Dr.Joe's Data Base

Do all people get depressed after a spinal cord injury?

In the past, mental health professionals felt that all people went through various stages in
the adjustment to their spinal cord injury. These included periods of denial, depression,
anger, and ventually acceptance. Today, this theory has been discarded. It is believed that
all people go through their own individual process that may or may not include
depression. A reaction to a disability is an individual process that contains personal
feelings and thoughts. If you do find your- self depressed after your injury, this should
improve with time, especially if you are able to share your feelings with another person.
Many people have found peer counseling is helpful after injury. Talking about your
feelings will help give you a sense of mastery and control. It can also help you to develop
healthy ways to handle the stress and pressure that you may be experiencing. If the
depression does not improve within a few months after your injury, you may want.

Is it okay to be sexual in the rehabilitation center?

Exploring your body and enjoying sexual pleasures is a natural part of life that you can
certainly enjoy even in the rehabilitation center. During rehabilitation, it is a good idea to
touch yourself, explore your body, and get as much information as you can. For example,
don't hesitate to ask your nurse whether you become erect when you receive a
catheterization. This is important information, especially if you are unable to see your
penis or if the sensation is decreased.
A word of caution, however. Although sexual experimentation during rehabilitation may
be a good idea, doing it in the privacy of your room is also important. In addition, don't
expect staff members to be sexual with you or pressure them into embarrassing situations.
Touching staff member; in a sexual way is inappropriate and is considered sexua
harassment. Respect the people working with you, and keep your intimate relationships
separate from the ones you develop with staff members.

Can I still have a sex life?

A spinal cord injury changes your sexual options, but it does not prevent you from having
a fulfilling sex life. You can still be a desirable and exciting sexual person. The necessary
components of having a sex life include feeling good about yourself, knowing what you
want sexually, and understanding how your body responds since your injury. Only you
can decide how to express your sexuality and how to feel as good as possible about your
looks and your body. Your partner may help improve your feelings of self-esteem, but
these feelings come from inside and are your responsibility.
Everyone is capable of responding in a sexual manner. Explore your body to learn what
works for you now. Ask yourself what you want to give and receive in a sexual
relationship. When you have thought about all this, select a partner who has similar
values and can give and receive in a compatible fashion. For now, you may choose to
express your sexuality with yourself. There is nothing wrong with not being in a
relationship. You can have a fulfilling and rich life as a single person with a support
system of friends and relatives.

I've never had sex. What will it be like?

There is no formula for sex. Everyone has different fantasies about what sex may be like.
To a large extent, these fantasies are based on our history and our needs at a particular
time. Most people need to feel a degree of physical attraction to another individual. Many
need to feel emotionally connected and to trust the other person. Most people prefer a
quiet, comfortable setting where there is little chance of interruption as they become
physically familiar with one another.
People vary tremendously as to how they give and receive pleasure and arousal. While
many people equate sex with intercourse, real sexual contact is any exchange of
intimacies, whether physical or emotional. Foreplay implies kissing, caressing, stroking,
or licking. But that choice is better left to the couple themselves.
Orgasm is not a requirement of lovemaking or sexual stimulation. Having an orgasm
during lovemaking depends on the preference, mood, physical capacity, and values of
each partner. Some people expect orgasm, even simultaneous orgasms, for themselves
and their partner. Others do not. It is best to learn what works best for you and what
makes you and your partner feel the most comfortable.
Sex can be exciting, regardless of whether you had sexual experiences before your injury.
If you had no experiences before your injury, this may be a time of anxiety, excitement,
unexpected pleasures, and discovery, just as it is for people without injuries. Try to
discuss your feelings with your partner and begin slowly. Use the first time to explore
your bady and your partner's. Try not to focus on intercourse or orgasm. Instead, try to
enjoy the sensations of being touched and giving pleasure to your partner.

Can I ever get married?

Having a spinal cord injury is no reason not to get married. The rate of marriage for
people with spinal cord injury is about the same as it is for the general population,
although it tends to occur later in life. Generally, these marriages are more stable too;
spouses report that they are pleased with their relationships and enjoy positive sexual
relations. Divorce rates tend to be lower for people who marry after their injury, and these
relationships seem to be mature and healthy.

Will a head injury affect my sex life too?

It is not uncommon for people with spinal cord injuries also to have a head injury as a
result of their accidents. Head injuries also affect sexual functioning, but in a different
way than a spinal cord injury. Most often a head injury will affect your ability to
communicate, your memory, your thinking, or your ability to express feelings. People
with head injuries may also find that they have little interest in sex or that they act too
quickly before they have a chance to think about the consequences. At other times, it may
be difficult to control your temper, or you may cry easily. Partners also may find it
difficult to know what to expect since behavior can be unpredictable after head injury. If
you or your partner has a head injury in addition to a spinal cord injury, it may be a good
idea to talk with a neurologist about the sexual implications of your injury. Remember
that not all neurologists may feel comfortable discussing sexuality, and it may take time
to find a person who can provide accurate answers to your questions.

Is my erection problem caused by depression or poor self-
esteem?

If you are having a difficult time emotionally, it may affect your desire for sex or ability
to be with other people. When we are depressed, we tend to want to be alone and often
withdraw from others. We have little interest in doing things and don't have the energy to
interact with friends or family. All of these factors affect who we are as sexual entities.
Chances are that your erection problem is a result of a neurological or physical cause, not
depression and your emotional situation. Although these emotional reactions can affect
erection quality, you have a medical condition that is causing the erection problem. There
has been a disruption in the nerve pathways between your brain and your penis. Even
though you feel turned on, the message is unable to reach your penis, so you don't get the
response you once did.

What is a reflex erection?

Some men with spinal cord injuries are capable of achieving a reflex-stimulated erection.
These men tend to be those with higher level injuries, such as quadriplegia rather than
paraplegia. A reflex erection is caused by either nonsexual or sexual stimulation of the
penis or genital area. The stimulation may be from bed sheets, touch, a full bladder, or
rubbing of the penis on clothing. Unlike regular erections, there is no relationship
between a reflex erection and the level of sexual excitement. When the stimulation is
removed, the erecticn will disappear. Therefore, reflex erections are often not satisfying
for intercourse. They can even be a source of frustration and confusion. With practice,
however, the couple can develop techniques to make these erections last for prolonged
periods of time.

If I put a rubber band on the base of my penis, will it stay hard? Is it safe to do this?
A penis ring traps the blood inside the penis and maintains the erection for as long as the
ring is in place. Often, men have intercourse with the ring in place. You may, however,
notice that the penis begins to turn blue or purple and feels cold to the touch. If you can
ejaculate, you may not be able to with the ring in place. You will now notice that the
sperm drips out of the penis when the ring is removed. These reactions are normal. The
ring should not do any damage to the penis unless it is left on for too long. Doctors
suggest that a penis ring not be left in place for more than 30 minutes. It is best to check
with your urologist before using a device such as a ring.

How do vacuum devices work to give an erection?

The vacuum constriction device is the safest, least expensive, and probably the most
widely used technique to improve erections. A vacuum tube is placed over the penis, and
an erection is created by pumping air out and thus drawing blood into the penis. A ring is
then inserted around the base of the penis in order to trap the blood in the penis. With this
type of erection, the man is able to achieve vaginal penetration and have intercourse. The
device is usually obtained by getting a prescription from a urologist.

How do I use a vacuum device when I have limited use of
my hands?

Many men who have limited use of their hands have their partner learn to use the device.
This can be taught by the nurse or the doctor. Another option is for the man with the
spinal cord injury to instruct his partner at home after he has been trained in the doctor's
office. Since there are few complications, this is generally very safe and has worked well
for many couples. The techniques are not complicated but must be followed carefully.
Using this device should be avoided if the couple have consumed alcohol or other drugs.

Can there be complications from using a vacuum device?

No serious injuries have been reported using these devices. Most problems have been
minor and have not required treatment by a doctor. You may notice some changes of
color and the temperature of the penis, but this is generally normal. But never leave the
device on for more than 30 minutes, and be sure that the vacuum is from a reputable
manufacturer. Be especially careful if you use products that you find in the back of a
magazine or in a local sex shop. No studies have been reported that indicate how often a
person can use one of these devices. But one study did show that a man with paraplegia
developed skin problems after using the device three times a day for a period of a few
days. As always, use moderation and good judgment.