“I was shot through my neck during a robbery 5 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 because I have an indwelling catheter. I recently attended a clinic for a bladder infection and met a patient with the same injury who has sex with his wife without any problem! I have been with a girlfriend for a year now but we never have sex because of the catheter."

Ithas unfortunately become common practice to discharge patients with high spinal cord injuries, such as yourself, with indwelling or ‘in situ’ catheters. The reason behind this is reduced hand and grip function associated with an injury at C5 preventing the patient from performing self catheterization.During the in-patient and rehabilitation stage of recovery from spinal cord injury, an indwelling catheter provides a relatively low maintenance and user friendly manner of bladder control to wardstaff and rehabilitation therapists.

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

The ability to perform sexually in line with gender role expectations is an important part of self esteem and independence and should therefore not be ignored.If you are capable of gaining a voluntary erection of sufficient strength and duration 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 securing it in position with a condom. Be sure however 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 negative results.A better solution to your predicament however involves replacing your indwelling catheter with a suprapubic catheter.

A word of caution though: NEVER try to remove an indwelling catheter yourself as this can result in serious injury and/or inflammation. The catheter is kept in place in your bladder by a small, liquid filled, balloon which has to be deflated prior to removal by trained medical personnel.

A suprapubic catheter is basically an indwelling catheter that is placed directly into the bladder through the abdomen. The catheter is inserted above the pubic bone (suprapubic). This catheter must be put in place by a urologist or surgeon and involves only minor, outpatient surgery which is possible under local anesthetic. The procedure is fully reversible should normal bladder function return or if the patient wishes to revert back to indwelling catheterization.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 must 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 encumberment (free willy!) and allows you to perform sexually again.

The diagram above indicates the indwelling (urethral) catheter, as you have, on the left and the suprapubic catheter as suggested on the right.As you can no doubt see from the picture the suprapubic catheter leaves your penis free to perform sexual function.

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

Once the catheter placement has been changed to suprapubic you can, with the help of your partner, firstly establish whether you are capable of achieving a voluntary erection and secondly, whether you can maintain the erection for sufficient time to have intercourse.

As a result of the prolonged interruption of intercourse you will most likely experience a much reduced rate of sperm production and fertility caused by a marked reduction of sperm motility which is common to spinal cord injury but still evades medical explanation.Ejaculatory function will also be reduced as a result of your injury but this can be addressed by electro vibratory stimulation.

As you are a regular reader of Rolling Inspiration I recommend that you read the September/October 2009 issue, if you have a problem with erectile dysfunction, where this topic was discussed in detail.I sincerely hope that five years of abstinence due to uninformed advice will soon come to an end with the resumption of your intimate life and regular intercourse, an activity of daily life which so many people take for granted.


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