“I was in a car accident in January. I am a paraplegic now and I need a wheelchair to get around. I have made peace with this and I am working again too. I am married and we have two children. We always had a good sex life but now I have very little feeling in my penis and I struggle to get an erection and keep it erect."

Is there help??? Perhaps pills? I am 29 and desperate!

Erectile dysfunction orE.D. is the inability to produce an erection of sufficient strength or durationto initiate or complete intercourse. It is the most common problem relating tomale sexual dysfunction and is not limited to persons with a disability.

The most common causes ofE.D. are diabetes, high (or low) blood pressure, heart disease, alcohol,smoking, stress and the natural aging process. These also apply to a personwith spinal cord injury but the injury itself often causes furtherdifficulties.

There are two types oferections. Psychogenic erections begin with sexual thoughts or seeing or hearingsomething stimulating or arousing. Signals from the brain are sent via thenerves of the spinal cord to the penis triggering an erection.

A reflex erection occurswith physical contact to the penis, scrotum or other erotic areas such as theears, nipples or neck. It is involuntary and can occur without sexuallystimulating thoughts.

An erection is maintainedby continuous psychogenic and reflex stimulation. If you have a low levelinjury you should retain the ability to have a psychogenic erection as well asa reflex erection. If the erection does not last this could be related toworries about your sexual ability. This is called performance anxiety.

There are optionsavailable to address E.D. but they are relatively expensive and cannot beclaimed from medical aid. Phosphodiesterase inhibitor pills such as Viagra,Cialis or Levitra increase blood flow to the penis. You will not get anerection just by taking the pill, stimulation is also required. After sexualactivity the blood flow to the penis usually decreases and the erection goesaway. These pills must be prescribed by a general physician as certainconditions exclude their use. There are other options. These also have risks soit is important to talk to a doctor for more information.

Penile injection therapyinvolves injecting a drug, or drugs, into the side of the penis. This producesa hard erection lasting for several hours. These drugs must be used exactly asprescribed and should not be used more than once a week. They may be difficultfor a man with limited hand function to administer.

The vacuum pump(Vacurect) is a mechanical option. The penis is placed in a vacuum cylinder andthe air is pumped out of the cylinder. This causes blood to be drawn into thepenis and a constrictive ring on the base of the penis prevents the blood fromescaping. The pump produces a strong erection but the ring has to be removedafter about 30 minutes to allow blood circulation. After a few minutes you mayuse the device again which allows you to have sex as frequently as you want.The vacuum pump is a popular option and, although the initial cost isrelatively high, it soon pays for itself.

There is often a fearthat the partner will leave for a ‘stronger man’. Many factors, besides sexualintercourse, maintain a relationship: mutual respect, love, being genuine,dedication and companionship rank equal in importance.

If you had a strongrelationship with your wife before there is no reason why this relationshipcannot continue. You will then find in her a friend and an ally who can workwith you to find new ways to make your sex life exciting and satisfying again.