Sexual life and spinal cord injury

Libido – the desire for sex

Libido is the desire for and pleasure of sex. In men, it depends on a certain amount of the sexual hormone testosterone and in women, the hormone oxytocin plays an important role. Libido is triggered through the senses, e. g. through touching, pictures, taste, smell or music. People with spinal cord injury may have as much desire as people without SCI since the above-mentioned senses (excluding touch) are hardly influenced. Depression or medication against depression (antidepressants), pain medication (opiates, neuroleptica), spasticity reducing medication (diazepam), and for women the birth control pill, may reduce libido.

With restricted sensitivity in the genital area in particular, it is possible to discover other, new erogenous zones, such as around the neck or behind the ear. Furthermore, the intact sensory organs can be stimulated increasingly with erotic music and sounds, whispering sweet nothings, wearing sexy clothes, a glass of champagne, sensory lighting and scents. Face and body oils, balms, as well as essential oils for an oil burner or scented candles indulge your sense of smell. Find out what works for you.

Sensuality

Spinal cord injury often causes loss of sensitivity of the skin. Touching can no longer be sensed or is sensed differently on certain body parts (generally below the lesion level). However, there are ways of compensating in part for these deficits. You can try new techniques or discover previously unknown erogenous zones. Make full use of your existing senses by developing and paying closer attention to them. People affected can learn and discover that sex can also be satisfying, nourishing and enjoyable without “normal physical reactions”.

Positions

Various positions for making love can also be performed by people with SCI. Variation increases libido as well as pleasure and allows for different kinds of touching and sensing. The more open and direct you are about your needs, the more pleasurable the encounter will be. The partner can help to stabilise you; often it is enough to just give a little bit of support to change position. Also ramps and cushions, positioned under the woman’s hip for example, or straps that are attached to the ceiling are useful aids.

Prerequisites for sex

Being able to relax and overcome insecurity or fear – one’s own or the partner’s – is a pre-condition for a fulfilling sex life. Handling fear productively makes it possible to experiment, to be curious and open for pleasurable experiences. This may relate to one’s physical condition, the position in which you feel comfortable and attractive or the kind of stimulation one wishes for. It is possible to experiment with the surroundings, decoration, room temperature and lighting or necessary aids. Another important pre-condition may be an informative conversation with the partner. Being aware of your own needs, being able to deal with them and to stand up for them may be an enhancing step towards a fulfilled sex life.

Fear may decrease libido

The changed situation after SCI may cause fear in the first place: fear of failing, of not pleasing somebody or not meeting somebody’s expectations; fear of incontinence or of spasticity. This may be experienced as exhausting or not pleasurable for everybody involved. On a permanent basis, this fear can also make you lose interest in sex. Therefore people with SCI, their partners and the whole rehabilitation team of professionals need to be informed about the problems. This is the only way to address and discuss fears and search for solutions. If these problems are not addressed, they are being made a taboo. As Moeller wrote in 1998, “Was man tabuisiert, kann man nicht gestalten”, which means that things that are being made taboo can never be staged.

Fear of incontinence

Managing bladder and bowel functions is very important. People with SCI get to know their bodies very well over time, and will be careful, before having sex, to empty their bladders (as well as, perhaps, their bowels), to regulate the amount they drink and to keep an underlay handy. Informing the partner beforehand that unpredictable physical reactions might happen and knowing how the partner will react can help the couple relax.

Fear of not having an erection

Despite all aids and medications, many men are afraid of not having an erection. Pictures of highly potent men have been internalised, and sex is often being confused with high performance sports. However, sex is not an Olympic discipline – the goal is not higher, faster, better – there is not even a goal to be reached. A man often thinks a woman will leave him if he cannot have a proper erection. Speak about it openly with your partner.

Fear of spasms and spasticity

Spasms might be hindering, such as when it comes time to finding a certain position, but they can also be used to reach a better erection or movement of the pelvis. Spasticity (increased body tension) can mostly be stopped by changing the position or with a massage. In general, it is very helpful if the partner is informed about the fact that spasticity or spasms might occur.

Fear of autonomic dysregulation

Stimulation of the genitals can trigger autonomic dysregulation in a person with SCI with a lesion level above T8. In most cases, the symptoms disappear immediately after the stimulation is stopped. However, this requires precise and gentle clarification about what can be done to stop autonomic dysregulation, and the precautions which need to be taken.

Sexual guidance and sexual assistance

People with disabilities may have more difficulties than others when it comes to finding partners for sex or masturbating. Therefore, they may have a real wish to seek assistance. Since the nursing staff is not allowed, and does not want to, assist sexually, a special form of prostitution – sexual assistance and sexual guidance – has emerged. Sexual guides enable their customers to enjoy erotically sensual experiences through touching, holding, caressing or hugging.

Most institutions (hospitals, care facilities, etc.) neither have the amenities nor the staff for offering such services. Sexual assistance must therefore be organised privately. Services offered by specifically trained sexual therapists and counsellors can be found, e. g. on the internet.