Having a spinal cord injury can impact a man’s sex life in many ways. Here’s everything you need to know about spinal cord injuries and male sexual function.
Last Updated: 09/08/2023
Most men with a spinal cord injury (SCI) experience some degree of sexual dysfunction, including erectile dysfunction. In addition, according to one survey, only 48% of men with spinal cord injuries were able to ejaculate after their injury.
People living with a spinal cord injury rate improving sexual function as a high priority and believe it’s a key to enhancing quality of life.
Although sexual dysfunction is common in men with spinal cord injuries, many men with a spinal cord injury are able to have satisfying sex lives and experience sexual pleasure. To accomplish this, many of these men use erection-enhancing methods to solve their erectile dysfunction and improve their sexual response.
This blog post will explain how a spinal cord injury impacts male sexual function, and how men can improve their sexual satisfaction after suffering this type of injury.
Men with spinal cord damage have a reduced ability to send messages between the brain and parts of the body below the level of spinal cord injury. This leads to lost or reduced genital sensation and muscle motion, and in some cases, erectile dysfunction.
Approximately only 20%-30% of spinal cord injury male patients are unable to have erections or their erectile function is not strong enough for sexual intercourse.1 Many men with a spinal cord injury are able to experience erections but are unable to achieve ejaculation. Up to 95% of spinal cord injured men experience ejaculatory problems, whereas 80% of men with a spinal cord injury regain some erectile function by two years after their injury.2
The ability to have erections does not mean that spinal cord injured men can experience sexual arousal. In addition, the erections might not be hard enough or maintained long enough for sexual intercourse.2
Yet, approximately half of men with a spinal cord injury can have orgasms, even if their orgasms are weaker compared to before their injury.3,4 Orgasms can occur even in men who can’t achieve ejaculation, and the ability to reach orgasm isn’t determined by whether or not it’s a complete spinal cord injury.2
Which neurons are damaged during spinal cord injury and the extent of damage will determine the degree of sexual functioning and sexual response that remains and the extent of erectile dysfunction.
Immediately after a chronic spinal cord injury, men often can’t have reflexive sexual responses. However, when reflexes return, men can start having erections after genital stimulation, but only if sacral spinal segments and the collection of nerves at the end of the spinal cord, which are responsible for sensations, remain intact after injury.2 Reflexive responses often don’t last long and stop when genital stimulation stops.2
Some men with spinal cord injury can experience sexual arousal in response to visual, auditory, imaginative, and tactile stimuli, which leads to sexual pleasure.2 This is known as a psychogenic erection.
As a man with a spinal cord injury begins to face a new reality, it can change the dynamics of the relationship with his partner. At the same time as you are learning to be dependent on your partner for your needs, feeling as though you can give your partner sexual satisfaction is important, too.
Suffering a spinal cord injury also can affect a man’s self-esteem, which in turn can impact sexual activity, sexual desire, sexual responses, erectile function, and your sexual relationship.
People with a spinal cord injury report better sexual satisfaction if they are in a long-term sexual relationship. Sexual rehabilitation post spinal cord injury should include open dialogue between you and your partner and honest communication and experimentation in order to maintain a positive relationship.
A spinal cord injury can lead to physical effects that can impact sexual satisfaction and male sexual function. Here are some ways in which having a spinal cord injury influences sexual functioning and leads to sexual dysfunction:
Some male spinal cord injured patients can’t feel when they have to go to the bathroom and have little to no voluntary control over voiding the contents of their bowel or bladder, which leads to incontinence and can interfere with sexual activity.2 It can become less of an obstacle if the person with a spinal cord injury empties their bladder and bowel before sexual intercourse and stops or reduces drinking fluids for several hours before sexual activity. 2
Your doctor can suggest other ways to deal with incontinence after a spinal cord injury.
For example, doctors can prescribe bladder relaxants to reduce bladder spasms that can lead to urinary leakage during sex.2
About 65% to 78% of people with chronic spinal cord injury experience spasticity, which can affect sexual positions and lead to sexual dysfunction.2 Sometimes gentle stretching of the affected muscles prior to getting into position for sex is sufficient and can easily be incorporated into foreplay.2
Putting a pillow or wedge under the pelvis and legs of the person with a spinal cord injury can reduce stretch on spastic muscles and allow comfortable positioning. In some cases, pillows placed between the knees prevent rubbing and skin breakdown.2
Another option for people whose hip and knee spasms are pronounced after a spinal cord injury is to have sex while seated in a wheelchair. This is best suited for people who have sufficient strength in the trunks of their bodies and balance to maintain a seated position without needing external support.2 Having sex in a wheelchair also is a better option for people in which sitting doesn’t lead to more spasms or spasticity.
However, your doctor may recommend taking medications for spasticity after a spinal cord injury. In a survey studying the impact of a spinal cord injury on sexual function, 28.7% of respondents reported their spasticity was severe enough to require medication.2 Taking spasmolytic medications before sexual intercourse may reduce spasticity during sex.2
A type of prescription skeletal muscle relaxant called Baclofen is used to treat spasticity after spinal cord injury. When administered in the form of a surgically implanted pump that delivers the medication, it’s linked to erectile dysfunction and inability to ejaculate.5
Autonomic dysreflexia occurs when the involuntary (autonomic) nervous system overreacts to stimulation below the level of a spinal cord injury.2 Because it can lead to severe blood pressure spikes that can be life-threatening, it is a medical emergency.2
Ejaculation is a common trigger for autonomic dysreflexia, although erections and sexual stimulation of any kind can lead to the condition.6 Usually, the autonomic dysreflexia goes away after the trigger is removed, but in some people the problem persists.6
Some people with autonomic dysreflexia don’t have any symptoms, while others develop headaches even when their blood pressure doesn’t rise.2
To stop the blood pressure rise, placing the person with the spinal cord injury in an upright position can cause a drop in blood pressure.2 Medications are used if the systolic blood pressure remains at or above 150 mmHg.2
Consult with your doctor to find out the best approach for dealing with autonomic dysreflexia and the resulting increased blood pressure.
Men with a spinal cord injury are more likely to have testosterone deficiency compared with men who don’t have spinal cord damage.7 Low serum testosterone levels are associated with spinal cord injury severity and the length of time since becoming injured.8,9
Studies have found that testosterone replacement therapy in male spinal cord injured patients resulted in modestly improved body composition.10,11 In addition, testosterone replacement therapy combined with resistance training improves muscle quality in people with a spinal cord injury.12
However, the effect of testosterone replacement on sexual function and libido in men with a spinal cord injury isn’t as clear cut since the subject isn’t well researched.
People with a spinal cord injury are vulnerable to skin wounds and pressure sores. Because of this, they should have their skin checked after sexual intercourse. Be on the lookout for redness, thickening, and hardening of the skin. Healthcare providers can show partners of people with a spinal cord injury how to check the skin both visually and by touch. It’s especially important to check the skin after using a vacuum device to make sure there’s no tissue damage.
Using satin sheets and pillow cases can reduce friction and the risk of abrasions in spinal cord injury patients, while at the same time adding romance to your sexual relationship.
If a spinal cord patient has a pre-existing ulcer, it’s important to avoid sexual positions that could make it worse by creating pressure or friction. Which positions to avoid will depend on the ulcer’s location. Some people may need to avoid lying on their side, others should avoid seated positions, while others should avoid lying face upward during sex.2
To stop ulcers from coming in contact with a sexual partner, the wounds can be temporarily covered with a self-adhesive dressing.2
Many options exist for treating erectile dysfunction after a spinal cord injury. Several studies have demonstrated that Viagra is a safe and effective treatment for erectile dysfunction and improving sexual response in many SCI patients.13-15
Another option for male sexual dysfunction after a spinal cord injury is using penile rings.16 Penile vibration using vibrators with amplitudes of 2.5 mm and frequencies of 100 Hz can lead to erections and ejaculation and enhanced sexual pleasure.17
Men with a spinal cord injury may also be able to have erections with catheter manipulation, applying hot towels to the penile shaft, and using a constrictive band at the root of the penis.18
Another frequently prescribed solution for erectile dysfunction after a spinal cord injury is using a vacuum erection device, otherwise known as a penis pump. A battery-operated vacuum erection device requires less hand function than the manual versions, but some use of the hand is still required.19
It can also help to become reacquainted with your body and use multiple senses to discover erotic areas beyond the genitals to improve sexual satisfaction and enhance your sex life and sexual response. After a spinal cord injury, you may notice that touching different parts of the body can produce sexual pleasure equal to that of genital stimulation. For example, sexual stimulation of erogenous zones like the nipples, earlobes, or inner thighs can lead to genital awareness even in the absence of genital sensation.
Men whose erections aren’t strong enough for sexual intercourse can try the “stuffing technique,” where the flaccid or semi-erect penis is inserted in the partner. This might be sexually satisfying to your partner while helping stimulate and maintain reflex erections.
Perineal training is another option for men with spinal cord injuries who have sexual dysfunction. The perineal region is the space between the genitals and anus. In men who have some voluntary control of perineal muscles, exercising this area can improve the hardness of the penis and erectile function.20
For men who want to have children, fertility after a spinal cord injury is an issue. Two of the factors that can contribute to infertility in male SCI patients is the inability to ejaculate and damaged sperm. Penile vibratory stimulation and electroejaculation are common ways used to trigger ejaculation in order to collect sperm for fertility.21,22
However, semen retrieved in this way often has high levels of inflammatory markers, which reduce sperm motility,23 which refers to the ability of sperm to move toward the egg. Less motility equals less chance the sperm will fertilize the egg.23 There are ways to enhance sperm motility, so talk with your doctor about the best ways to enhance fertility after a spinal cord injury.23
Another problem with induced ejaculation using penile vibratory stimulation or electroejaculation is that it can cause autonomic dysreflexia in some male SCI patients.24
In some cases, the autonomic dysreflexia can last for several days and can result in a silent rise in blood pressure that goes undetected.25 Therefore, blood pressure should always be monitored after induced ejaculation.
Depending upon where a man’s spinal cord injury is located, it can affect the ability to have a penile erection and/or the ability to ejaculate. Which neurons are damaged during spinal cord injury and the extent of damage will determine the degree of sexual functioning that remains.
Only about 20% to 30% of spinal cord injury male patients are unable to have erections or they have erections not sufficient for sexual intercourse.
Many men with a spinal cord injury are able to experience erections but are unable to ejaculate. Up to 95% of spinal cord injured men experience ejaculatory problems, whereas 80% of men with a spinal cord injury regain some erectile function by two years after their injury.
The nerves that control erectile function depend upon the type of penile erection. There are two types of erections:
Psychogenic erections – Psychogenic sexual arousal occurs after visual or auditory stimuli or when having a sexual fantasy or other mental stimulation. After a complete spinal cord injury, a man may lose the ability to have this type of penile erection.
Reflexogenic erections – Reflexogenic erections, or reflex erections, occur due to physical stimulation. Men with a spinal cord injury are often still able to have this type of penile erection if their injury occurred on the higher section of the spinal cord. If the injury occurred on the lower part of the spinal cord where the sacral segments are located, then reflex erections may not be possible.
Nerves involved in psychogenic erections are:
Nerves that transmit messages from the brain through the spinal cord (T11-L2 and S2-S4)
Pelvic splanchnic nerves
Dorsal penile nerve
Pelvic splanchnic nerves
Having erectile dysfunction and not being able to achieve ejaculation after a spinal cord injury, can be stressful for men who want to start a family or have more kids. Penile vibratory stimulation and electroejaculation are two ways used to trigger ejaculation in male SCI patients in order to collect sperm. These methods of induced ejaculation can cause autonomic dysreflexia in some male SCI patients, a condition linked to high blood pressure spikes, so be certain to monitor your blood pressure after trying these methods.