Anyone who has ever so much as sprained a thumb can testify to the fact that we take our physical abilities for granted on a daily basis. What most of us don’t, however, realise is that not only do we take the practical convenience of our physical abilities for granted, but we underestimate how much our sense of who we are is based on our physical abilities. My work with men following spinal cord injuries (SCI) has taught me just how much of ‘who I am’ and ‘what I do’ is bound to my physical abilities. For some men, the most traumatic experience following a spinal cord injury may not be the brutality of the accident but the fact that he can no longer ride a bike with his son, stand at the braai with his “mates”, or be able to achieve an erection out of excitement for his partner.

However, when you have just come to terms with the realisation that you are, in fact, lying in a rehabilitation hospital and you can’t remember the last few weeks of your traumatic recovery in ICU - your ability to function sexually might not be the first thing on your mind. But, it’s probably not long before you start to consider the implications of this life-changing event for your sex life. You or your partner may also have been thinking about it for some time before someone has the courage to ask about it. You may not be ready to try it out while lying in a hospital bed. After all, most rehab units are pretty open plan. And, as a patient once told me, “I am slowly learning to use this body…I think I’ll start with the basics before I get to sex”.

At some point you will have many questions. Questions made difficult by the bizarre ‘unspoken rule’ that sex is not meant to be openly discussed. But, the biggest mistake that we can make is to assume that a person with a SCI is no longer interested in sex. Just because the body may no longer function exactly the same, sexually, does not mean that the mind will never be interested in sex again. The reality is that, at the very least, other parts of the body are still capable of experiencing touch and pleasure. The ability to achieve an erection may be possible in many cases and the ability to give someone else pleasure is always possible. All it takes is open conversation, asking questions and the willingness to experiment.

Ultimately, damage to the spinal cord disrupts messages between the genitals and the brain. The nature of this disruption depends on the level and completeness of the injury. It is only over time that you start to discover the extent of this disruption and it requires experimentation to get to know what is still working and how. Unfortunately a complete injury at any level of the spinal cord results in the inability to achieve an erection in response to sexual thoughts and stimulation. However, this does not necessarily mean that physical stimulation will not cause an erection (even if there is no sensation). Even when erections don’t seem to be present or as strong, the use of medication (PDE5 inhibitors) does help many men. One of the most reliable ways to achieve an erection is through the use of a vacuum pump, available locally. 

Fortunately, sex is not just about getting erections. Sex is best enjoyed with two people who can touch each other as much as possible. Compromised sensation and movement may make this a bit tricky, but not impossible. There are also a few important, potentially embarrassing topics that you need to get out of the way like: bowel accidents; catheterisation; and muscle spasms.

Unfortunately, we men have been fooled into thinking that getting and keeping erections is what makes us “real man”. I have worked with hundreds of men with spinal cord injuries: all of them have been much greater men than me. Because, at the end of the day, rehab is not for wimps!

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