In this article:

• Male Sexuality
• Female Sexuality
• Couples Experimentation

Some people assume that because they have no genital feeling that sex must only involve satisfying the other able-bodied partner.  This is not necessary because there are ways to help disabled people also experience sexual feelings despite their limitations.  With proper education, the couple can find ways to satisfy both members of the partnership.

The couple needs to focus more on the process of sexuality rather than the end goal of having an orgasm.  Shortly after the injury, it is difficult for many paralyzed individuals to imagine themselves as still being sexy and this can be very disheartening.

The first step is to begin to see yourself as a sensual and sexual being.  Without this, you cannot begin to explore sexual relationships with others.  Some things you can do to feel more sexual include buying some sexy clothing for those occasions when you want to impress someone.  You can also spend time on your facial appearance and hair.  Women can have their makeup professionally done so they can replicate the look on their own at home.

Being confident can be a sensual and sexy thing.  As a sexual being, you can enjoy a modified sexual arrangement that can be every bit as satisfying as a sexual relationship between two able-bodied people.  Research tells us that as soon as you become better adjusted to your disability, the better able you will be to be confident about your sexual experiences with others.

The anatomy and physiology of the genital structures are the same as before the accident and men can have erections even after they sustain a spinal cord injury.  The erection may not last as long or be as firm as it was before but there are treatments that can be given that will enhance a male’s ability to have an erection to have intercourse.  The kind of erection that men get after spinal cord injuries is called ‘reflex erections.’ They can come on spontaneously or in reaction touch.

At first, erections are erratic and uncontrollable, but eventually, a man can figure out what things stimulate an erection as well as what keeps the erection lasting longer.  Phosphodiesterase-5 inhibitors such as Viagra, Cialis, and Levitra have successfully been used for men who want a better erection after a spinal cord injury.  They relax the smooth muscle in the penis so that more blood can flow to the penis, sustaining an erection.  The man still needs some sexual stimulation for the erection to occur.

Some men cannot use phosphodiesterase-5 inhibitors because they have vascular disease, high blood pressure or low blood pressure.  Insurance doesn’t always pay for these types of medications or only allow a certain amount to be used per month.  For those who don’t have the insurance company coverage, the drug is somewhat expensive.

Other men can be candidates for penile injections.  Medication is injected into the side of the penis just before sexual activity.  The blood vessels open up in the penis, and the blood can flow into the penis, causing an expected erection.  Injections can scar the penis so doctors usually limit the number of times a man can do this to only twice per week.  Some men can have priapism, which is the same thing as a prolonged, painful erection of injected medications but this is uncommon.

Sometimes the man is unable to give himself the injection so that the sexual partner needs to be taught how to give them.  This can be less spontaneous than sex before paralysis, but it does work and can mean a better sex life for both men and women.  Injections are more reliable than the pills, and they give harder erections.

Other men resort to vacuum erection devices that draw blood up into the penis to achieve an erection.  A ring is then placed at the base of the penis to keep the blood in there until sexual activity is over.   The ring can only be placed at the base of the penis for thirty minutes or less because it can cause blood to clot within the penis itself.  Men still often resort to vacuum-delivered erections because it can be used for longer and it gives the hardest erections of all of the above choices.

Penile implants can be done which create a permanent erection through surgical implantation techniques. Some implants can be inflated during sex and deflated after sex is over with.  They make flexible partial erection implants that are less obvious than rigid implants and can be used in some men.  Implants are permanent, and if they need to be removed for whatever reason, it will have damaged the penile tissue to the point that erections are harder than ever before.  Implants are costly and usually aren’t covered by insurance.

Women who are paralyzed can have a satisfactory sex life as well.  Their reproductive function is the same as it was before the injury so the woman with a spinal cord injury can get pregnant and carry their pregnancy to term.  Many women don’t have menstrual periods for six months or so following their injury, but this is believed to be due to the psychological stress they are under post-injury. Even so, if they do not want to become pregnant, they must use some form of birth control.  They run the same risk of STDs as before so condoms should be used with any partner not known to be clear of infections. (The same is true of men).

The biggest problem many paralyzed women face is a lack of lubrication of the vagina during sex.  During sexual stimulation (or just thinking about sex), lubrication can happen in a woman but it is erratic, and sometimes it just isn’t enough.  The vaginal lubrication is possible as a reflexive response if a woman has a T12 or lower incomplete spinal cord injury.  If lubrication is not enough, a water-soluble lubricant can be used.  It can be something as simple as using KY jelly.

Other problems facing both men and women regarding sexuality and the sex act include issues such as contractures of the lower extremities, lack of mobility of the lower half of the body, and decreased sensation in the genital area.

Very few men can ejaculate during sex after a spinal cord injury.  They can, however, experience an orgasm.  It is estimated that about half of all men and women who have sustained a spinal cord injury can still experience an orgasm.  It all depends on the level of the injury and on whether or not the injury is complete.  Some say the orgasms are the same as before their injury while others simply feel the sense of satisfaction and pleasure that comes with an orgasm.

Women can achieve orgasm from sexual stimulation even if their brain does not register a sensation in the area.  Some can experience orgasms by stimulating other body parts, usually those above the level of their injury.  Orgasms sometimes take longer to achieve after a spinal cord injury, but this is not a problem for the patient partner.

Experimentation is good when it comes to finding out how sex can work post-injury.  Couples that do this will usually find that they can experience better sex than they did before the injury.  It takes a great deal of open communication between the partners, but it helps the pair find those things that are the most erotic and sexual.

Couples can experiment with massage as a form of sexual expression, and imagination and imagery are important parts of the sex act.  They can work on what scents help them feel more sensual and can set a more intimate scene going on around them such as candles and low lighting.   Mutual masturbation is a good way to start as this involves using the hands which are in better control for many paralytic people than their lower extremities.

Self-masturbation is another way that a person can find out what works for them.  This can be done in a private setting, so no one has to know you are experimenting with your sexuality.  Vibrators can work for those whose hand strength and coordination aren’t optimal.  People with T6 or higher lesions can suffer from autonomic dysreflexia from intense genital stimulation and can get dizzy, have a headache, lightheadedness or skin flushing.

Some people find that non-sexual areas above the level of their injury are intensely sexual after their spinal cord trauma.  It takes experimentation to figure out where these areas are located.  The zone where the sensation ends and begins again is an especially erotic area.

Couples need to try new positions when one or both are paralyzed.  There are many different positions a couple can try, including side-to-side positions and sitting positions. If there is spasticity or rigidity of the muscles, adjustments need to be made for that.  Sometimes relaxation techniques work to loosen the muscles, while others find that a long hot bath can help with spasms of the muscles.

Oral sex is better and is one of the methods of choice for paralyzed individuals.  This way couples take turns stimulating the other.  A technique called ‘stuffing’ is sometimes used in which the flaccid penis is stuffed into the vagina for female pleasure.  It sometimes leads to a male erection, which is a bonus.  Other couples use vibrators on each other for sexual stimulation.

Sex is less spontaneous after a spinal cord injury, but couples must come to accept that.  Personal care attendants may need to help undress paralyzed individuals and may have to position them for sex.  Sometimes the able-bodied person can be the one who positions the disabled partner.  Bowel and bladder accidents can happen during sex with a disabled person, and this must be discussed openly and honestly.  Emptying the bladder before sex is a good measure for both men and women with spinal cord injuries.   A regular bowel program can help avoid accidents during sex.

Catheters can interfere with sex but, by no means do they mean you can’t work around them.  Men can fold the catheter up inside a condom, while women can tape the catheter up onto her abdomen to get it out of the way.

Some spinal cord injured patients use prostitutes for sexual gratification out of embarrassment in doing the sex act with someone they care about.  This can be very dangerous because of the risk of STDs, which can happen to paralyzed and non-paralyzed people alike.  Some handle this issue through the hiring of a sexual surrogate and going to sex therapy.  Surrogates are trained professionals that help a couple better find ways to cope with their disabilities and have a better sex life.

Patients with T6 level injuries and above can develop autonomic dysreflexia with sexual stimulation.  As this can be dangerous for a person’s blood pressure, it is recommended to stop a sexual activity, sit up and wait for the symptoms to pass.  Medications to lower blood pressure may be necessary if this sort of thing happens all the time.

Many doctors recommend IUDs for women who do not wish to get pregnant because birth control pills can increase leg blood clots in those who are paralyzed.  Other women will go on the lowest dose of birth control pills possible in the hope of not getting a blood clot.  Barrier methods of birth control can also be effective.

Couples where one or more is a paralyzed can be difficult and certainly is not spontaneous. With the right attitude, however, sex can be fun and beneficial to everyone involved.

Photo by Alexa Cait

Editor’s Note: This page has been updated for accuracy and relevancy [cha 1.29.20]