulting in a sexual response.

How does my body respond differently to sexual stimulation after a spinal cord injury?

  • Your response to what you see, hear, feel, smell, taste, and think about may change after a SCI. For sexual stimulation to occur there needs to be a connection between the spinal cord and the brain. Whether you can respond depends on the level and extent (how complete) your SCI is.

  • Your response to physical stimulation below the level of your injury may change. This is because the messages cannot travel to your brain. Even though you have a SCI, you still have body areas that may give you pleasure when they are touched. A reflex sexual response, such as a reflex erection, is not under your control. It occurs when your penis or other erotic areas are touched even if you cannot feel the touching. Physical stimulation of your genitals or skin may not travel to your brain. This does not necessarily mean that you cannot have an erection. Even though you have a SCI, you still have erotic areas that can give you great pleasure when they are touched. Work with your partner to discover these erotic areas.

Can I have erections after a spinal cord injury?

Erectile function is your ability to have an erection. Most men with SCIs can have an erection and are able to have intercourse. You may be able to have an erection if you still have sacral reflexes after the SCI. Your erection may not be as hard, or last as long as it used to. This is called erectile dysfunction (ED).

Can erectile dysfunction be treated?

Erectile dysfunction may be treated by using mechanical equipment, medicine, or a penile prosthesis called an implant or artificial part.

  • Mechanical equipment includes vacuum pumps or rings. The vacuum pump is put over the penis and pumped to draw blood into the penis. This gives you an erection. Then you put a tight band or ring around the base of your penis to keep in the blood.

  • Several medicines are available to treat ED. These medicines improve your erection and may work if your injury is between T6 and L5 on your spinal cord. You must take these medicines exactly as your caregiver tells you to. You may not be able to take these medicines if you have problems with your blood vessels or blood pressure. Some of these medicines come in the form of a pill.

  • Other types of medicine are injected (shot) into the side of your penis. This causes your erection to last one to two hours. You may need help giving yourself the medicine if you have problems moving your hands. This medicine may cause bruising, scarring, or an infection in your penis. It also can cause priapism. This is a condition that occurs when the blood does not drain out of your penis after several hours. This can damage your penis, and be very painful.

  • Another type of medicine can be put into the end of your penis in the form of a pellet like a suppository. You may have a burning feeling because of this medicine. It also can cause your blood pressure to go too low or cause you to faint.

  • Caregivers may suggest one of several types of penile prostheses if the other treatments for ED are not successful. Semi-rigid or bendable rods may be placed in the erectile tissue inside the penis, which gives you a permanent semi-erection. Fully inflatable implants are tubes placed in the erectile tissue. Egg-shaped spheres are placed in your scrotum and are connected to the tubes. The spheres contain a fluid so that when you squeeze the sphere the fluid moves into the empty tubes, which gives you an erection. All implants increase your risk of infection. They may also break down, or push through the skin of the penis.

What positions can we use to make love?

You might not be able to use all of the positions to make love that you used before. The man on top position may not work for you because some of your muscles may not function. There are many other positions that can work well for you and satisfy both you and your partner. Making love while sitting in a chair with arms or even in your wheelchair may work very well for you. Making love while lying down in different positions, such as on your side or on your back may work best. Talk openly with your partner to learn what works best for you and your partner. You may also talk to your caregiver.

Can I father a baby even though I have a spinal cord injury?

Many men still can father children after a SCI. You may have two problems. These are problems with ejaculation, and problems with sperm motility (movement). Many men are not able to ejaculate during intercourse or have retrograde (backwards) ejaculation. This means that the sperm travel backwards into the bladder instead of leaving the body through the urethra. Having a SCI does not affect the amount of sperm you have but the sperm may move slower. There are ways to treat these problems. Artificial insemination can be used to get your partner pregnant. One of the following methods may be used to obtain sperm for the pregnancy:

  • A vibrator (massager) is used to produce an erection and then cause you to ejaculate so that sperm can be collected. It works like a vacuum pump. This is called penile vibratory stimulation or "PVS." Caregivers will teach you to use it correctly so that you do not cause bruising, bleeding, or sores on your penis.

  • With rectal probe electroejaculation, a finger-shaped probe is put into your rectum. Electrical stimulation is sent through the probe to stimulate your prostate to cause ejaculation so sperm can be collected. This is also called "RPE."

  • Caregivers can take sperm from your testicle during surgery if neither PVS nor RPE work.

What can I do if I want a child but cannot father a child of my own?

Many men feel that if they cannot be the natural father of a baby then they are not a real man. This is the way some women feel about being able to give birth to a baby after having had a SCI. If the other methods of getting your partner pregnant do not work, you may want to think about adoption. This is a beautiful way to be able to be a father.

What is autonomic dysreflexia?

Autonomic dysreflexia is a condition that happens when your body reacts to a problem. Common problems causing autonomic dysreflexia include having a full bladder, or being unable to have a bowel movement. It is also called "AD" or autonomic hyperreflexia. This very serious emergency can be life threatening. AD causes your blood pressure to go dangerously high. High blood pressure can cause a stroke, seizure, and even death. It is most common in people who have a SCI at or above the sixth thoracic (chest) level (T6). Ask caregivers for more information about autonomic dysreflexia.

What other problems should I avoid during intimate situations?

  • Many men worry about having a bowel or bladder accident while with a partner. You can work to avoid these problems by closely following your regular bowel and bladder program. Wait to get close to your partner until after performing your regular bowel and bladder program. Caregivers may suggest that you avoid drinking fluids for an hour or two before. If you have a urinary catheter, you must remove the catheter to prevent the catheter balloon from moving, which could cause injury. Ask caregivers for more information about neurogenic bowel and bladder and a bowel and bladder training program.

  • Getting a sexually transmitted disease (STD) is just as possible after having a SCI as it was before. Always practice safe sex if you are not in a long-term relationship. This is also important if there is any possibility that your partner is sexually active outside your relationship.

  • Having a SCI can cause strain on your relationship with your partner. If you were not in a long-term relationship before the SCI, you may worry about finding a partner. Talk to your caregiver or see a specially-trained counselor if you are worried about how to cope with these problems.

Do I still have to do testicular self-exams and prostate exams after a spinal cord injury?

Having a SCI does not change your need to continue doing testicular self-exams and having prostate exams. These tests help find changes that may show cancer. Ask your caregiver for more information about testicular self-exams.

Where can I go for support?

  • Having a spinal cord injury is life changing for you and your family. It may be difficult to accept that your sexuality is different than it was before. Although your sexual experiences may be different now, with patience they can be satisfying for both you and your partner. It is normal for you and those close to you to feel angry, sad, or frightened. Talk to your caregivers, family, or friends about your feelings and let them help you. Encourage those close to you to talk to your caregiver about how things are at home.

  • You may want to join a support group. This is a group of people who also have spinal cord injuries. Ask your caregiver for the names and numbers of support groups in your town. You can contact one of the following national organizations for more information.
  • National Spinal Cord Injury Association
    1 Church Street, Suite 600
    Rockville , MD 20850
    Phone: 1- 800 - 962-9629
    Web Address: www.spinalcord.org
  • American Spinal Cord Association
    2020 Peachtree Road, NW
    Atlanta, Georgia , 30309-1402
    Phone: 1- 404 - 355-9772
    Web Address: www.asia-spinalinjury.org

Contact your caregiver if:

You have signs and symptoms of a urinary tract infection. These may include:

  • You have a fever.

  • Blood or blood clots in your urine.

  • Nausea (upset stomach) or vomiting (throwing up).

  • Increase in bladder spasms.

  • Decrease in your urine output.

  • Pain in your back around your waist (if you have feeling there).
Other reasons to call are:
  • You think you may have a sexually-transmitted disease (STD).

  • You feel that the changes in your sexual function are interfering with your relationship with your partner.

  • You find a lump during your monthly self-prostate exam.

  • You feel that you need sexual counseling or education.

  • You have chest pain or trouble breathing that is getting worse over time.

  • You have questions or concerns about your sexual function that have not been answered.

Seek care immediately if:

  • You suddenly feel lightheaded and have trouble breathing.

  • You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.

  • Your arm or leg feels warm, tender, and painful. It may look swollen and red.

  • You have the symptoms of autonomic dysreflexia that are not relieved by your bowel program or bladder emptying. These may include:

    • Sudden increase in blood pressure.

    • Blurred vision or seeing spots.

    • Cold, dry skin with goose bumps below your SCI.

    • Hot, sweating, flushed (red) skin above your SCI.

    • Sudden throbbing headache.

Care Agreement

You have the right to help plan your care. To help with this plan, you must learn about spinal cord injury. You can then discuss choices with your caregivers. Work with them to decide what choices may be best for you. You always have the right to refuse and make your own decisions.The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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