Every year, approximately 11,000 Americans suffer a spinal cord injury. The majority of them – 82% – involve males between the ages of 16 and 30, and the most common cause of spinal cord injury is motor vehicle crashes.

Spinal cord injuries damage cells within the spinal cord, or may even sever the nerve tracts that relay signals up and down the cord. When injured, the spinal cord usually swells, causing changes in almost every system of the body. While some patients regain all pre-injury functioning, it is not common. While there is no “cure” for spinal cord injuries, there have been advances in their treatment, including new surgical procedures and techniques and experimental drugs that appear to reduce the loss of function.

One area of interest to researchers in recent years is that of sexuality after a spinal cord injury. Irma Fiedler, PhD, Associate Clinical Professor of Physical Medicine and Rehabilitation at the Medical College of Wisconsin, was one of the researchers involved in a recent 5-year study that sought to clarify some of the issues around sexuality after spinal cord injury, and to identify the appropriate timing of sexual health interventions.

The paper, called Sexual Health after Spinal Cord Injury: A Longitudinal Study, appeared in the August, 2002 issue of Archives of Physical Medicine and Rehabilitation (Volume 83, Number 8). The authors of the study were Thomas L. Fisher, PhD; Prakash W. Laud, PhD; Margaret G. Byfield, PhD; Tracie T. Brown, MS, CRC, CDMS and Matthew J. Hayat, MS; and Dr. Fiedler of the Medical College.

More than Just Function
It’s important to remember that sexuality after a spinal cord injury is not just a matter of whether a patient is physically able to engage in sexual acts. Certainly, how much mobility and how a patient moves can have an impact on intimacy with a partner, but there are many other issues that couples have to face.

Sexual health includes not only function, but also the physical and mental sensations of the partners before, during and after sex. The level of interest one or both partners have in sex after the injury might change. Bowel and bladder functioning can affect their sex life, as can fertility, since the patient’s ability to father or to bear a child can be affected. Additionally, there are a host of emotional issues related to the patient’s own feelings of self-esteem and to society’s perception of disabled individuals.

Sexual Activity Decreased after Injury
Although most of the patients in the study assumed that their overall sexuality would not be different after their spinal cord injury, the study showed that sexual activity decreased dramatically from the pre-injury period to the post-injury inpatient rehabilitation period.

Unfortunately, not many people get the psychological and social counseling they need after the initial injury. At the time of injury patients are told that their sex lives could change, Dr. Fiedler says, “but many simply don’t remember being told, either because of psychological blocking, or because of the traumatic events surrounding their injury.”

“Few hospitals have a psychological social worker available at the post-acute stage of the injury; that is, when the patient leaves the hospital,” say the researchers. While sexual activity decreased during the patients’ rehabilitation period, it increased somewhat during the time after their rehabilitation ended, then leveled off. This led the researchers to conclude that the time between the end of their physical rehabilitation and the six-month mark was a significant time for intervention.

The Right Information, the Right Time
Perhaps the most significant information the research revealed is the importance of the timing of the intervention. The study, which involved 40 spinal-cord-injured men and women, analyzed the patients’ responses to questions at 4 intervals from the time of their injury until 18 months after their discharge from rehabilitation. The results suggested a definite need for advice, education and counseling for the patients and their sexual partners, and that the optimum time for the intervention is usually about 6 months after the patients leave rehabilitation.

Patients need to be given the appropriate amount of information at the appropriate time, say the authors of the study. “Some people can’t deal with this type of information earlier than 6 months,” Dr. Fiedler notes. By six months after their discharge, the patients in the study had made the significant changes in sexual activity and sexual interest that they would achieve, and had begun to think about their partners’ and their own sexual satisfaction.

Caretaking, Finances Are Also Issues
The support of the patient’s sexual partner is very important to their sex life. “Spousal support is essential in the event of a spinal cord injury,” the authors note. And it is needed long term. “The research team found that for at least 2 years after the injury, this support is critical to the patient,” Dr. Fiedler noted. She stresses the importance of the two partners working together. “If you have been injured in a motorcycle accident, you might go into denial, and need not only a counselor, but also your partner, for support.”

Unfortunately, life can be difficult for the patient’s spouse. Spouses are often worn out, tired from the caretaking responsibilities, and it becomes a physical and a mental strain. Many people disregard these hardships and it can be emotionally taxing if the patient’s partner doesn’t have a support system of his or her own. If patient and spouse are working together as a team, however, these issues will be much easier to work through.

One major issue that can cause difficulties in a post-injury relationship is the financial burden. The Christopher Reeve Paralysis Foundation lists the average costs of a spinal cord injury as follows:
Initial hospitalization, adaptive equipment and home modification costs following injury average $140,000.
Trauma and rehabilitation costs alone are almost $250,000 for each spinal cord injured person.
Additional lifetime costs incurred by spinal-cord-injured individuals averages $400,000 and, depending on the level of injury, can reach as high as $2.1 million.

Support and teamwork will play a huge role in patient/partner relations as the financial aspects of spinal cord injury continue to build.

Hope for the Future
As teams of physicians and rehabilitation specialists look further into the many aspects of sexuality after a spinal cord injury, it’s encouraging to know researchers continue to offer patients and their spouses hope for a satisfying sex life. Education and counseling, as well as a determination to work as a team, will benefit both partners greatly in the months and years following a spinal cord injury.

This article includes information from the National Spinal Cord Injury Association; the National Institute of Neurological Disorders and Stroke and the Christopher Reeve Paralysis Foundation.

Article Created: 2003-09-16