Intimacy and relationships

Forming or maintaining intimate relationships can feel different after a spinal cord injury (SCI). This may be due to physical changes, shifts in sexual expression, self-esteem, body image, or sexual identity. Some people may also experience grief over the loss of their previous sense of self, and may need time and support to rebuild confidence before pursuing or re-engaging in intimate relationships.

Health professionals play an important role in helping people with SCI adjust and navigate these changes. Key areas of support include:

Emotional adjustment  

• Recognise grief as personal: Everyone adjusts differently, and there’s no set timeline or “right” emotional response.
• Support physical needs: Meeting a person’s physical needs with respect and consistency can also help support their emotional wellbeing.

Communication 

• Encourage open dialogue: Help the person explore emotional intimacy, closeness, and sexual connection through conversation.
• Use supportive tools:
  • Apps like Gottman Card Decks can encourage meaningful conversations between partners.
  • Tools like body-mapping can help individuals and their partners identify areas of sexual sensation and explore what feels good and why.

Respecting personal experience 

• Consider cultural values: A person’s background, beliefs, and attitudes can shape how they view intimacy and sexuality.
• Avoid assumptions based on age: Intimacy and sexuality are relevant at all stages of life.
• Promote autonomy and dignity: Always ask for consent during personal care and provide privacy whenever possible.

Supporting personal growth

• Acknowledge the impact of relationships: Healthy intimate and romantic relationships can enhance self-esteem, wellbeing, and life satisfaction.
• Build confidence: Encourage goal setting, celebrate progress (no matter how small), and support the person in focusing on their own journey—not comparisons with others.

Promoting safe and supportive intimate relationships 

• Provide timely, inclusive education: Early conversations about sexual health, pleasure, and function help reduce stigma and build confidence. Choosing not to engage in sexual activity is valid, but it is important to address how this may affect relationships, physical closeness, or emotional connection.
• Address safety concerns: People with SCI may be more vulnerable to abuse. Talk openly about boundaries and healthy relationships.
• Involve partners: Where appropriate, include partners in discussions, planning, and education.
• Connect to services: Let people know about community supports like psychologists, sex therapists, relationship counsellors, or specialist sex services for people with disabilities.

Social connections 

• Support community participation: Social engagement, through outings, friendships, or groups, can improve mental health, promote physical wellbeing, and contribute meaningfully to overall quality of life.