What other considerations affect sexual health?

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

The function of the sex organs is only one part of sexual health. There are many other important considerations that may affect sexual health after SCI.

Loss of bowel and bladder control is often one of the biggest concerns related to sex after SCI. People with SCI may experience bladder or bowel accidents during sex or have medical equipment such as an indwelling catheter. This can lead to anxiety or feeling self-conscious about being sexual with a partner.

Bladder and bowel changes can be managed in a number of different ways. The most important is to maintain a regular routine of bowel and bladder care to reduce the likelihood of having an accident. It may also help to:

• Discuss the topic openly with partners before sex (outside of the bedroom)
• Empty the bladder and bowel before sexual activity
• Maintain good bowel and bladder hygiene
• Prepare for potential accidents ahead of time by using waterproof sheets and having towels and wipes on hand to manage if an accident happens

Condoms can also be worn over an indwelling catheter that is folded back over the penis; please see the ‘Contraception’ page on SCISexualHealth.ca for more information.

Please see our articles on Bladder Changes After SCI and Bowel Changes After SCI for more information.

Listen to Cory describe how he manages bowel, bladder, and sex.

Hear about Cory’s initial concerns with positioning during the his recovery.

Assuming positions for sex may be more challenging after an SCI because of changes in movement control and flexibility. It may also be hard to get into certain positions because of reduced flexibility caused by spasticity and joint contractures. It may help to:

• Try out different positions to find out which positions work best
• Try out different places to have sex, such as in a wheelchair
• Use assistive devices, such as bolsters, slings, and other devices to help with movement and positioning

For a guide to assistive sexual devices, please see the pleasureABLE Sexual Device Manual for Persons with Disabilities.

Autonomic dysreflexia is a serious medical emergency that can affect people with SCI at T6 and above. This condition involves a sudden rise in blood pressure, which may be accompanied by heart rate changes, headaches, sweating, and other symptoms. It typically occurs in response to strong stimulation below the level of injury, even if there is no feeling in the area.

Autonomic dysreflexia may happen during sexual activity and ejaculation or as a result of sexual health treatments. If you are prone to autonomic dysreflexia, it is important to be able to recognize it when it happens and know how to treat it right away.

Please see our article on Autonomic Dysreflexia Emergency Treatments for more information.

Certain medications can contribute to sexual dysfunction as a side effect.¹²

Some medications that are used to treat other symptoms of SCI may have sexual side effects. One of the most common is Baclofen, a medication that is used to treat spasticity, which can make it more difficult to have an erection. Other medications, such as some antidepressant medications, may reduce sexual desire. If you suspect that your medications may be affecting your sexual health, speak to your health providers for more information.

Care needs to be taken to avoid injuring the skin during sexual activity. Excessive rubbing, pressure or other forces to the skin during sexual activity can lead to pressure injuries. Care should be taken to avoid irritating or damaging the skin and any changes in skin condition should be noted and cared for as soon as possible.

Please see our article on Pressure Injuries for more information.

Priapism is an erection that lasts for more than two hours. If an erection is maintained for a long time, there will not be adequate blood circulation, which can damage the penis. Priapism is a medical emergency requiring immediate treatment from a doctor. It may happen as a side effect of treatment for erectile dysfunction, such as medications, penile rings, or injections. If you or your partner experiences an erection that lasts more than two hours, seek medical attention immediately.

Birth control is an important consideration in women who are sexually active.¹³

Following an SCI, most women are still able to become pregnant, even if menstruation is temporarily stopped (which may last up to 6 months after injury). Men may also be able to cause a pregnancy after SCI. It is important that individuals who could potentially become pregnant use birth control according to their doctor’s instructions.

In addition, your risk of contracting a sexually transmitted infection (an STI) is the same after injury as it was before the injury, so it is important to engage in safe sex practices.