Sexuality and reproductive health for men with SCI
A spinal cord injury (SCI) affects a man’s sexuality both physically and psychologically. After injury, men may face changes in relationships, sexual activity, and their ability to biologically father children. Men can also experience emotional changes that can affect sexuality. All of these issues involve both the man with SCI and his partner. Therefore, it is very important to understand and confront these issues as a part of the overall adjustment to life after injury.
Many men with SCI are capable of having an erection. However, the erection may not be hard enough or last long enough for sexual activity. This condition is called Erectile Dysfunction (ED). There are various treatments and products available for treating ED but men with SCI may have special concerns or problems with their use. It is important to see a doctor or urologist for accurate information on the various treatments and products available.
Men with SCI also experience a change in their ability to biologically father a child. The major factor interfering with a man’s fertility is primarily due to an inability to ejaculate as a result of damage to the spinal cord. In fact, 90% of men with SCI are not able to ejaculate during intercourse; this is called anejaculation. Another problem men with SCI may experience is retrograde ejaculation. This occurs when semen does not leave the urethra but travels back up the tube and is deposited in the bladder.
Options are available to assist men with spinal cord injury improve their ability to father children. Men who are interested in fathering a child should get medical advice and treatment options from a fertility specialist experienced in issues of spinal cord injury. The fertility specialist needs to be aware of methods that can improve sperm quality in men with SCI, as well as complications that can occur, such as autonomic dysreflexia.
A romantic and intimate relationship with a partner can be developed or maintained after a spinal cord injury. It is important to keep the lines of communication open as well as an openness to explore and experiment with different ways to be intimate. Together, you can discover what it takes to maintain a sexually stimulating and fulfilling relationship.
Sexuality and Reproductive Health for Women with SCI
Women with a spinal cord injury represent about 20% of all individuals with SCI/D and the majority of these women are of childbearing age. Regardless of a woman’s level of injury or dysfunction, women with SCI can engage in sexual activity, can have children and will need to use a contraceptive method if they choose not to have children. Education is the key for women with SCI/D to understand the facts related to pregnancy, labor, and delivery. The first step in the journey towards motherhood is visiting with an obstetrician. If your obstetrician has limited experience in managing pregnancies of women with SCI/D, it is recommended that you take a “team” approach to your pregnancy. You and your obstetrician can consult with an experienced physiatrist, nurse, urologist, anesthesiologist, neurologist, respiratory therapist, physical therapist, and occupational therapist on specific concerns about pregnancy, labor and delivery. Although women with SCI/D may be considered to have “high risk” pregnancies, it does not mean that pregnancy should be avoided. It simply means that you need to take precautions to prevent and treat complications. Pregnant women with SCI/D are at greater risk for developing:
- Autonomic Dysreflexia (AD)
- Changes in bowel function (constipation or diarrhea)
- Bladder spasms resulting from increased weight on the bladder
- Urinary tract infections (a UTI might actually trigger premature labor if not properly managed)
- Pressure sores resulting from weight gain and/or posture changes
- Respiratory complications
- Muscle Spasms
- Swelling of the legs and feet caused by lack of blood flow in the lower extremities
Many prescribed and over-the-counter medications normally used by women with SCI/D can cause problems during pregnancy. Some medications can also have an adverse effect on fetal growth. Therefore, it is essential that all medications be evaluated by your obstetrician before pregnancy and continually re-evaluated each trimester. Some conditions that you might manage with medications include bowel management, pain, sexual dysfunction, muscle spasms, and urinary tract infection (UTI). Some women with SCI/D may have signs of labor, while others may not. Therefore, those with SCI/D must be aware of the common signs of labor, including abdominal tightening, changes in breathing, backache. Autonomic Dysreflexia is common during labor and can be life threatening if not managed properly.
Most women can, and should, deliver vaginally whenever possible. Some may deliver with ease, while others may need the assistance of a vacuum device or forceps. Some women with SCI/D have skeletal abnormalities such as curvature of the spine, pelvic fracture, or hip dislocation. These conditions can limit the space in the abdomen necessary to carry a full-term fetus. These abnormalities can make vaginal delivery difficult. In these cases, a Caesarean section (C-section) may be necessary.
Once the baby is born, the decision on whether or not to breast-feed must be made.
Although breast-feeding is possible for most women, you may notice an increase in your spasticity as you breast-feed. Also, breast-feeding normally stimulates the production of breast milk, so women with limited sensation in their nipples may notice a reduction in milk.
Although there are risks for complications related to pregnancy, risks can be reduced and managed through proper prenatal care and adequate planning.