Sex & Intimacy After a Spinal Cord Injury: Part One of a Three Part Series

As Sexuality and Intimacy Trailblazers, we know that sexuality and intimacy are important parts of our lives, bringing us joy and enhancing our overall well-being. However, when someone experiences a spinal cord injury (SCI), these aspects can be profoundly affected. Today, we'll discuss when to address these topics, the impacts of SCI on sexual health, specific complications that can arise, and the role of occupational therapy in supporting individuals on this journey.

When to Address Sex and Intimacy:

So, the big question is: when should we start talking about sex and intimacy with SCI patients? 

The answer? at every point in their occupational therapy (OT) engagement! 

It's not about when exactly, but more about what to focus on depending on where the individual is in their injury timeline. In the inpatient setting, when people have recently experienced acute trauma, they may benefit from SCI sexuality education. On the other hand, those receiving outpatient care have more experience living with SCI and tend to focus on specific sexuality and intimacy-related goals. It's important to keep in mind that many patients did not receive sexuality education during their acute care phase. Plus, it can be challenging for them to absorb such information and learn about their bodies in the early weeks following the injury. The key is to meet clients where they are and tailor treatments based on what they find relevant. After all, client-centered care is always the way to go.

Key Questions to Ask:

Now, let's talk about some essential questions to ask when developing interventions that truly center around the client:

1. What are your concerns about sex? It's important to give individuals the space to express any worries or fears they might have.

2. What are your goals related to sex? Understanding their desired outcomes helps us guide our interventions effectively.

3. Everyone has their own unique way of experiencing and enjoying sex. Can you share what sex looks like for you or used to look before the injury? What activities do you enjoy? How do you reach orgasm? Ask them about prior to their injury and now currently.  This information helps us personalize our approach to meet their specific needs and preferences.

Impacts of SCI on Sexual Health:

SCI can have various impacts on sexual health, both physically and emotionally. Common challenges include difficulties in obtaining erections, loss of ejaculation ability, impaired vaginal lubrication, inability to orgasm, decreased sensation, loss of mobility, and pain. Naturally, these issues can affect sexual pleasure and fertility. But it's not just physical impacts—mental health, self-perception, body image, anxiety, and coping skills also come into play as initial barriers that need to be addressed during intervention.

Specific Complications during Sexual Activity:

To prevent complications during sexual activity and enhance the overall experience, patient education is crucial. Here are a few specific considerations to include:

1. Skin integrity: People with SCI have a higher risk of pressure wounds, and sexual activity can put them at even greater risk due to increased pressure, shearing, and friction on bony areas. Encouraging individuals to inspect their skin after sexual activity involving high friction can help them take better care of their skin.

2. Circulation and Respiration: Orthostasis and Autonomic Dysreflexia (AD) can occur during sex. AD is a serious condition that needs immediate attention if it happens. Additionally, decreased respiratory capacity can impact participation. Educating patients about body awareness, changing positions, and taking breaks can help them adapt and enjoy sex safely.

3. Bowel and Bladder: Loss of bowel and bladder function, as well as the need for catheterization and bowel programs, can create challenges for sexual activity. Simple steps like maintaining a regular bowel program, emptying catheters and ostomies before sex, or choosing a location like a shower for easy cleanup can make individuals feel more comfortable during sexual activity.

4. Motor Control and Mobility: Depending on the stage of their injury, patients may have restrictions or precautions that affect their safety with positioning and movements. Changes in bone density after SCI increase the risk of fractures. Impaired mobility can affect positions, the use of toys, and engaging with a partner or oneself. Occupational therapists can be real problem solvers here, providing creative solutions for positioning and techniques. They can suggest a wide range of sexual activities that require less effort or cause less friction but are still just as exciting and pleasurable. Think oral sex, fingering, breast play, power play, impact play, kink, massage, teasing, and more.

5. Change in Sensation: Loss of sensation or decreased sensitivity can impact the ability to orgasm and find pleasure in erogenous zones. However, exploring other areas of the body can still offer sources of pleasure. Interestingly, the last dermatome level with intact sensation may become extra receptive to sexual touch and register as highly sexually arousing in the brain.

Sexuality and intimacy remain important parts of the lives of individuals with SCI, even after the injury. That's why occupational therapy professionals play a crucial role in addressing these topics throughout the rehabilitation journey. By understanding the impacts of SCI on sexual health, potential complications during sexual activity, and by providing interventions that truly center around the client, occupational therapists empower individuals to navigate their sexual and intimate lives with confidence and pleasure. Let's keep having open and supportive conversations to foster a greater understanding of the unique challenges faced by individuals with SCI and work together to create a more inclusive and fulfilling world of sex and intimacy.

This article is part one of three in a special SCI series. Stay tuned for our second conversation about the role of occupational therapy in Spinal Cord Injury Rehabilitation!

_{This blog was written in collaboration with Brittany Gosserand, MOT OTR,} 

_{https://www.linkedin.com/in/brittany-gosserand/}

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