Content Written By: Irwin Goldstein, MD

April 05, 2010 - Spinal cord injury and sexual function

Specialty(ies): Penile Revascularization, Sexual Pain, HSDD, Penile Implants, FSD, Peyronie's Disease

Dr. Irwin Goldstein has been involved with sexual dysfunction research since the late 1970's. His interests include penile microvascular bypass surgery, surgery for dyspareunia, physiologic investigation of sexual function in men and women, and diagnosis and treatment of sexual dysfunction in men and women. He has authored more than 325 publications in the field of sexual dysfunction, with 20 consecutive years of funding by the National Institutes of Health in this area. He is Editor-in Chief of The Journal of Sexual Medicine, the official journal of the International Society for Sexual Medicine, its regional affiliate societies, and the International Society for the Study of Women's Sexual Health. Dr. Goldstein is the Director of Sexual Medicine at Alvarado Hospital, Clinical Professor of Surgery at University of California at San Diego and Director of San Diego Sexual Medicine where he maintains his clinical practice. Read more

Can women with complete spinal cord injuries have an orgasm?

Until a few years ago, there was a common belief that men and women with complete injuries were not capable of achieving a physiological orgasm. Instead, memories of the past, feelings of closeness and a sense of well-being were described as an "emotional orgasm" and were offered as a substitute to a physical orgasm. The research done by Marca Sipski, M.D. at Kessler Rehabilitation Center and at the University of Miami has clearly demonstrated otherwise. This groundbreaking research is worth reviewing by women who see this as important. Although the physical reasons for this are still unclear, many women of all levels and with complete injuries can be orgasmic under the right conditions. Some of the factors that have been found to correlate with the ability to have an orgasm are: comfort with one’s body, persistence, knowledge about one’s sexuality and intensity of stimulation. To date, no studies have demonstrated similar results for men with spinal cord injuries.

I am a 25 year old man with a spinal cord injury. Since getting injured, I can never quite reach an orgasm. Is there anything I can do that would get me closer to an orgasm?

The ability to ejaculate and have an orgasm is a complex neuromuscular process that is adversely affected by a SCI. Following injury, it is not unusual for individuals to have significant difficulties in reaching orgasm. In most cases, loss of sensation and inadequate stimulation contribute to the problem. Thus increasing stimulation, especially in areas where sensation may be spared, is a worthwhile pursuit. Many individuals find that using a vibrator with adjustable amplitude can provide the level of stimulation necessary for ejaculation and orgasm. Increasing visual and auditory stimulation may also be helpful in enhancing the level of arousal. In addition, some experts believe that regular and frequent sexual activity may increase the likelihood of restored ejaculatory functioning. Ongoing sexual activity maintains the integrity of the various chambers and arteries of the penis. Remember when using a vibrator; be especially careful of autonomic dysreflexia.

Does sexual functioning improve over time since spinal cord injury?

There is no precise answer to this question although many people do report positive changes over a period of years since injury. For example, it is not unusual for some men to report having an ejaculation or an orgasm for the first time several years after injury. Other men notice gradual improvements in the quality of their erections. Being sexually active on a frequent basis may be the most helpful tool in improving your sexual functioning over time. Frequent sexual activity tends to maintain good blood flow to the genitals and contributes to the integrity of penile tissue. Many of the early studies with Viagra demonstrated the long term benefits of frequent engorgement of the cavernosal arteries and corporal chambers. There is truth to the old saying, "use it or lose it!"

So much changed after my injury. Can guys with spinal cord injury really enjoy sex?

Early after injury the idea of resuming a positive sexual life can be overwhelming. Some men tend to avoid sexual activity because of embarrassment regarding their body, poor self esteem or the fear of failure. On the other hand, some men see this as a challenge to be conquered, learn as much as they can and take advantage of every opportunity to be intimate. Over time and with confidence about their sexual abilities, these men enjoy long lasting relationships and frequent sexual intimacy. It is possible to have a great sex life after an injury but it doesn’t develop without a personal commitment to make it happen. Having an enjoyable sex life requires time, practice, and the knowledge that sex is an important part of life not to be missed.

Do Viagra, Levitra or Cialis improve sexual functioning for women with spinal cord injury?

Research is still trying to answer this question and a multi center SCI study is currently underway. Early studies with women did show that Viagra was no better than a placebo for women who had low desire and poor lubrication. Currently, the new studies with women have been redesigned to exclude women with poor desire. Thus, in addition to the SCI studies now underway, Pfizer is exploring the impact of Viagra on women with poor lubrication and normal desire. It is just a matter of time before oral medications to improve women’s sexual functioning make their debut. Today however, we just don’t have the answers.

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