Sexuality for Men
with SCI
A spinal cord injury (SCI) affects a man’s sexuality both physically and psychologically. The type and level ofinjury both can play a role on the impact that the injury has on a man’s sexuality. After injury, men may facechanges in relationships, sexual activity, and their ability to biologically father children. Men can also experienceemotional 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 lifeafter injury.
Physical Changes
concerns or problems with their use. It is importantto see a doctor or urologist for accurate information Men normally have two types of erections. The first on the various treatments and products as they relate is a psychogenic erection, which results from sexual thoughts or seeing or hearing something stimulatingor arousing. The brain sends these messages Because each spinal cord injury is different, each through the nerves of the spinal cord that exit at the man’s physical response is different. Men with SCI T10-L2 levels. The messages are then relayed to the need to rely on their own observations and penis, resulting in an erection. For men with spinal experiences to fully understand the changes in their cord injury, the ability to have a psychogenic erection depends on the level and extent of injury.
Generally, men with an incomplete injury at a low Sexual Aids & Options for Men with SCI
level are more likely to have psychogenic erectionsthan men with high level, incomplete injury. Men The most recent breakthrough in treating ED is the with complete injuries are less likely to experience use of the medication Viagra® (sildenafil), a pill
taken by mouth. The Food and Drug Administration(FDA) approved Viagra in 1998 for use in the The second type of erection is a reflex erection.
treatment of erectile dysfunction. It quickly drew This occurs when there is direct physical contact to the interest of men because it is a noninvasive the penis or other erotic areas such as the ears, technique and can be self-administered. Research nipples or neck. A reflex erection is involuntary and studies show that Viagra, taken as required (not can occur without sexual or stimulating thoughts.
more than once daily), significantly improves the The nerves that control a man’s ability to have a quality of erections and satisfaction with sex life in reflex erection are located in the sacral segments men with ED due to spinal cord injury between T6 (S2-S4) of the spinal cord. Most men with spinal and L51. Men who have low or high blood pressure cord injury are able to have a reflex erection with or vascular disease should not take Viagra. Some physical stimulation if the S2-S4 pathway is not medications can not be taken with Viagra so all medications should be reviewed with the prescribingphysician.
Many men with SCI are capable of having anerection. However, the erection may not be hard Penile injection therapy is another treatment
enough or last long enough for sexual activity. This option. It involves injecting a single drug or a condition is called Erectile Dysfunction (ED).
combination of drugs into the side of the penis. This There are various treatments and products available produces a hard erection that can last for one to two for treating ED but men with SCI may have special hours. These drugs must be used exactly as Rehabilitation Research and Training Center on Secondary Conditions of SCI prescribed by the physician. If not used correctly, signs of pain to indicate that the implant is breaking the result could be a prolonged erection, called through the skin. All surgical implants also carry a priapism. When priapism occurs, the blood fails to high risk of infection. If an infection develops, the drain from the penis. This can damage the penile prosthesis may need to be removed. Penile implants tissue and be extremely painful. Other risks from are the most expensive option and some health the injection are bruising, scarring or infection of insurance plans do not cover the costs.
the penis. This method is not recommended for usemore than once a week. A penile injection is a Talk to a doctor before any treatment. Men with
difficult option for a man with limited hand function spinal cord injury who are experiencing ED should due to spinal cord injury. Therefore, he must have have a thorough physical exam by a urologist assistance in getting the injection.
familiar with SCI before using any medications orassistive devices. Level of injury, possible side- Medicated Urethral System Erection (MUSE), or
effects, and other medical conditions need to be transurethral therapy, is a relatively new treatment considered when deciding which treatment option is option. A medicated pellet is placed into the urethra best. With all treatments, men with SCI must be where it is absorbed into the surrounding tissue.
watchful for signs of Autonomic Dysreflexia (AD), This causes the blood vessels to relax and allows a life-threatening condition. Signs of AD include blood to fill the penis. The drug, alprostadil, is the flushing in the face, headaches, nasal congestion same as used in penile injection therapy. Reported side effects include a risk of infection, a burningsensation and decreased blood pressure and fainting.
The vacuum pump is a mechanical option for
Men with SCI also experience a change in their producing an erection that, for most men, is ability to biologically father a child. The major sufficient for intercourse. The penis is placed in a factor interfering with a man’s fertility is primarily vacuum cylinder and air is pumped out of the due to an inability to ejaculate as a result of damage cylinder causing blood to be drawn into the erectile to the spinal cord. In fact, 90% of men with SCI are tissues. The erection is maintained by placing a not able to ejaculate during intercourse; this is called constriction ring around the base of the penis. This anejaculation2. Another problem men with SCI may ring also prevents urinary leakage that some men experience is retrograde ejaculation. This occurs with SCI experience. It is important to remove the when semen does not leave the urethra but travels ring after intercourse to avoid prolong pressure and back up the tube and is deposited in the bladder.
the risk of sores. There are several models ofvacuum pumps available. A battery-operated model One myth is that the the number of sperm that a man is an option for those with limited hand function.
produces decreases the longer the time after injury.
Other models require good hand function to press There is no evidence that this occurs and should not the pump against the skin to create the necessary be a concern for men who want to biologically father a child3. However, the motility (movement)of the sperm is of concern. The average motility Surgical implantation is often the last treatment
rate among men with SCI is considerably lower than option for ED because it requires a permanent for the average man without SCI. Recent research penile prosthesis. The surgical procedure involves shows the average motility rate of sperm in semen inserting an implant directly into the erectile tissues samples from men with SCI is 20% compared to to obtain an erection. Three types of implants are available: semi-rigid or malleable rods, fullyinflatable devices, and self-contained unit implants.
Options are available to assist men with spinal cord There are risks of mechanical breakdown and the injury improve their ability to father children. Men danger that the implant could push out through the who are interested in fathering a child should get skin. Men with SCI usually do not have good medical advice and treatment options from a fertility sensation in the genital area, so there may be no specialist experienced in issues of spinal cord injury.
The fertility specialist needs to be aware of about relationships after the injury. It is important methods that can improve sperm quality in men for both partners to understand the physical changes with SCI, as well as complications that can occur, that occur after injury, but it is equally important to talk about how each person feels about the issues.
Without good communication, these emotions can be Penile vibratory stimulation (PVS) can be used to
inappropriately directed at each other, which can achieve an erection, but its main purpose is to produce result in more negative feelings. The couple can talk an ejaculate for those who wish to become fathers. A about, explore and experiment with different ways to variety of vibrators/massagers are available for this be romantic and intimate. Together, they can then purpose. Some are specifically designed with the discover what is sexually stimulating and fulfilling output power required to induce ejaculation in spinal cord injured men. It is important to consult a physicianbefore using a vibrator. One danger of using a vibrator A professional counselor can help in processing is it could cause swollen or inflamed skin. If the male feelings that are common after injury. This may does not have feeling, the vibrator must be used very include working through feelings of anxiety over Bowel/Bladder Accidents
Bladder or bowel accidents are a concern during sexual activity. The fear of an accident may be Rectal Probe
enough to keep a man from pursuing a physical Electroejaculation
relationship. Maintaining a regular bowel and bladder program is an important factor that can help prevent accidents. This can eliminate the fear of accidents and relieve anxiety.
and the controlled electrical stimulation produces transmitted disease (STD) is the same both before an ejaculation. When sperm cannot be retrieved and after spinal cord injury. STDs include diseases such as gonorrhea, syphilis, herpes, and the HIV performed to remove sperm from the testicle. Once virus. These STDs can cause other medical sperm are collected they can be used in artificial problems, such as infertility, urinary tract infections, pelvic inflammatory disease (PID), vaginaldischarge, genital warts, and AIDS.
Emotional Changes
Everyone needs to take precautions to protect against Men with SCI can experience many emotional STDs. The safest, most effective way to prevent changes that can influence sexual functioning. Men sexually transmitted diseases is to use a condom with are often concerned with maintaining their ability to a spermicidal gel. The condom must be used perform sexually as well as how their injury might correctly to be most effective in preventing both affect their relationship with a partner. Men who STDs and pregnancy. Even if the female partner is do not have a partner at the time of injury may also using another form of birth control, a condom still be concerned with how to meet and attract a needs to be used to protect against STDs. To ensure that both partners are disease free, each person can betested by a health care professional.
A man can continue both a romantic and anintimate relationship with a partner after a spinal Conclusion
cord injury. However, good communication with This information sheet cannot address in detail all the his partner is essential. Many men with spinal cord issues related to the sexuality of men with SCI. For injury become angry, depressed, and/or uncertain additional resources, see the following list.
Factsheets available on the Internet
Guide and Resource Directory to Male Fertility
The Facts about MUSE® (alprostadil) urethral following Spinal Cord Injury/Dysfunction. (2000) suppository. [Available: http://www.vivus.com/frames/products/facts.shtm].
Miami Project to Cure Paralysis. 305-243-7108[Available: http://www.scifertility.com].
Fertility and Parenting. SCI Forum, Dec, 1998.
Email: [email protected].
[Available: http://depts.washington.edu/rehab/sci/forum-fertility1298.shtml] NW Regional SCISystem.
Male Reproductive Function after Spinal Cord Injury.
Fact Sheet #10. (1996) National Spinal Cord Injury Association, 8701 Georgia Ave, Suite 500, Silver [Available: http://www.sexualhealth.com/content/ fertilit.htm] Sexual Health Network.
Springs, MD 20910. $2 or FREE with NSCIAassociation membership.
Reproductive Issue for Persons with Physical www.pn-magazine.com/pn/xxxxxxx/9807spou/default].
Disabilities. (1995) Florence Haseltine, Sandra SCole, & David Gray. Paul H Brooks Publishing Co.
Possible Effects of SCI on Sexual Function. (1997) [Available: http://www.sexualhealth.com/Disability/sci.htm] Sexual Health Network.
Sexual Function in People with Disability and Chronic Illness: A Health Professional’s Guide. (1997) Marca Sipski, MD and Craig Alexander, MD. Aspen Publishers. Cost $57. ISBN: 0834208865.
UAB-RRTC on Secondary Conditions of SpinalCord Injury, Birmingham, AL.
Sexuality after Spinal Cord Injury: Answers to your Sexuality and SCI: Update on Having Kids.(1999) questions. (1996) Stanley H Ducharme, PhD and Kathleen M Gill, PhD. Brookes Publishing Co.
www.pva.org/pn/articles/kids.htm] ParaplegiaNews.
Sexuality and SCI: Viagra Frenzy. (August, 1998) Spinal Network: The Total Wheelchair Resource Book.
Barry Corbet (1998, 3rd Ed) Chapter 7, Sex, www.pva.org/pn/xxxxxxx/9808sex/default.htm]Paraplegia News.
Relationships and Parenting. Cost: $49.95+s/h.
Sexuality in Spinal Injury Series. (1998) By the Louis Calder Memorial Library, U of Miami, The Treatment of Erectile Dysfunction Following Spinal • The SCI Injured Male: Ejaculation, Orgasm and Cord Injury. (1995) Produced by SCI Video, 706 Coitus. [Available: http://calder.med.miami.edu/ Sunnybrook Dr, Edmond, OK 73034. 405-330-8657 • The SCI Injured Male: Erections. [Available: http://calder.med.miami.edu/pointis/erections.html] Sexuality Reborn. (1993). Producers: Craig Alexander, • The SCI Injured Male: Sexual Drive and MD and Marca Sipski, MD. Kessler Institute for Activity. [Available: http://calder.med.miami.edu/ References:
1. Derry FA, Dinsmore WW, Fraser M, Gardner BP, Glass CA, Maytom MC & Smith MD. 1998. Efficacy and safety of oral sildenafil
(Viagra®) in men with erectile dysfunction caused by spinal cord injury. Neurology;51:1629-1633.
2. Amador MJ, Lynne CM, and Brackett NL. 2000. A guide and resouce directory to male fertility following spinal cord injury/
dysfunction. Miami Project to Cure Paralysis.
3. Brackett NL, Ferrell SM, Aballa TC, Amador MJ and Lynne CM. 1998. Semen quality in spinal cord injured men: does it
progressively decline post injury? Arch Phys Med Rehab;79(6):625-28.
Published by:
Revised: November, 2000
Developed by: Linda Lindsey, MEd, Phil Klebine, MA
2000 Board of Trustees of the University of Alabama (205) 934-3283 or (205) 934-4642 (TTD only) The University of Alabama at Birmingham provides equal Email: [email protected]
opportunity in education and employment.
This publication is supported by grant #H133B980016 from the National Institute of Disability and Rehabilitation Research, Office ofSpecial Education and Rehabilitative Services, U.S. Department of Education, Washington, DC. Opinions expressed in this documentare not necessarily those of the granting agency.

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