For many, sex and intimacy are vital components of a fulfilled life. Whilst sustaining a spinal cord injury can have an impact on your sex life, it doesn’t have to mean it is any less satisfying.

Sex may not be the first thing on your mind when you become spinal cord injured, but when you do begin to consider intimate relationships after injury you may have lots of questions and concerns. This guide aims to answer some of those questions and help you on the path to a healthy and happy sex life.

It can be difficult to change your mindset about sex, especially if you can no longer engage in sexual activity in the same way as you did prior to your injury. Try to remember that sex is not just a physical act, it’s an emotional one too and understanding how you and your partner feel, will help enhance the experience. Exploring different ways to be intimate with your partner and finding what turns them on can be very fulfilling!

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.

Guidance for Men

How will SCI affect my sexual function?

It will depend on what level your injury is and whether it is complete or incomplete. For those with a complete injury, achieving and maintaining an erection may be difficult. It may also not be possible to ejaculate. For those with an incomplete injury, the impact of spinal cord injury on sexual function will vary from person to person and it will depend on what specific nerves are affected. 

Can I get and maintain an erection?

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 (where stimulation occurs through touching the penis). Reflex erections can occur during non-sexual stimulation such as washing or catheterisation, they are not intentional, and you have little control over them.

There are several treatments to help get or maintain an erection:

Oral medication: erectile dysfunction drugs like Viagra, Cialis and Levitra can help. These tablets are usually taken 30 – 60 minutes prior to sexual activity. Your GP will normally start you on a low dose and build gradually. These drugs can have mild side effects (headaches, flushing, indigestion, blurred vision) and it’s important to follow the instructions carefully to maximise their effectiveness (for example, Viagra will work much better on an empty stomach). If you take medication to alleviate symptoms of autonomic dysreflexia, it’s important to consult your GP prior to taking erectile dysfunction medication.

Intracavernosal injections: these are drugs injected into the base of the penis to help achieve an erection. Like oral medication, they work by assisting blood flow to the area. Your GP can teach you or your partner the correct technique for administering the drug. Injections like this usually take effect within five to 10 minutes. 

Vacuum erection device: for those seeking a non-invasive method of achieving an erection, using a vacuum erection device (penis pump) with constrictor rings can help. The pump works by drawing blood into the penis, achieving an erection. The ring is then placed around the base of the penis to prevent the blood from flowing away from the area. The rings vary in size and it’s important the correct size is used for it to be both effective and not cause harm.

Will I be able to ejaculate?

Most men with SCI are unable to ejaculate. However, for those that can, it might take longer and require more stimulation than before injury. As it can still happen, it’s essential 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; the only noticeable sign may be a change in the colour of the urine. Retrograde ejaculation carries no risk to health, and 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 experience the sensation of an orgasm?

Even if you can reach the point of orgasm, it’s likely that it will not feel the same as it did prior to your spinal cord injury. Ejaculation can be a trigger for autonomic dysreflexia, so you may experience the early symptoms associated with raised blood pressure (warm feeling in the face, flushing above the level of injury/headache). This is nothing to worry about, as the symptoms will alleviate once the trigger has been removed, in this case when ejaculation stops.  

Can I still have children?

Whilst the majority of men with SCI will not be able to ejaculate through sexual stimulation, sperm can be retrieved via the use of penile vibratory stimulation (PVS) products like the Ferticare 2.0, or through IVF at a fertility clinic. If you are interested in finding out more about becoming a parent after a spinal cord injury, speak to a fertility specialist at your spinal centre, or get referred to one via your GP.

Guidance for Women

How will spinal cord injury affect my ability to have sex?

Spinal cord injury should not affect your ability to have sex. The main effects of SCI will be the loss of sensation and the ability to lubricate. Feelings of sensation will depend on the level of injury and whether you have a complete or incomplete injury. Lubrication can be aided by a water-based lubricant gel. It is important to use water-based if using a condom during sex, as oil-based lubricants can affect a condom’s protective properties.

Will I experience orgasm?

Most women with spinal cord injury can experience orgasm, but it may not be in the same way as prior to injury. As well as reaching climax through vaginal penetration, many SCI women report experiencing orgasm through stimulation of other parts of the body that become more sensitive following SCI, such as the breasts, neck and ears. Stimulation around the level of injury can also create a heightened sense of arousal, and it has also been reported that stimulation of the vagus nerve can result in orgasm. 

Can I still become pregnant?

Yes! Spinal cord injury has little effect on a woman’s fertility and therefore it’s important to practice safe sex to avoid unplanned pregnancies. 

How should I position myself?

It’s important to find positions that are comfortable for you and your partner. Be open-minded and approach sex with a creative sense of adventure and humour. Experiment with different positions to discover what works best for you.

Important considerations

It’s normal to be concerned about bladder or bowel accidents whilst having sex after spinal cord injury. The nerves that serve sexual function are the same that control the bladder and bowel, so stimulating the sexual function nerves can result in stimulating the bladder and bowel nerves accidentally. To avoid accidents, it’s important to ensure your bladder is empty prior to engaging in sexual activity, and your bowels well managed. Whilst this can reduce the spontaneity of sex, it can also prevent any unwanted accidents.

If you have an indwelling catheter, it can be removed or left in place whilst having sex. For women, you can tape it out of the way (to the thigh or abdomen) which will help avoid it being pulled, but it’s important that urine can still drain. For men, you can run it down the side of the penis and cover it with a condom, once again ensuring urine can drain. 

A lack of sensation and being too rigorous can increase the risk of damage to sensitive areas of the body, so being careful and inspecting the area during sex can help prevent skin or tissue damage.

Risks like unplanned pregnancies, STDs or urine infections are the same for anyone having sex. Using protection will minimise these risks.  

Top Tips

• Be creative and keep it fun. Don’t put too much pressure on sex, and enjoy experimenting.
• Get to know your body and how it responds to different sensations like hot/cold, hard or soft touch, or even blowing on the skin.
• Good communication is key. Talk about your concerns, and what feels good and what doesn’t.
• Prioritise discovering new and different sensations other than penetration.
• Talk to others who have been on the journey to sexual fulfilment after SCI.

Helpful resources

• Spinal Injuries Association: Sex after SCI Archives - SIA (spinal.co.uk)
• Back Up Trust: Sex After Spinal Cord Injury | Back Up (backuptrust.org.uk)
• Sex and the Spine: Sex and the Spine - YouTube
• Spokz: Sex Aids | Disability Sexual Aids (spokz.co.uk)
• SCI Women Facebook group: (2) SCI Powder Room | Facebook
• SCI Men Facebook group: (2) SCI Locker Room | Facebook
• Sexual positions for women with SCI: Sexual Positions for Women with Paralysis: Creativity, Adaptability and Sense of Humor - Dr. Mitchell Tepper (drmitchelltepper.com)