“I am a paraplegic and I am married. We have two children. Since my accident I cannot get a good erection like before. The problem is if I cannot make my wife happy with sex, she will leave me to find a man that is stronger and better with sex. Please help me!”

I have been working in the field of sexual rehabilitation for close on 12 years now. The majority of this work has been with spinal cord injured persons and I have more than 600 recorded case studies covering the South African context as far as race, culture and gender are concerned. More than 500 of these case studies areof male patients between the ages of 28 and 38. Post-discharge follow-up on these cases has shown that only eight women left their husbands post-injury and, in six of these cases, there was a pre-existing history of physical abuse and infidelity on the part of the husband.

There were 75 females in the case study who became spinal cord injured whilst in a permanent relationship. Every one of the husbands or lovers left their women within six months of the injury - and in some cases even while the patient was still in the rehabilitation process. Reasons given for leaving included: “It does no tsuit my style to be seen with a woman in a chair, my friends will laugh at me”,“I am scared I will break her back again” and “she smells and just lies there like a bread now”.

There are mixed reasons for this phenomenon but the main reason I find is that a global patriarchal social system still exists. This is a system where the male is seen as the primary authority figure where fathers hold authority over women, children and property. In some cultures in South Africa women are seen as the property of men and therefore may not leave their husbands even when the husband becomes physically disabled, but it also allows men to dispose of their property when she becomes redundant.

It may be some consolation to you that the second most frequently asked question from recently injured individuals is: “If I cannot satisfy my wife sexually will she leave me for someone else?” The first concern is usually: “Will I walk again?”

Male virility and the ability to have frequent and strong erections is commonly seen by men as part of the male-dominant gender-role expectation, and the loss of this function is therefore viewed as a disaster.

Many women I have spoken to agree that good quality, and even frequent, sexual intimacy is important but it certainly is not so important that they would consider leaving a partner. Women mostly look at the bigger picture and respect and love a husband who is gentle and caring and who accepts them as an indispensable part of the family union.

You already have two children as proof of your virility and ability to function in a family. Remember, the spinal cord injury has not necessarily affected your brain or your personality. If you were a desirable husband before you can still be one now, despite your disability and, if you interact with the same enthusiasm as before, very little changes in reality.

There is still anuninformed, and generally insensitive, approach in society at large about theworld of spinal cord injury and its effects - so the sooner you relax into yournew relationship with your wife the sooner you will be able to face your circleof friends and acquaintances with a united front that says: “See nothing haschanged – we are still together and it is business as usual”.

As far as your erectile dysfunction is concerned I recommend you read “A hard man is good to find” (RI May/June 2011) where this concern was fully addressed.