Sexual Health – The Elephant in the Room

Communication is key when it comes to sexual health with a SCI


Sex and sexuality are often considered a taboo subject to talk about and therefore becomes ‘the elephant in the room’. The Sexual Wellbeing service at the NRH endeavours to overcome this barrier and open the way for discussion.

What is Sexuality: Sexuality is an integral part of us all, it encompasses all the feelings, attitudes and behaviours that contribute to a person’s own sense of being a man or woman. Sexuality is inherently tied to a sense of self in all its dimensions and is highly influenced by what society in general defines as appropriate male or female roles, patterns of functioning and specific behaviours.

Understanding the impact of spinal cord injury on a person’s sexuality is not simply a matter of understanding the sexual physiology or even the medical side of the disability, but we also need to understand the psychosexual impact of the disability on the person.

Spinal cord injury can often alter the way a person experiences and expresses their sexuality; this can range from physical difficulties such as perception, change in sensation, balance, and sexual dysfunction to emotional problems such as depression, altered body image and self-esteem. The nature of the changes often depends on the level and completeness of the injury.

It is inevitable that as a result of such an injury, people begin to doubt their completeness as a man or woman, but sexuality has as much to do with one’s mental attitude as one’s physical state.

SCI can impact both positively and negatively on a relationship, on the positive side often bringing couples closer together with previous irritations and conflicts not seeming to matter as much, and the attitude of ‘we got through this we can got through anything’. On the negative side there is the physical separation and intimacy during rehab which sometimes extends to home, the increased worry about financial wellbeing, the uncertain future and the unclear roles or change of roles.

SCI may require an adaption to the dynamics of the relationship. There may be issues around dependence verses independence. The couple may want to ‘protect’ the other person to the point of creating a barrier for support and communication. When the communication is limited or unclear it’s likely you will create your own reality, where you can conjure up all sorts of issues that are non-existent. Avoiding talking about the ‘hot topics’ to minimise stress can create stress. There can be a fear of hurting the partner leading to limited touch and affection.

Talking about the elephant, sex, remember partners are often affected by the experience and they may have their own issues. Encourage discussion and be prepared to listen, then talk, then discuss, including the fears you may have about sexual rejection or breaking up. Try to avoid arguments. Arguments can often be brought up as a way of avoiding having to talk. Spend time getting used to body changes and touch. Ask for what you need, try and focus on the positive. Remember that time apart is as important as your time together.

Individuals who are not involved in a relationship at this time may feel that they will never meet anyone now. They may need to consider how they met people before their injury. Most likely you met them in various aspects of your life, at work, at college, in the pub or nightclub or through your friends. The only place you didn’t meet them was sitting at home. The same can be said for now. The first thing you need to do is get back out there. Try to get comfortable talking about yourself and your injury. People are naturally curious and will often open conversations. If you don’t make the effort don’t expect others to.

Men and women with SCI have different physical problems with sexual activity and fertility. The Sexual Wellbeing service of the NRH is run by a Clinical Nurse Specialist in Relationships and Sexuality, who is open to discussing all and any of these issues. As a Registered Nurse prescriber she can prescribe treatments for sexual dysfunction and establish fertility programs if necessary. Bur her biggest qualification to the service is being married 27 years to a person with a spinal cord injury and with two children of her own living a bit of the ‘been there, done that’.

Article written by Pauline Sheils from the Sexual Wellbeing service of the NRH. For more information you can phone Pauline on 01-2355288 or email   


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