“I am aquadriplegic person and was discharged from hospital a year ago with acatheter. I am getting used to living with my injury but my wife and I miss ourintimate life and sex. Is there some way we can still have sex with thecatheter in my penis?"

It is common to discharge patients with high spinal cordinjuries (resulting in reduced hand and grip function), with indwelling or insitu catheters. These provide a relatively low-maintenance and user-friendlymanner of bladder control for ward staff and rehabilitation therapists. Rehabshould promote independence of mobility and function within the limits causedby the injury however, the resumption of sexual function receives little or noconsideration and sexual rehab is often viewed as non-essential or of littleimportance.

The ability to perform sexually in line with gender roleexpectations is an important part of self-esteem and independence and shouldnot be ignored. If you are capable of gaining a voluntary erection ofsufficient strength and duration it is possible to have intercourse. Fold thecatheter tube back along the length of the erect penis and secure it with acondom. DO remove the condom afterwards and straighten the catheter tube as anykinks will restrict the free flow of urine to the drainage bag.

A far better solution involves replacing your indwellingcatheter with a suprapubic catheter. NEVER try to remove an indwelling catheteryourself as this can result in serious injury. The catheter is kept in place inyour bladder by a small liquid-filled balloon that has to be deflated bymedical personnel prior to removal.

A suprapubic catheter is basically an indwelling catheterplaced directly into the bladder through an opening in the abdomen above thepubic bone. This requires outpatient surgery under local anesthetic and isfully reversible. The abdomen opening and tube must be cleaned daily with soapand water and covered with dry gauze. The catheter must only be changed byqualified medical personnel and can be fitted with a drainage valve or astandard drainage bag.

The suprapubic catheter frees up your penis and allows youto perform sexually again and, because it follows a much shorter route to your bladder, the risk ofurinary tract infections is greatly reduced. Also, if the catheter becomesblocked, urine will be able to drain via the urethra, a safety net if youare prone to autonomic dysreflexia.

After changing to suprapubic you should find out, with thehelp of your partner, whether you can achieve and maintain a voluntary erectionfor intercourse.

The prolonged interruption of intercourse may have reducedsperm production and motility, common to SCI but lacking medical explanation.Ejaculatory function will also be reduced but can be addressed by electrovibratory stimulation.

You do not mention if youare capable of getting an erection at will. Once the suprapubic catheter hasbeen inserted you can begin experimenting with your regained sexuality. If youexperience no, or reduced, sensation in the genital area you may only be ableto get a half erection that will probably go flaccid before intercourse. Inthat case you will require assistance, either pills (Viagra, Cialis, Levitra),an intra-cavernosal injection (Caverject) or vacuum pump (Vacurect) asdiscussed in previous issues of Rolling Inspiration.