Paraplegics and Sex

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The spinal cord functions like a telephone cable, linking the brain with the body’s other organs. When the spinal cord is injured, many neurological impairments result, including sexual dysfunction. When the cord is severely injured quadriplegia (paralysis of all four extremities) results; if the lower half is interrupted, the lower half of the body is paralyzed (paraplegia).

In women with paraplegia or quadriplegia, transient amenorrhea (no menstrual periods) lasts for approximately six months from the time of spinal cord injury (SCI). Their ability to be pregnant is restored with the return of menstruation. Although women with complete SCI are not able to feel sensations in the genital area, they may have orgasms if other sensitive areas in the rest of the body, above the level of the neurologic damage, are stimulated—the ears, neck, nipples, etc. However, spasticity (involuntary muscle spasms) of the legs and poor vaginal secretion may be problematic during sexual intercourse. Under such circumstances, the use of antispastic medication, gentle leg muscle stretching, and lubrication of the genital area are useful prior to physical intimacy. During pregnancy, SCI women are prone to developing urinary tract infections. While in labor, women with quadriplegia or high paraplegia may experience various symptoms, including headaches, excessive sweating, high blood pressure, and changes in the heart rate. The development of this clinical syndrome, known medically as automatic hyperreflexia (overactivity of the physiological reflexes), should be closely watched until the baby is delivered. After delivery, women in this category are considered to be at high risk for thrombophlebitis (blood clots forming in veins) in the pelvis or lower extremities.

Males with quadriplegia or paraplegia commonly experience erections of the penis induced by spasticity. However, such erections are frequently of short duration and do not usually last long enough to enable them to engage a female partner satisfactorily. Male patients who have suffered damage in the lower end of the spinal cord or in the bundle of nerves exiting the lower end of the cord may experience impotence. However, male patients lacking adequate erections may be assisted through the use of an external mechanical device such as a vacuum pump with a proximal penile ring. Also, intrapenile injections of papaverine (a blood vessel dilator) just before intercourse may cause erections. For selected cases, penile prostheses are available and can be implanted surgically (see also impotence).

When psychologically excited during sexual activity, SCI males may fall out of bed due to heightened muscle spasticity in their bodies. Unfortunately, the majority of male quadriplegics and paraplegics do not experience orgasm or ejaculation. To assist ejaculation when fertility is desired, the injection of prostigmin (a muscle stimulant) into the spinal fluid was tried in the past. However, if prostigmin is used, caution should be taken because it can be accompanied by serious side effects such as high blood pressure and even cerebral hemorrhage. Intrarectal electrical stimulation and penile electrovibration are the two most commonly used methods today and reasonably good results have been obtained. However, there is also a possibility of developing autonomic hyperreflexia during electrical stimulation for ejaculation. Further research is required to improve the quality of sperm in quadriplegic and paraplegic males in order to make successful fertilization possible (see also handicapped persons and sex).

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