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Sex After a Spinal Cord Injury: How to Get Your Groove Back

After a spinal cord injury (SCI), life can throw some serious curveballs, sparking questions and fears about your new normal. For men, some of the biggest concerns have to do with erectile dysfunction—and whether they and their partners will ever get back into the groove of things. The good news is yes: a satisfying sex life is indeed possible.

“There is no reason why, after an SCI, you shouldn't be able to have an erection and give your partner satisfaction,” says Alexander Pastuszak, MD, PhD, assistant professor of surgery-urology at the University of Utah Spencer Fox Eccles School of Medicine. “I tell my patients they have almost a 100% chance of regaining their ability to have an erection, regardless of the cause of their erectile dysfunction. It all depends on how far they want to go with treatment.” 

Spinal Anatomy 101

Stretching from the bottom of the brain and ending in the lower back, the spinal cord is a long, tube-like band of tightly bundled cells, nerve fibers, and blood vessels. Each of these four main sections (marked with letters and numbers) control different bodily functions.

Cervical: (C1-C7)
Thoracic: (T1-T12)
Lumbar: (L1-L5)
Sacral: (S1-S5)

vertebral column spinal cord

SCIs and Sexual Performance

Your prognosis depends on your level of injury. Men with complete SCIs no longer have a line of communication between the brain and the body, thus resulting in a loss of sensation and function below the injury site. As for men with incomplete SCIs, erectile dysfunction may be minimal depending on the extent of their injuries. These two types of erections are possible for men, depending on the location of their SCI: 

1. Psychogenic Erection

A psychogenic erection happens when a psychological stimulus (i.e. arousing thoughts, sexual dreams, alluring images) travels down from the brain to the T-11-L2 region of the spinal cord. This type of erection is not possible for men with complete SCIs at L2 and above. They can, however, achieve a reflex erection. 

2. Reflex Erection

A reflex erection happens—sometimes unwantedly—by physical touch, such as rubbing, stroking, or brushing against something. Men with SCIs at the root of the spinal cord (S2-S4) are unable to achieve this type of erection. 

Types of Treatment

Rising to the occasion may be difficult at first, but give it some time and patience. Your first course of action is to book an appointment with a urologist to get started on a treatment plan. Common forms of treatment include: 

  • Medication: Oral medications, such as Viagra and Levitra, increase blood flow to the penis. Note: this form of treatment is not likely to be effective for men with complete SCIs.
  • Urethral suppositories: Medications inserted directly into the urethra (the tube that you urinate out of) increases blood flow into the penis, causing an erection. 
  • Vacuum erection device: This non-invasive option draws blood into the penis using a hand-held pump. A constriction band is then placed over the penis to maintain a temporary erection. 
  • Penile injection therapy: Erections can be temporarily restored by injecting medications into the penis, which helps produce blood flow. This sounds scary, but the needle is small and the injection is painless. 
  • Penile implants: This surgical option is for men who don't respond to other treatments. During surgery, the strength columns within the penis are replaced with two cylinders that provide rigidity.

Don’t Go It Alone

Change can be hard, especially when it comes to your sexual health. If you’re facing communication difficulties with your partner, or if you just need to talk to someone, please don’t hesitate to seek guidance from a professional.  

"A spinal cord injury can completely change your life in so many ways," Pastuszak says. "But over time, people can learn to cope and do reasonably well with treatment. It can also be beneficial to talk to a therapist who can help when you’re struggling.”