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. Below are some of the treatment options currently available:
Penile injection therapy involves injecting a single drug or a combination of drugs into the side of the penis. This produces a hard erection that can last for one to two hours. These drugs must be used exactly as prescribed by the physician. If not used correctly, the result could be a prolonged erection, called priapism. When priapism occurs, the blood fails to drain from the penis. This can damage the penile tissue and be extremely painful. Other risks from the injection are bruising, scarring or infection of the penis. This method is not recommended for use more than once a week. A penile injection is a difficult option for a man with limited hand function due to spinal cord injury. Therefore, he must have assistance in getting the injection.
Medicated Urethral System Erection (MUSE), or transurethral therapy, is a relatively new treatment option. A medicated pellet is placed into the urethra where it is absorbed into the surrounding tissue. This causes the blood vessels to relax and allows blood to fill the penis. Reported side effects include a risk of infection, a burning sensation and decreased blood pressure and fainting.
The vacuum pump is a mechanical option for producing an erection that, for most men, is sufficient for intercourse. The penis is placed in a vacuum cylinder and air is pumped out of the cylinder causing blood to be drawn into the erectile tissues. The erection is maintained by placing a constriction ring around the base of the penis. This ring also prevents urinary leakage that some men with SCI experience. It is important to remove the ring after intercourse to avoid prolonged pressure and the risk of sores. There are several models of vacuum pumps available. A battery-operated model is an option for those with limited hand function. Other models require good hand function to press the pump against the skin to create the necessary vacuum.
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 an 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 romantic and intimate. Together, you can discover what it takes to maintain a sexually stimulating and fulfilling relationship.