What changes after SCI?

Author: SCIRE Community Team | Reviewers: Lesley Houle , Rachel Nicoletti | Published: 12 June 2018 | Updated: ~

When the spinal cord is injured, some or all of the nerve signals that would normally allow the brain and sex organs to communicate with one another cannot get through. This can affect sexual responses in many different ways.

Most people will have some loss of feeling in the genitals and nearby skin after injury. Some people experience sensations that are less intense and others may not be able to feel their genitals at all. In some cases, pain or other unusual sensations may be felt in response to touch which was previously pleasurable.

While there is typically reduced feeling below the injury, some people notice that areas at or above the level of injury (such as the nipples, lips or ears) may be more sensitive to sexual touch after injury.

Most men experience changes to their ability to get an erection and maintain it during sex. This is called erectile dysfunction. The type of erectile dysfunction that a person has depends on where the injury is on the spinal cord.

• Men with injuries at T10 and above typically lose the ability to get an erection from sexual thoughts (a psychogenic erection). However, they are usually able to get an erection through touch (a reflex erection). Sometimes reflex erections may happen in non-sexual situations (such as while inserting a catheter).
• Men with injuries from L3 to S1 may be able to have both psychogenic and reflex erections, although these responses may be poorly coordinated during sex.
• Men with injuries from S2 to S4 typically lose the ability to have reflex erections; however, they may be able to have psychogenic erections.

Listen to Cory’s experience with erections after spinal cord injury.

Most men with SCI can get an erection in some form. However, erections are rarely the same as they were before the injury. Most men find that their erections are unreliable and can often be inadequate for penetrative sexual activity. It may also be difficult to keep the erection during sex. There are many different options for treating erectile dysfunction after SCI, which are explained below.

Most men with SCI also experience changes to their ability to ejaculate. They may experience an inability to ejaculate during sex, unpredictable ejaculation, or a condition called retrograde ejaculation.

Retrograde ejaculation

is when semen is propelled into the bladder during ejaculation because the bladder neck muscles do not close at the right time. Retrograde ejaculation is most common in people with injuries from T11 to L3. Many men with SCI require medical assistance to obtain sperm to have biological children. For some men with injuries above T6, ejaculation can also trigger autonomic dysreflexia.

In women, SCI may lead to reduced arousal responses (such as reduced vaginal lubrication). These changes depend on where the injury is on the spinal cord.

• Women with injuries at T10 and above may lose the ability to become aroused from sexual thoughts (psychogenic arousal), but may still be able to experience arousal from touch (reflex arousal).
• Women with injuries from L3 to S1 may retain both psychogenic and reflex arousal.
• Women with injuries from S2 to S4 may lose reflex arousal, but may still have psychogenic arousal.

In addition, women with SCI may also experience spasms of the vaginal muscles related to spasticity. This can cause difficulties with penetration. Treatments and techniques for improving genital arousal responses in women are outlined below.

Women may experience a change in their ability to orgasm following SCI. This typically involves greater difficulties in having an orgasm or an inability to have an orgasm at all. Having an orgasm may also feel different after SCI.

Many people experience changes to sexual desire (sometimes called libido) after an SCI. This can happen for several reasons, related to both physical changes from the injury and other life changes. For example, hormonal changes, emotional distress, and reduced sexual sensation may affect sexual desire.

Changes to your body following SCI can affect your sexual self-esteem.⁹

Self-image describes how a person sees themselves and believes that others see them. Self-image may affect how sexually attractive a person feels and their confidence in becoming sexual after an injury. It is also an important aspect of one’s willingness to engage in social activities like dating or becoming intimate with a new partner. For some people, it takes time to adjust to the physical and life changes after an SCI and become comfortable in their own skin. Other people may find that assistance from mental health providers or peers can help them regain their self-confidence to be sexual and participate fully in intimate relationships.

Watch a SCIRE YouTube video about sexual self-esteem after SCI.

Spinal cord injury affects all aspects of life and this can cause changes to relationships as well. For example, partners may take on greater caregiving responsibilities and there may be changes in working and family roles within the partnership. While every couple is different, most people do experience some changes to their relationships which can have an impact on their sexual health.

Pregnancy is still possible after a SCI.¹⁰

Fertility is a male’s capacity to cause a pregnancy in a fertile female and a female’s ability to become pregnant from a fertile male. Men may have difficulty ejaculating during sex and often require medical interventions to obtain sperm. Sperm may also be lower quality following SCI because of a number of changes to the body. However, there are many medical interventions that may assist with fertility in men after SCI.

Women’s fertility is typically not affected by an SCI and they can usually become pregnant after injury. Immediately after the injury, women may experience a temporary loss in menstruation (having a period), but can still become pregnant.

This page does not discuss fertility treatments, for more information, please see SCISexualHealth.ca.