Disability and Sexual Complications

Disability or illness can potentially impact any aspect of a person's sexuality. Learn what factors can affect sexual function and how to manage them.

My fiancee is a paraplegic. He has a c-7 spinal cord injury. We both want children, but we aren't sure if he can have children. I wanted to know if there is anyway to find out if he is able to conceive?

Mitch Tepper at Sexualhealth.com: Thanks for your question. There certainly is a way to find out if you fiance is able to father a child. The first step toward exploring his fertility is to retrieve some sperm. If he is unable to ejaculate through manual stimulation, there are two widely used and accepted methods: electrical and penile vibratory stimulation (PVS).

Electrical stimulation, otherwise known as electroejaculation stimulation (EES), is usually performed under anesthesia in a hospital setting or clinic. An electric probe is inserted into the rectum to stimulate the nerves responsible for controlling emission and ejaculation. Vibratory stimulation--applying a vibrator to the penis--is less invasive than electrical stimulation, does not require anesthesia, can be done at home, and often feels good whether you ejaculate or not. In addition, studies at the Miami Project demonstrate better sperm quality in samples obtained by vibratory stimulation. Although many clinics still use only electrical stimulation because it is more dependable, the American Urological Association recommends vibratory stimulation as the first line of treatment for people with SCI.

Once a sample is obtained, sperm quality should be assessed for several factors: sperm count, motility, morphology, viscosity, volume and ability to penetrate mucus. An average sperm count is about 100 million per milliliter. Motility represents the percentage of sperm that are moving, and at least 50 percent "swimmers" is considered normal. Morphology refers to the shape of the sperm. Typically, only 50 percent to 80 percent are normal, but malformations do not necessarily cause malformations in the fetus. Viscosity is the thickness of the semen. Volume, as opposed to sperm count, measures the total amount of ejaculate and may vary from 1 to 5 milliliters, or about a teaspoon.

Then a penetration test is done to determine whether the sperm, once it gets to the ovum, will be able to bore through the cell lining to deliver its genetic message. Men with SCI generally have adequate volume and sperm count. If there¹s a problem, it¹s usually caused by low motility. But even if your sperm¹s motility is too low for home intravaginal insemination, it can still be used in combination with other assisted reproductive technology (ART) to improve chances of conception. ARTs are ways to deliver sperm to the ovum. For more on this subject, please see my article, Making Babies: At-Home Vibrostimulation and Insemination.

I am an incomplete C5-6 quad, 26, male, injured nine years. I have no problem getting or maintaining an erection, with little or no stimulation, but the problem is that during intercourse or masturbation, if I go too fast or rub the head of my penis, my stomach begins to spasm and my penis shrinks. Also, my ejaculations take too long, but when I stimulate the base above the testes, I get quicker results. Is there a toy that stimulates just this area?

Mitch Tepper at Sexualhealth.com: Losing your erection as a result of direct stimulation of the head of the penis is not unusual in men with spinal cord injury. In your case, I wonder if this is the result of retrograde ejaculation--ejaculation that goes backward into the bladder instead of outward through the urethra. If this is the case, you may see a sign of ejaculate in your urine afterwards.

If retrograde ejaculation is not the cause, I can only speculate that there is an overload of stimulation to the nerve endings in the head of the penis, and that the injured spinal cord interferes with processing that information. When the focus is on ejaculation or orgasm, the sexual experience is likely to be goal-oriented. Goal orientation sounds more like work to me than fun. When sex is goal-oriented, the mind starts to wander away from the erotic and toward distracting thoughts, increasing performance anxiety. Focusing on the process and not the outcome will enhance affirming sexual experiences whether by yourself or with a partner.

Yes, there are toys that may enhance your pleasure. Since you are online, you can go to Sexualhealth.com and look through the toys for men. There are sleeves, pumps, tubes and other devices to choose from. See, for example, the Jelly Vibro Tube that has both ends open so you can position the sleeve to provide maximum stimulation exactly where you want it. Slow down, savor the sensations and let sexual energy grow. Try positions that increase the amount of full-body contact. Chances are you and your partner will appreciate it immensely if you take the time to get more physically and emotionally connected.

I am a C6-7 incomplete quad with pretty good sensation and no trouble getting erections. The problem is, I can only ejaculate for about two days in a row, sometimes three. Then I must "save up" for two or three weeks before I can ejaculate again, even though I have good erections during this period. Is this normal? If not, is there anything I can do or take (vitamins?) that would charge me up faster?

Mitch Tepper at Sexualhealth.com: The range of normal human sexuality is very large, with or without spinal cord injury. For those of us with SCI who can ejaculate, frequency is often inconsistent and may vary greatly over time. But from what I understand, frequency of ejaculation in men with SCI has nothing to do with "saving up" seminal fluid. Semen is made of sperm from the testicles and fluid from the seminal vesicles and prostate. The seminal vesicles produce about 70 percent of the seminal fluid, which activates the sperm and supplies sugar--energy--for the long journey to follow. The prostate gland produces a thin, milky, alkaline fluid that accounts for most of the balance of the fluid. Together, the sperm, seminal fluid and prostatic fluid equal only about one teaspoon. The production of semen does not seem to be affected by SCI. The problem seems to lie in the two-stage process of ejaculation--emission and propulsion. Emission is controlled primarily by nerves exiting the spine at T11 and Tl2 and propulsion is primarily controlled by nerves exiting the lower spine at S2 to S4. The combined process of emission and propulsion is a complex neurological reflex causing the seminal vesicles and prostate gland to contract and squeeze their fluids into the urethra (this point is experienced as ejaculatory inevitability) which in turn triggers rhythmic contractions of muscles along the penis. Voila, ejaculation occurs. After ejaculation there is a so-called refractory period during which most men cannot respond to additional sexual stimulation. The length of this period increases with age. For men with SCI, the complex reflex responsible for ejaculation seems to become exhausted and needs much more time to recuperate. I've searched for a more complete answer to this problem, and this is the only explanation I've found. There are no nutritional supplements or special diets that will help you recharge any faster. Fortunately, sexual pleasure and orgasm are not solely dependent on ejaculation.