Sexual Behaviour

Discussion

Both women and men remain interested in sexual activity after SCI, but there is a decrease in the frequency of sexual intercourse; recent larger surveys report approximately 50% of people with SCI engaged in sexual activity with some regularity (Stewart et al. 2004; Taylan et al. 2021).  One longitudinal study found that by 6 months post-discharge, the participants had made cognitive shifts required to consider sexual activity, especially their own and their partner’s sexual satisfaction (Fisher et al. 2002).  Psychosocial factors that supported sexual activity were living independently, having a partner, and higher social integration (Stewart et al. 2024). The preferred type of sexual activity for men and women changes after injury with a marked shift towards non-penetrative sexual activities. Preferred activities for women are kissing, hugging, and touching, instead of penile-vaginal intercourse (Sipski & Alexander 1993) and for men, oral sex, kissing, and hugging (Alexander et al. 1993).

Sexual dysfunction increased for both female (e.g., sexual arousal and orgasm issues) and male (e.g., erectile dysfunction and ejaculation issues) following SCI (p<0.001) (Taylan et al. 2021). For women with SCI, psychological barriers to engaging in sexual activity include feeling unattractive, low self-esteem, low sexual desire, lack of confidence in sexual ability and ability to satisfy a partner, and difficulty meeting a partner (Julia & Othman 2011; Kreuter et al. 2011; Kreuter et al. 2008). Physical barriers for sexual activity for women with SCI include: impaired genital sensation, difficulty with positioning oneself, bowel and bladder problems, and vaginal lubrication (Julia & Othman 2011; Kreuter et al. 2011; Otero-Villaverde et al. 2015). Longer duration of injury and lower level of injury (not extent of injury) were significant positive predictors of women’s participation in sexual intercourse (Jackson & Wadley 1999). In men with SCI, the level and extent of injury have not been found to affect frequency of sexual activity (Alexander 1993). Males reported engaging in masturbation significantly more often than females whereas females indicated being involved in intimate touching more often than males (Mona et al. 2000). Sexual embarrassment was negatively associated with greater cohesion and consensus with their partner (p<0.01) (Taylan et al. 2024). The more connected an individual felt, the more comfortable they were in engaging in sexual activity after injury (Taylan et al. 2024).

Conclusion

There is level 1 evidence (Cramp et al. 2014) that women and men are affected by different areas of their sexual health after SCI.

There is level 1 evidence (Cramp et al. 2014) that the ability to orgasm decreased after injury.

There is level 5 evidence (Stewart et al. 2024) that injury severity and SHC were not significant predictors of the frequency of physical intimacy.

There is level 5 evidence (Taylan et al. 2021) that frequency of sexual intercourse decreased after SCI.