“My husband and I were in a car accident and I escaped with bruises while my husband sustained a spinal cord injury and is now a paraplegic.

We are middle aged and I have recently gone through menopause and I am on hormone treatment. We have had an active sex life but since my menopause I have found my libido wanting. With the added problem of my husbands’ injury I have suggested we call it quits on our lovemaking as cuddles and hugs are more than enough for me. My husband does not agree and it seems as if he sees it as his duty to make love to me at all costs. Is this normal? What is your view on this?

Your ‘problem’ is not unique and as spinal cord injury is certainly a life changing event persons with spinal cord injury often make big changes to their life style during, or after rehabilitation.

As the rehabilitation period often is longer than six weeks and the person in rehabilitation is confined to lifestyle in an environment other than what he or she was used to, some changes are inevitable like excessive drinking or smoking prior to the injury not being possible in rehabilitation. On discharge the spinal cord injured person will have successfully given up smoking and/or drinking as a bonus to the independence regained during rehabilitation.

The same applies to the loss of sexual function after the spinal cord injury and the rehabilitation environment not allowing normal sexual relations between spouses.

After rehabilitation return to smoking, drinking or sex remains an option and a choice to the person with spinal cord injury. Although the rehabilitation of sexual function is offered as part of the holistic rehabilitation program in the unit where I work, it remains the individuals’ choice whether he or she wants to resume a sexual relationship after discharge.

Living in a social system in South Africa that to a large extent still embraces male patriarchy, male dominance is regarded as important and part of this dominance is perceived to be the male ability to perform sexually as and when required. Gender role expectations often then go beyond what is physically possible due to medical condition, natural ageing and spinal cord injury and this in turn gives rise to performance anxiety which usually then exacerbates the problem.

The female partner can play an important role with this conundrum by reassuring their partner that she is content and happy with the present situation and that she still loves her husband as much as before and that the absence of sexual intercourse can be replaced adequately by cuddling, hugging mutual massage and companionship. There is a whole new world of experience waiting to be explored by you both and here it is important to remember that the human brain and not the genitals is the most important sexual organ in the human body so sharing a naughty thought or two might be all you need to get the ball rolling. Dopamine and Oxytocin are two pleasure and ‘feel good’ hormones in the human body that are activated by the brain after touch and sexually arousal

Research has shown that people with active fantasy lives are more sexually satisfied, more sexually responsive and more adventurous about sex in general.

When you have had an active sex life for many years it is easy to fall into a routine. In the beginning of a relationship we have no shortage of thoughts and sexy feelings that turn us on and create a sense of sexual anticipation, but after a while the mental component can easily fade away as it requires additional effort and this then leaves only the physical stimulation of intercourse which by itself can become pretty boring and routine driven. We have learnt how to pleasure each others’ bodies but we don’t appreciate the journey any more. So perhaps now the time in your relationship to rekindle the route and paths to intimacy in a more holistic manner that can exclude the physical sexual act but still include all the pleasure and satisfaction derived from dopamine and oxytocin hormone release.

You could also remind your husband that what goes on (or not) behind your bedroom door is your business, as long as it keeps your intimate life interesting and rewarding.