Intimacy

Numbness in your genital area may mean having sex and orgasm can feel different. For some there may be no sensation at all. Remember that sex is not always about the physical act but the relationship you have with your partner.

Make sure your bladder is empty before sexual activity.

Female

If you have a urethral catheter in place, you can tape it to the inside of your leg during sexual activity. If you know how to do so you could also remove the catheter and replace it after sexual activity.

A suprapubic catheter should not get in the way of sexual activity.

Male

If you have a urethral catheter in place, you can tape it along the shaft of your erect penis and place a condom on top for sexual activity. If you know how to do so, you can remove the catheter and replace it after sexual activity. 

If you are using a condom sheath to manage your bladder, you can either leave it in place and remove the urine bag, or you can remove the condom sheath completely and re-apply it after sexual activity.

If you follow your bowel routine it is unlikely you will have any accidents during sexual activity.

If you are worried you may wish to empty your bowels prior to sexual activity.

Autonomic dysreflexia only occurs with a spinal cord injury at level T6 or above. If this applies to you, you will be taught the common causes and treatment of Autonomic Dysreflexia.

Autonomic Dysreflexia can occasionally happen during sexual activity. If this happens, stop activity immediately, sit upright & take Nifedipine.

Remember that it is still important to practice safe sex to avoid sexually transmitted infections.

Erections

Erectile Dysfunction (ED) or impotence is when you cannot get or keep an erection.

Treatments

We can advise you on which treatment may be best for you. You may need to try more than one treatment before you find the best one for you.

• Tablets

Sildenafil / Tadalafil tablets can help you achieve an erection. They can be taken when required or as a daily tablet. Direct sexual stimulation is required. You cannot take these tablets if you are prescribed nitrate tablets for your heart.

• Injections

These involve a single injection into the side of the penis. You will be taught how to prepare the injection and how to inject yourself. You may need help from your partner to inject if your hand function is poor.

• Vacuum Pump

This is a plastic cylinder which you place over the penis and then pump the air out. This causes the penis to become erect. You place a special ring at the base of the penis to maintain the erection.

• Surgery

Occasionally, surgery is an option. This involves placing a penile implant into the penis which allows you to achieve an erection. This is generally the last treatment option as it is permanent and there can be complications with the implant, such as infection.

Ejaculation

After spinal cord injury, the nerve pathways that control ejaculation can be disrupted. Ejaculation can be more difficult or impossible to achieve. There is no medical treatment to improve the ability to ejaculate but some men may be able to ejaculate by using a vibrator or by masturbation. Sometimes semen may backflow into the bladder, which is known as retrograde ejaculation.

Male Fertility

Facts about sperm:

• Men with spinal cord injury usually produce normal numbers of sperm, but the number of swimming sperm can be lower than normal.
• Sperm mobility does not relate to injury, age or frequency of ejaculation.
• Sperm quality can decline within the first few weeks of spinal cord injury but does not seem to continue to decline over the years.

Fertility Treatments

The clinic runs a fertility clinic on a regular basis. If you are in a stable relationship and are actively trying for a pregnancy you can self-refer to the clinic. At the clinic, we will look at ways to achieve ejaculation in order to assess your sperm. We can use procedures such as vibrators or electro-ejaculation to obtain a sperm sample. The quality of your sperm will determine which methods of fertility treatment could be appropriate for you. We will discuss this with you and your partner at your clinic visits.

Arousal in women can be more difficult following a spinal cord injury and you may find that your genitals are very dry even after arousal. Using a water-soluble jelly lubrication is best, as a petroleum-based jelly can cause infections. You can use the jelly on yourself for more lubrication or you can put it on your partner’s genitals or fingers so that when they enter you they will lubricate you at the same time.

Menstruation/Contraception

Initially after your injury you may find that menstruation (having periods) stops. Over time you will begin to menstruate again. Manging your periods can be more difficult if you are a wheelchair user and you may need to change the way you deal with your periods. Sanitary towels can cause skin issues if you have no sensation. Tampons can be used but may be difficult to insert if you have poor hand function and you may need to rely on a carer to help you. Some methods of contraception such as implants and injections can also reduce the frequency of your periods.

Spinal cord injury does not affect female fertility. If you were menstruating before your injury, you will need to use contraception to avoid an unplanned pregnancy, even if your periods have not yet returned. Please speak to your GP, family planning clinic or the Spinal Clinic for advice on contraception.

Pregnancy

As fertility in females is not affected by spinal cord injury you will still be able to become pregnant. You may need extra help and advice during and after your pregnancy as it may be more difficult to manage your bowels, bladder, skin, transfers etc.

Some of the medicines you are prescribed may not be safe to use during pregnancy so contact your GP or the spinal clinic for advice.

Please contact the nurses in the ourpatient clinic for further help, support and advice.