Men and sex after SCI
Sex may not be the first thing on your mind when you become spinal cord injured but when you do consider it there are often many questions to be asked
Here our SCI specialist nurse Damian Smith covers some of the more common questions asked specifically by men.
Will my injury affect my sexual function?
If yours is a complete spinal cord injury than yes, it will. It also depends on what your injury level is – some may be able to get reflex erections, others most likely won’t if their injury is below level T12/L1. For those who can get an erection, maintaining one might be an issue.
With incomplete injuries, sexual function may or may not be affected. There is no rule book as it depends on which specific nerves have been affected. It’s a matter of assessing patients on an individual basis to determine what functions are still available.
What kind of physical changes/differences can I expect?
Depending on your injury level, there are two types of erection SCI men may experience – psychogenic, caused by arousal from sights, sounds or thoughts and reflexogenic (reflex) where stimulation may occur even when it wasn’t intended and which you have little control over.
You may have difficulty maintaining an erection and require medication or other interventions to help.
Although sensation may not occur where it once did – for example the genitals – areas where you do feel can compensate for those where you can’t. Heightened sensitivity can be experienced in certain areas of the body, triggering sexual feelings in a way they hadn’t done before. Exploring your body will give you a greater understanding of what turns you on.
Will I be able to feel the sensation of an orgasm?
You may or may not. If you do reach the point of orgasm, it might not feel the same. Depending on your level of SCI, you might experience early symptoms of Autonomic Dysreflexia (AD). Ejaculation can be a trigger for AD, so you may experience those early symptoms such as a warm feeling around the face as your blood pressure goes up – it might not be enough to trigger a full-blown episode.
Don’t be alarmed by this, it’s just something to be aware of. As with AD, as soon as you eliminate the cause, all symptoms subside and as you only ejaculate for a matter of seconds, once that has happened, the trigger disappears and your blood pressure will come back down.
Again, with incomplete injuries, the ability to experience sensations of an orgasm will vary. Some people may but it might be different from what you can remember, pre-injury.
Will I be able to ejaculate?
The majority of men with SCI are unable to ejaculate. However, although it doesn’t happen in the same way – it might take longer, may require more stimulation to reach that point or it may be less forceful – it can still happen so we advise you to use protection to avoid unplanned pregnancies or sexually transmitted diseases.
Some men may experience retrograde ejaculation where sperm travels back into the bladder. You might not realise this has happened, just that your urine looks a bit different. This isn’t a cause for concern – there’s no increased risk of urine infection, it’s just one of those things. Also, if you’re planning to try for children, sperm can be extracted from urine as it’s a sterile environment.
Will I be able to get or maintain an erection?
Yes. Depending on your level of injury, you might need devices or medication to help. For those who can get an erection but have difficulty maintaining it, there are erectile dysfunction medications such as Viagra, Cialis and Levitra that may help. Your doctor will generally start you on a low dose and there might be scope to increase that dose further.
For those with a flaccid paralysis who can’t achieve an erection as there’s no reflex activity there at all, using a vacuum erection device (penis pump) with constrictor rings can help. The rings vary in size and it’s important the correct size is used in order for it to be both effective and not cause harm.
Erectile dysfunction injections directly into the penis can also help by assisting blood flow into the area.
It’s worth bearing in mind that medications are only effective if instructions are carefully followed. For example, Viagra needs to be taken on an empty stomach. Some people may get disheartened that it’s not working, but it may simply be a case of not following instructions properly.
Also important is understanding how medications work with others you’re taking. Any meds need to be taken under supervision and your GP or pharmacist can advise on whether it’s safe for certain medications to interact with one another and things you might need to look out for. We strongly advise that those with heart problems and those with injuries of T6 or above who have medication for AD, speak to their GP before taking erectile dysfunction medication.
Top tip: Some meds like Viagra can cause things like mild headaches which can be off putting for sex. A simple solution to that is taking paracetamol at the same time.
Are there risks associated with having sex with a SCI?
There are some but these are minimal. If you’re T6 or below and won’t experience those early symptoms of AD, the main one would be being careful not to be too vigorous as, with no sensation, you wouldn’t be aware of causing damage to a sensitive area.
Other risks are the same as anyone having sex, regardless of a SCI. The risk of unplanned pregnancies, STD’s or urine infections can be minimised by using protection.
I’ve been asked in the past about an increased risk of pressure sores. Bear in mind that while having sex, you’re in motion and not in the same position for a prolonged period so the risks are minimal.
Will I still be able to have children?
Yes. As we’ve discussed, most men are not able to ejaculate so you may need support from a sexual function clinic with retrieval of sperm through penile vibratory stimulation (PVS) products like the Ferticare 2.0, and with IVF at a fertility clinic.
Sex and the Spine – easily accessible and trusted resources on sexual well-being from professional experts.
Spokz – Online shop offering products aimed at enhancing sexual wellbeing for disabled people
Sexual Health and Disability Alliance (SHADA) are involved in the positive promotion of sex for disabled people. This link provides a list of numerous sex-related resources
If you would like to discuss any of the issues mentioned above with someone who has lived experience of SCI visit our support page to find the contact for your area. Alternatively you can ring our support line on 0800 980 0501 or request a call from one of our SCI specialist nurses.