Sexual Function In Women After Spinal Cord Injury

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

Sexual Function In Women After Spinal Cord Injury Care Guide

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 woman?

  • A woman has a uterus, fallopian tubes, ovaries, a urethra (u-REE-thrah), a vagina, and a clitoris. The uterus is the pear-shaped organ where a baby grows before birth. Each month the lining of the uterus fills with blood. This will help support a baby if you become pregnant. An egg is released from an ovary and travels through the fallopian tube to the uterus. If the egg is fertilized by a sperm cell, it settles into the lining of the uterus where it grows and develops. If you do not become pregnant, this lining leaves the body each month in the form of menstruation (men-stroo-AY-shun). This is often called a woman's "period".

  • The vagina is a soft tube that runs from the end of the uterus to the outside of your body. The vagina is several inches long, but gets longer during sexual intercourse. It is lined with cells that produce lubricating fluid that is important during intercourse. The urethra is a tube that runs from the bladder to the outside of the body to empty the bladder of urine. The urethral opening is just above the vaginal opening. The clitoris is a small gland that lies just above the urethral opening. It is like the penis because it contains nerves and blood vessels and becomes erect during sexual stimulation.

How did my body react to sexual stimulation before I had the SCI?

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 feeling, smelling, and tasting 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, breasts, 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?

  • Many women need emotional ties to become sexually excited. You may want and need your partner to touch and hold you in a non-sexual way to become excited. These needs usually do not change after a spinal cord injury. You also may need to work with your partner to discover sexually sensitive areas that help you to become excited.

  • Your response to what you see, hear, feel, smell, taste, and think about may change after an 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 was.

  • 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 an SCI, you still have body areas that may give you pleasure when they are touched. A reflex sexual response, such as reflex vaginal lubrication, is not under your control. This means that when your clitoris or other body areas are touched, your vagina may become wet. This happens even if you cannot feel the touching. Other areas such as around your nipples, or the insides of your legs may also be sensitive.

What happens if my body does not produce enough lubrication?

Using lubricating jelly is the easiest way to make sure you are lubricated enough. Asking your partner to help you apply this lubrication can be part of your foreplay (excitement getting ready for intercourse).

What positions can we use to make love?

You might not be able to use all of the positions to make love that you did before your injury. There are many positions that can work well for you, and satisfy both you and your partner. The man on top position may work well as long as your partner does not put too much weight on your chest. This could make it difficult for you to breathe. Some women like this position because there is direct clitoral stimulation. Making love while lying down in different positions might be easiest for you. Try lying on your back with your partner on his side and putting your legs over his. Talk openly with your partner to find out what works best for both of you. Ask caregivers for advice if you need help with positions or have questions.

How do I deal with my menstrual cycle?

  • Right after the SCI, your menstrual cycle (monthly period) may stop for up to six months. With time, you will begin to menstruate again. Even during the time that you are not menstruating, you can become pregnant. You should use birth control unless you are trying to become pregnant. Talk with your caregivers if you have not started your period after six months.

  • Deciding how you should deal with your menstrual cycle when it returns depends on many things. Think about what methods (tampons or pads) you used before your SCI. You should be able to use the same method you used before your SCI unless you are physically unable to. Talk with your partner and your caregiver to decide which methods works best for you.

Can I have a baby after a spinal cord injury?

  • Having an SCI does not change your ability to become pregnant. You must have very good prenatal (pregnancy) care to make sure that your baby is born as healthy as possible. Women with spinal cord injuries who choose to go through pregnancy, labor, and delivering a baby have extra problems. Women with an SCI may have problems with high blood pressure. You also may not be able to know when you are in labor.

  • Some women find it easier to breathe during pregnancy because the baby pushes up on the lungs. Other women find it more difficult to breathe. You may have problems with balance because of the added weight of the baby. You will also have an increased risk of developing pressure sores because of the weight gain of pregnancy. Ask caregivers for more information about having a baby.

What if I want a baby, but cannot or should not give birth?

Many women feel that if they cannot have a baby of their own then they are not a "woman". This is also the way some men feel about being able to father a child after they have had an SCI. If the other methods of becoming pregnant do not work, you may want to think about adopting a child.

What is autonomic dysreflexia?

Autonomic (aw-toh-NOM-ik) dysreflexia (dis-ree-FLEK-see-ah) 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 (hi-per-ree-FLEK-see-ah). 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 an 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 intimacy?

  • Many women worry about having a bowel or bladder accident when they are getting close to a partner. You can work to avoid these problems by closely following your regular bowel and bladder program. Plan intimate times after you perform your regular bowel and bladder program. Caregivers may suggest that you avoid drinking liquids for an hour or two before. 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 an SCI as it was before. Always practice safe sex if you are not in a long-term relationship. This also is important if there is any possibility that your partner is sexually active outside your relationship.

  • Having an 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 deal with these problems.

Do I still need to do self-breast exams and have PAP smears?

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

Is menopause different after a spinal cord injury?

Menopause is about the same for women with or without an SCI. You may have more problems with spasticity, AD, and bladder spasms. Osteoporosis (bone loss) is a problem that all women have after menopause. This can especially be a problem because having an SCI also increases the risk of osteoporosis. Talk with your caregiver to find out how to prevent or decrease the problems of osteoporosis and menopause.

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.
    • Paralyzed Veterans of America
      801 Eighteenth Street NW
      Washington, DC , 20006
      Phone: 1- 800 - 424-8200
      Web Address: www.pva.org
    • 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.

    • 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.

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

    • You find a lump in your breast during your breast self-exam.

    • You feel that you need sexual counseling or education.

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

    • You feel you are going into menopause.

Seek care immediately if:

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.

© 2013 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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