Introduction
Matters of sexuality and fertility especially during rehabilitation for the past thirty years have remained controversial because not so many people want to talk about them (Phelps et al., 2001). Persons with spinal cord injuries are in need of answers on how to handle their sexuality. These questions cannot be ignored. Most of them ask questions about their attractiveness, ability to have kids and relationships. To make the matters worse, studies on sexuality among people with spinal cord injuries are scarce (Karellou, 2003).
On a positive note, advances in this sector have provided ways through which such people can live their lives positively lead sexually rewarding lives. People now realize the fact that spinal cord injuries do not bring life to halt; they can still lead fulfilling lives including rewarding sexually active lives (Karellou, 2003). In the first few months, the focus on boosting recovery. However, people with spinal cord injuries find it hard to cope with sexual functions after recovering from their injuries. They have a tough decision to make; whether to remain sexual active or not (Karellou, 2003).
A spinal cord injury is not something to be taken likely because it is a life–changing event (HCP, 2012). Spinal cord injuries limit one’s ability to function in different ways. Sexuality and intimacy are some of the functions that can be affected following a spinal cord injury. It is essential to note that the way one feels about sex or their ability to have sex varies from person to person. In addition, the importance of sex or intimacy varies depending the stage of life one is at (HCP, 2012).
In this case, the degree at which the sexual functioning is limited by spinal cord injury relies on the extent of the injury. At times, the injury could be complete or incomplete (HCP, 2012). Additionally, the limitation varies between men and women. If the injury is incomplete, there is minimal change in sexual functioning. Conversely, if the injury is complete, greater sexual limitation takes stage when the spinal cord injury is complete. In men, for instance, three main effects take center stage. The sensation or feeling aspect is the first to be affected. Secondly, men encounter erection and ejaculation abnormalities. On the other hand, in women, the main changes include the inability to sense and get wet (lubricate) (HCP, 2012).
Following these changes, most people spinal cord injuries shy away from asking questions about their sexuality (Phelps et al., 2001). In most cases, the healthcare professionals provide guidance and counseling during the rehabilitation period. However, when the patient is discharged, they lack someone to talk to or share their experiences with. It is thus essential to help such people air out their challenges; the best approach would be to invite a sexologist to talk to them or take the patient to the clinic for counseling. Sexuality for Men
As noted earlier, the degree of the injury, as well as the area of the injury determine the degree of effect the injury will have on sexuality. In men, T11-L2 and S2-S4 are the two principal areas that regulate sexuality in men (HCP, 2012). Firstly, the T11-L2 center regulates psychogenic erections. These erections are triggered in the brain through fantasy. In addition, this center regulates the discharge of essential sexual fluids. S2-4 center, on the other hand, takes charge of reflexogenic erections such as those triggered by a full bladder, masturbation, catheterization and rubbing the inside of the thigh. This center also controls ejaculation; the release of semen. In normal circumstances, messages travel to and out of the brain via the spinal cord. When the injuries set in, the normal flow of these messages is disrupted (HCP, 2012).
A number of important aspects come into play when injuries at the T11-L2 are involved. For example, when the injury is situated in the thoracic area or cervical region, the exchange of messages between the brain and the T11–L2 center is distorted. Consequently, erections may be affected; only erections triggered by a sense of touching or rubbing are possible (HCP, 2012). Those usually triggered by sight are become dysfunctional. Again, the extent and the firmness of the erection vary between people.
Conversely, when the injury is situated below the T11–L2 area, the erection is likely to be normal because erection nerves are not affected in this injury (HCP, 2012). The only variation is in the firmness and extent of the erection. On top of that, fertility is another important aspect of the sexuality that is affected when there is a spinal cord injury. In this case, ejaculation is affected, and the injured person cannot produce sperms. This depends on the location of the injury. Fertility is another area that may be affected by spinal cord injury. The ability to ejaculate relies on the location of the injury. On top of that, the sperm count may be less thus limiting fertility. The quality of the sperms produced can be assessed by undertaking a laboratory test (HCP, 2012). Sexuality for Women
In women, the inability to lubricate and loss of sensation are the two most common effects that occur following a spinal cord injury. Several solutions to the lack of lubrication have been identified. Patients can use water–soluble, non–lanolin substances such as K–Y jelly. Vaseline and petroleum products are not suitable in this condition. In addition, some women’s menstrual cycle may also be affected. In some cases, menses delay for up to a year; however, even as menses disappear, ovulation still occurs, and pregnancy is possible. Thus, depending on the extent of the injury, some women with spinal cord injuries can carry a pregnancy. However, there are some challenges associated with such pregnancies.
In some, there could be difficulties with transferring. In others, urinary tract infections rise not to forget problems with bladder management. At times, in women with injuries above T-6, autonomic dysreflexia becomes rampant. It is important for women with spinal cord injuries that are anticipating to have a pregnancy to consult first. In addition, women with spinal cord injuries ought to have gynecological exams regularly. These exams should include pap smears, mammograms, and breast exams. Tips for Men and Women with Spinal Cord InjuriesPlanning for Caregiving
At times, a person with a spinal cord injury may consider receiving care. When planning for such help, it is important to take into consideration the effect the caregiving exercise will have on the relationship with the caregiver (Phelps et al., 2001). At times, your sex partner might turn out to be your caregiver. It is important to assess whether this association might have an impact on the relationship. In some cases, the aspect of getting care might put stress on your relationship with your sexual partner. It might be useful to employ a neutral person such as a family member (Phelps et al., 2001).
Enjoying Intimate Time
When people have spinal cord injuries, it does not mean that there sexual life is over. They can still have quality intimate times with their significant others (Rowles, 2012). When planning to have an intimate time, it is paramount for the people concerned to plan appropriately. This may involve preparing yourself and the environment that the two of you will use. It would be appropriate to make the room appealing by dimming the lights, playing soft music, burning candles, and touching. In essence, setting the mood makes the experience enjoyable. Options for sexual enjoyment are many. First, it is important to find out from your significant other the things that matter or do not matter to them; what they like or hate. It is vital to for the two parties to talk about the effects they have; let your partner know that you have lost your sensation or erection, and lubrication among others. This will help the two parties to plan on how to have quality time by utilizing the working functions (Rowles, 2012).
It is vital for the two partners to talk about what makes them feel good or touch where sensation can be felt (Sakellariou & Sawada, 2006). It would be helpful to experiment by touching different areas to identify those which can cause a stimulation. Examples include the nipple line, shoulders, the back of the neck, and the thoracic level. These areas are very sensitive and can be stimulated by the smallest touch. On the other hand, the stimulation of genital sensation will rely on the degree of spinal cord injury, as well as the return of function and sensation. Others may have the fear of triggering genital stimulation because they think they might hurt their partner. It is essential to talk about it and have fun if there is no sensation of pain (Sakellariou & Sawada, 2006). Positioning
It is recommended for people with spinal cord injuries to have sex in a wheelchair. In such a chair, spasms are better controlled (Sakellariou & Sawada, 2006). Besides, the hand and arm function well. Another preferred place is the shower; the sensation of water brings out an enjoyable feeling. In some people, spams can be employed to boost the movement but if they are very severe, it will be appropriate to change the position and reduce their interference. It is also advisable to try as many positions as possible until the most appropriate one has been identified (Sakellariou & Sawada, 2006). Orgasm
Revelations from many people that have suffered spinal cord injuries indicate that orgasm does occur, but it is different (Sakellariou & Sawada, 2006). It would be appropriate to talk to the doctor about how to enhance orgasm. Orgasm in people with spinal cord injuries is said to be as a psychological response; it happens in the mind. Practicing Safe Sex
Just like in other normal people, it is vital for people with spinal cord injuries to practice safe sex. This means using a condom in case the sexual partner is new or has been away for a long time (Sakellariou & Sawada, 2006). Contraception
It might also be useful to use contraceptives if pregnancy is not intended. It would be helpful for the two parties to talk to the doctor to find out the best contraceptive to use. The doctor should guide the two parties in choosing contraceptives that have few side effects. Some contraceptives cannot be used in people with spinal cord injuries. Therefore, the doctor’s guidance is vital (Sakellariou & Sawada, 2006).
Medications
Prior to prescribing any medication, the doctor in charge if a patient with spinal cord injuries must first assess the effects that medication might have on the sexual functioning (Sakellariou & Simo-Algado, 2006). Review medications with your health care provider to see if any affect sexual functioning. For instance, some medications make it hard to get a lubrication or erection. On the other hand, it would be appropriate to take anti-spasms thirty minutes prior to having sex if spasms are a problem. Again, this ought to be done according to the guidance of a doctor. On the other hand, if the spasms are used to boost positioning, it would appropriate to take them after sex (Sakellariou & Simo-Algado, 2006).
Bladder and Bowel Function
Another important measure that people with spinal cord injuries is to have a better control of the bladder and bowel functions (Urbanowski, 2003). The nerves that regulate the bladder and bowel are situated in proximity on the spinal cord with those that regulate sexual functions. At times, when one nerve is excited, it might trigger a secondary excitement in the neighboring nerves. For that matter, in people with spinal cord injuries, the stimulation of sexual nerves in the spinal cord could also trigger unintended excitement of nerves that enervate the bowel and bladder. Therefore, it might be helpful to catheterize and execute a bowel program to empty the bowel and bladder prior to engaging in intercourse. In some people, especially those using an indwelling (Foley) catheter, it might be useful to live it in remove it after the conclusion of intercourse. For those who opt to live it in, there are some measures that can be taken to make the whole exercise enjoyable (Urbanowski, 2003).
One such approach involves taping the catheter out of the way making sure that the urine can drain without interference (Urbanowski, 2003). In most cases, the catheter is taped up to the hip or abdomen. For men, it would be appropriate to run the catheter along the side of the penis. This can then be covered with a condom to allow the drainage of urine without interference. For those who opt to remove it before sex, they must have a fresh one that will be inserted after sex. People should be guided on how to use this procedure to avoid undesired effects such as autonomic dysreflexia. If this condition occurs, it is advisable to stop the intercourse for a while and ensure that the bowel or bladder is empty. But if it persists, it would be useful to talk to the doctor (Urbanowski, 2003).
Harvey (2008) opines that spinal cord injury commonly affects the bladder, bowel and sexual malfunction. One of the most comprehensive studies in this area has shown that up to 81 percent of people with spinal cord injuries have impaired bladder malfunction. Sixty-three percent of the participants had lower bowel malfunction. The control of these three bodily functions are complex, and they rely on the coordinated activity of between parasympathetic and sympathetic nervous systems and skeletal muscle control via S2-S4 nerve roots. Injuries underneath the conus result into a flaccid paralysis of the skeletal muscle of the balder, bowel and sexual function. Besides, there is the loss of the sacral part associated with parasympathetic spinal cord mediated reflexes (Harvey, 2008).
On this note, people who gave suffered spinal cord injuries need guidance on how to approach sexuality. In some cases, it would be essential for a sexologist to outline to them how they ought to conduct themselves during intimacy. Therefore, it is the duty of close friends and family members to encourage their injured friend/relative. They can offer support by helping to transport the person in question to the clinic or by inviting the doctor to the home setting. In addition, family members can help by purchasing easy to use beds or chairs that will make the intimacy of the injured person better. If the injured person has difficulties getting over their setback, it would be essential to invite a psychologist to guide them. At times, because of their condition, the intimate relationship might turn out to be irritating because they cannot have their way as expected. This could be a source of stress and that is why a psychologist might be needed.
Summary
In summary, this paper has evaluated how spinal cord injuries affect sexuality of the injured persons. A spinal cord injury is not something to be taken likely because it is a life–changing event. Spinal cord injuries limit one’s ability to function in different ways. Sexuality and intimacy are some of the functions that can be affected following a spinal cord injury. Most people spinal cord injuries shy away from asking questions about their sexuality. In most cases, the healthcare professionals provide guidance and counseling during the rehabilitation period. The extent to which sexual functioning is limited by spinal cord injury relies on the extent of the injury. In some cases, the injury could be complete or incomplete. Additionally, the limitation varies between men and women.
If the injury is incomplete, there is minimal change in sexual functioning. Conversely, if the injury is complete, greater sexual limitation takes stage when the spinal cord injury is complete. In men, for instance, three main effects take center stage. The sensation or feeling aspect is the first to be affected. Secondly, men encounter erection and ejaculation abnormalities. On the other hand, in women, the main changes include the inability to sense and get wet (lubricate). However, when the patient is discharged, they lack someone to talk to or share their experiences with.
Thus, it is essential to help such people air out their challenges; the best approach would be to invite a sexologist to talk to them or take the patient to the clinic for counseling. These people need guidance and counseling because spinal cord injuries do not mean that life and its pleasures such as sex have ended. People with spinal cord injuries can still lead normal sexual lives, but they have to be guided on how to approach it.
References
Harvey, L. (2008). Management of Spinal Cord Injuries: A Guide for Physiotherapists. Amsterdam: Elsevier Health Sciences.
HCP (2012). Sexuality and Reproductive Health in Adults with Spinal Cord Injury. The Journal of Spinal Cord Medicine, 33(3), 281-336. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2941243/
Karellou, J. (2003). Laypeople’s attitudes towards the sexuality of people with learning disabilities in Greece. Sexuality and Disability, 21, 65–84.
Phelps, J., Albo, M., Dunn, K., & Joseph, A. (2001). Spinal cord injury in married or partnered men: Activities, function, needs and predictors of sexual adjustment. Archives of Sexual Behavior, 30, 591–603.
Rowles, N. (2012). Spinal Cord Injury and Sexuality. Retrieved from https://lifecenter.ric.org/index.php?tray=content&cid=2560#pagetop
Sakellariou, D., & Sawada, Y. (2006). Sexuality after spinal cord injury: The Greek male’s perspective. American Journal of Occupational Therapy, 60, 311–319.
Sakellariou, D., & Simó-Algado, S. (2006). Sexuality and disability: A case of occupational injustice. British Journal of Occupational Therapy, 69, 69–76.
Urbanowski, R. (2003). Spirituality in changed occupational lives. In A. McColl (Ed.), Spirituality and occupational therapy (pp. 95–114). Ottawa, Ontario, Canada: CAOT Publications ACE.
