I am 32 years old and a regular reader of this magazine. I was shot through my neck, during a robbery five years ago.  I have a C6 injury and use an electric wheelchair. I was told that I would never be able to have sex again. I have an indwelling catheter and recently visited a clinic for treatment of a bladder infection. During my visit, I met another patient at the clinic, who has the same injury as me, who told me that he has sex with his wife without any problem. Is this possible, because I have been in a relationship for a year now, but we never have sex because of the catheter?

Unfortunately, it has become common practice to discharge patients with high spinal cord injuries, with indwelling or ‘in situ’ catheters. The reason for this, is the reduced hand and grip function, associated with an injury at C6, which prevents the patient from performing self-catheterization.

During the in-patient and rehabilitation stage of recovery, an indwelling catheter provides a relatively low maintenance and is an easy way to forward staff and rehabilitation therapists, to control the bladder.

The very purpose of rehabilitation is to promote as much independence of mobility and function, as possible, within the limits brought on by the injury. However, the resumption of sexual function, post-discharge, receives little or no consideration, as sexual rehabilitation is often still viewed as a non-essential.

The ability to perform sexually - in line with gender role expectations - is vital for your self-esteem and independence and should therefore, never be ignored.

If you are capable of achieving and maintaining, a voluntary erection, of sufficient strength, it is possible at a push (pun intended!) to have intercourse.

This is achieved, by folding the catheter tube back along the length of the erect penis and to secure it, in position, with a condom. However, be sure to remove the condom after intercourse and to straighten the catheter tube again, as the kink in the tube can restrict the free flow of urine to the drainage bag, with bad results.

A far better solution to your predicament, involves replacing your indwelling catheter with a suprapubic catheter.

A word of caution: NEVER remove an indwelling catheter yourself, as this can result in serious injury and/or inflammation.

A suprapubic catheter is an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone (suprapubic) and will be inserted by an urologist or surgeon, during a minor, outpatient surgery, possibly under local anesthetic. The process is fully reversible. The insertion site (opening on the abdomen) and the tube, must be cleansed daily with soap and water, and covered with dry gauze.

The catheter needs to be changed by qualified medical personnel and can be fitted with a drainage valve, or a standard drainage bag.

The major advantage of the suprapubic catheter is that it leaves your penis free from obstructions (free willy) and allows you to perform sexually again.

Because the suprapubic catheter follows a much shorter route to your bladder, the risk of urinary tract infection is greatly reduced. If the catheter should become blocked, urine will be able to drain, via the urethra, and will therefore act as a ‘safety net’, if you are prone to autonomic dysreflexia.

Once you have your new catheter, you and your partner can establish whether you are capable of achieving a voluntary erection and the extent to which you are able to maintain an erection, during intercourse.

As a result of the prolonged interruption of intercourse, you will most likely experience a reduced rate of sperm production and fertility. Ejaculatory function will also be reduced, as a result of your injury, but this can be addressed by electro-vibratory stimulation.