Let's Talk about Sex

It’s not always easy to talk about sexuality. With a spinal cord injury, it may require an even higher level of trust, communication, and honesty. However, it’s important to talk openly, both to dispel myths and to establish shared goals and expectations. Working with your partner – and with additional supports and resources – leads to greater enjoyment of intimate relations.

Pleasure seeking

Sexual feelings are natural and pervasive, and paralysis or the absence of sensation does not prevent a person from giving and receiving pleasure.

Below are some basic questions related to sexuality. We invite you to reach out to us for additional support and resources.

pair of naked feet between the sheets on a bed

What are the main physical issues related to sexual function?

Physical changes to your body such as loss of movement and dexterity, loss of sensation and altered sexual reflexes are common following an SCI. These changes can affect arousal, your ability to orgasm, and your fertility.  The extent of this impact depends on the level of injury and whether your injury is complete or incomplete.

Men may experience difficulty achieving erection depending on their level of injury. There is generally less response to sexual thoughts or images (“psychogenic”) than to physical stimulation (“reflex”). Even with an ability to attain and maintain an erection, erectile dysfunction (ED) is common, either when newly injured or over time. There are many options to address this, from medications to pumps and implants. Additionally, if couples wish to have children, men with an SCI may not be able to ejaculate or may produce low numbers of motile sperm. Fertility treatments are available.

Women with an SCI may experience decreased vaginal lubrication (as a result of the interruption of nerve signals from the brain), a change in sensation and a lesser ability to contract muscles. A majority of women with an SCI are able to experience orgasm, but it may take longer or require more stimulation than before. And while women may experience a pause in their menstrual cycle after an SCI, it generally resumes and pregnancy becomes an option if desired.

Both men and women may deal with challenging emotions about bladder and bowel management, sexual arousal, sexual satisfaction, and not satisfying a partner or feeling unattractive – many issues faced by everyone, disability or not. These can be addressed if both partners are committed to finding solutions and if the shared goal is to express sexuality and intimacy, physically and emotionally.

How can I and my current/future partner talk about sexuality after a spinal cord injury?

As in any sexual relationship, an open, honest, and non-judgmental approach helps each partner to ask questions, express their thoughts and listen carefully without worry of being criticized or corrected. And if there aren’t yet answers to some questions, that’s fine! This is not the only conversation you will have. Your intimate relationship will likely change and grow over time, so it’s okay to be uncertain about some things.

In short, agree up front to establish an open line of communication. And it doesn’t hurt to have some humour – sexual talk (and sex itself) can be awkward and inelegant under any circumstances! Most of all, work together to stay positive. Maintaining an optimistic mindset will take you places you may not yet imagine.

What should we talk about?

There are some very basic topics worth covering, depending on your time of life and relationship status. Even if you’re in a long-term relationship, you may want to “rewind” and talk about issues you have already addressed. Life with an SCI may redirect your thinking.

  • How you define sex and sexuality
  • Your values and beliefs
  • Reproduction and contraception
  • Sexually transmitted diseases
  • Disability-related challenges
  • Sexual aids of interest

Work hard to share your honest thoughts – including fears and desires – and listen intently to your partner without interrupting.

How can I tell if my health care provider is sex positive?

You have the right to quality sexual health care, and that may mean finding a doctor, nurse or nurse-practitioner who is sex positive. A sex positive professional is comfortable discussing your sexual and reproductive health issues, sensitive and respectful, and inclusive. You ought to receive confidential care and unbiased sexual and reproductive health options.

It is ideal to feel at ease with your health care provider. You have a role to play in being open about discussing your sexuality, and they should make you feel as comfortable as possible.

Choose Cortree for powerful online learning on Sex and Disability.

This course covers fears and misconceptions about sex and disability; talking about sex with your partner, your health care provider, and your attendant; planning ahead for some considerations that may affect you during sex; and exploring what works for you, which presents a few sex toy options which can help adapt to your fatigue, lubrication, increased or decreased sensation, and mobility.