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Chapter 13 presents information on sexual function and fertility after spinal cord injury and therapeutic strategies for facilitating adaptation.

INTRODUCTION

Sexuality is a central aspect of our lives. Because sexuality is such a basic component of our biological, cultural, spiritual, social, relational, and psychological makeup,1 it is an important ingredient of holistic health. Feelings of sexual inadequacy can have a strong effect on a person's sense of identity and self-esteem.2 Sexuality is also important in our social relations. It is used to form and maintain relationships, wield power, communicate with others,3 and bolster self-esteem.4 Feelings of unattractiveness can lead to withdrawal from social and sexual relationships.5

“It is a tremendous core of who I am. Everything else comes out of that. How I think and feel about my body, my physical body. How I would define myself as a woman. How I am in all of my relationships, whether they are sexual or otherwise.”

Anonymous, SCI survivor6

We express our sexuality not only, not even mostly, through sexual intercourse. Our attire, interactions with others, the images we present, and our flirtations, smiles, and reactions to others are expressions of our sexuality. And yes, we express our sexuality in a wide variety of “sexual acts,” ranging from holding hands to more intimate sexual encounters.

The essence of a person's sexual nature is in their mind. Spinal cord injury does not alter this; people continue to desire sexual expression, and most people living with spinal cord injury remain sexually active.5,7-17 Unfortunately, damage to the spinal cord brings on changes that can interfere with sexual expression and activity. Both sexual activity and sexual satisfaction decrease after injury. Although both areas subsequently increase, they remain at lower levels than before the injury.18 In one survey, people with spinal cord injuries reported that decreased sexual function is one of the more difficult sequelae of cord injury to deal with, second only to decreased ability to walk or move.19

Perhaps the most obvious way in which a spinal cord injury affects sexuality is in its effect on the person's physical capacity to perform sexual acts. Changes in genital functioning, motor abilities, sensation, range of motion, and muscle tone may interfere with a person's accustomed modes of sexual expression.1 Spinal cord injury can also create logistical problems: altered body language, the potential for bowel and bladder accidents, decreased spontaneity resulting from the need to manage catheters, and the mechanics of undressing can complicate sexual encounters. In addition, a person with impaired mobility faces architectural and transportation barriers that can impede their ability to meet potential partners.

The social consequences of spinal cord injury add to the problem. People who have disabilities are often viewed by others as asexual, devoid of sexual urges, and undeserving of sexual expression ...

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