Sex and spinal cord injuries

Originally Published: April 27, 1995 - Last Updated / Reviewed On: December 23, 2011
Share this
Dear Alice,

Boy do I have a question for you, Alice! A friend of mine has a spinal cord injury and is paralyzed from the waist down. I was wondering if he is capable of having an erection and ejaculating. Also, if a male has a catheter inserted into his penis, is it possible for him to have intercourse? Will the catheter cause him to feel uncomfortable during intercourse? Will the catheter cause any discomfort for the women?

Wanting to be informed

Dear Wanting to be informed,

Boy do we have answers for you! Spinal cord injury (SCI) can affect a man's ability to have orgasms, erections, and to ejaculate, but the extent of its affect depends largely on the location and severity of the injury. Men normally have two types of erections – one type is generated in the brain, called a psychogenic erection, and the other is physically stimulated, called a reflex erection. In the first case, a man sees, thinks, or hears something arousing and brain signals travel down the nerves of his spinal cord to trigger an erection in the penis. Generally, men with injuries higher on the spinal cord are more likely to lose this ability, while injuries lower down on the spinal cord often leave psychogenic erections unaffected. The other kind of erection, reflex erections, results from physical contact to the penis, anus, nipples, or other erogenous zones. As long as sacral nerves S2-S4 are intact, most men with SCI are able to have reflex erections. Of course, emotional issues can inhibit both erections and sexual desire, and should certainly be handled in a careful and compassionate way; but more on that later.

Even though men with SCI can feel desire and pleasure, many experience erectile dysfunction (ED), which means they have trouble achieving or maintaining an erection firm enough or for a long enough time for sexual intercourse. It might be encouraging to know that weak erections can be helped through various aids, like the application of a tight rubber ring around the base of the penis or by taking a prescription medication. For those unable to have an erection, there are surgical procedures that implant devices in the penis that can manually initiate an erection. But that's not the end of the story. About 90% of men with SCI cannot ejaculate or experience retrograde ejaculation, a condition in which semen flows back into the bladder instead of out the urethra. If men with SCI want to father children, and cannot ejaculate out of the penis, sperm can be retrieved through stimulation or surgical methods. 

You are right to question the safety of intercourse with a catheter in. Men who use indwelling catheters do need to remove them before intercourse, because movement during sex could push the balloon of the catheter through the sphincter of the bladder, potentially resulting in serious damage. To help prevent wetter-than-desired intercourse, men can try emptying their bladders right before intercourse and avoiding drinking fluids for an hour or two ahead of time. For more information on SCI, you can check out the resources at the National Rehabilitation Information Center (NARIC).

People are often sensitive about their bodies, what they look like, and what they can and can't comfortably do. In all relationships, open and honest communication is essential for couples to maintain healthy relationships and sexual lives. This is even more crucial when dealing with injuries that affect sexual abilities, sensation, and heath. No matter what the limitations may be as a result of an SCI, both men and their partners can discover together how to best give and receive pleasure and satisfaction.

Alice