Sexuality and SCI

Considerations for SCI and sexuality

• Physiological: Level of injury (motor and sensory), complete or incomplete, co-morbidities or pain, spasticity, bowel and bladder function

• Psychological: Pre-injury considerations, beliefs about sexuality, level of sexual desire, relationships pre- and post-injury, self-concept

Erection and SCI

• Psychogenic – brain sends arousing messages through T10-L2, resulting in tumescence.

• Reflex – an involuntary response to direct contact with the penis or other erotic areas. Controlled by S2-S4, so flaccid if the injury is in this area

• Spasticity may interfere with sexual activity and may increase the risk of autonomic dysreflexia for people with injuries T7 and higher

Ejaculation in SCI

• 70% people with incomplete paraplegia

• 17% people with complete paraplegia

• 30% people with incomplete quadriplegia

• Almost never with complete quadriplegia

Fertility in SCI

• In AMAB:

  • Motility of sperm decreased after SCI

  • May have retrograde ejaculation into bladder

  • Options: Penile vibratory stim (above T10 level injury), rectal probe electroejaculation, surgery to remove sperm from testicle, specialized clinics to work with sperm with reduced motility

• In AFAB:

  • Not usually impacted

  • Contraception may be more complicated

  • Childbearing is possible, not necessarily c-section

What is the PLISSIT model?

P: obtaining Permission from client to initiate sexual discussion

LI: providing LImited info needed to function sexually

SS: giving Specific Suggestions for the individual to proceed with sexual relations

IT: providing Intensive Therapy surrounding the issues of sexuality for that client