The spinal cord brings impulses from the brain to the various parts of the body; damage to the cord can cut off those impulses in any areas served by nerves below the damaged section. Therefore, to assess the dysfunctions that result from a spinal cord injury (SCI; or a spinal tumor), a physician must know exactly where on the spine the injury occurred and how extensively the cord has been damaged (Benevento & Sipski, 2002). Though some return of sensation and movement can be achieved in many injuries, most people are left with permanent disabilities. In more extreme cases, SCI can result in total or par­tial paraplegia (pah-ruh-PLEE-jee-uh) or total or partial quadriplegia (kwa-druh-PLEE- jee-uh). In these cases, the person is rendered extremely dependent on his or her part­ner or caretaker.

| quadriplegia

Paralyis of all four limbs.

Men are four times more likely than women to experience SCI. If the injury is above a certain vertebra and the cord is not completely severed, a man may still be able to have an erection through the body’s reflex mechanism, although it may be difficult to maintain as he will not be able to feel skin sensations in the penis. Injuries to the lower part of the spine are more likely to result in erectile difficulties in men, but they are also more likely to preserve some sensation in the genitals. Men without disabilities maintain erections in part through psychic arousal, such as thoughts and feelings and fantasies about the sex act; but, with SCI, psychic arousal cannot provide continuing stimulation. Most men with SCI who are capable of having erections are not able to climax or ejaculate, which involves a more complex mechanism than an erection (Benevento & Sipski, 2002).

Women with SCI remain fertile and can bear children, and so they must continue to use contraception. However, women with SCI can also lose sensation in the genitals and with it the ability to lubricate during sexual activity. In one survey, 52% were able to achieve an orgasm after SCI, but half said that the orgasm felt different from before (Kettl et al., 1991). Some women (and men) report experiencing “phantom orgasm,” a psychic sensation of having an orgasm without the corresponding physical reactions. Also, skin sensation in the areas unaffected by the injury can become greater, and new erogenous zones can appear (Brown et al., 2005; Ferreiro-Velasco et al., 2005). The breasts, for example, may become even more sexually sensitive in women who retain sensation there.

Sexual problems develop over time as the full impact of their situation takes effect. Although men with SCI resume sexual activity within a year of their injury, their fre­quency of sexual activity decreases after the injury. Ninety-nine percent of men with SCI reported sexual intercourse as their favorite sexual activity before SCI, and only 16% report this after injury (Alexander et al., 1993). Many men and women enjoy a va­riety of sexual activities after SCI, including kissing, hugging, and touching.

Rehabilitation from SCI is a long, difficult process. Still, with a caring partner, meaningful sexual contact can be achieved. Men incapable of having an erection can still use their mouths and sometimes their hands. If vaginal penetration is desired, cou­ples can consider a penile prosthesis or use the technique of “stuffing,” in which the flac­cid penis is pushed into the vagina. Newer treatment methods including prosthesis im­plantation, vacuum erection devices, and the injection of vasoactive drugs have all been used in men with SCI. However, men with SCI have higher rates of complications with prosthetic implants (Kabalin & Kessler, 1988) and may not be able to use other treat­ment methods, such as the vacuum pump or injections, because of limited mobility. Research has found that Viagra can significantly improve erections in men with spinal cord injury (Fink et al., 2002).