Uterine function and menstruation

Fertility

Immediately following a spinal cord injury (SCI), individuals may temporarily stop menstruating (amenorrhoea). This usually lasts between 3 and 12 months. Fertility often returns with the first menstrual cycle.

Having an SCI does not prevent the ability to conceive, carry or deliver a baby. However, physical changes may affect reproductive function and require specialised health care and equipment during pregnancy.

People with fertility challenges generally require the same assessments and treatments as the general population.

Menstruation

It is important for people to talk to a spinal injuries rehabilitation consultant or gynaecologist about managing menstruation and contraception. This helps individuals make informed decisions that suit their lifestyle, choices and support needs.

Key considerations when managing menstruation include:

  • Fluid retention: Hormonal changes can cause fluid retention. This can impact bowel routines and contribute to oedema.
  • Spasticity: Menstrual pain and cramping can increase spasticity.
  • Skin care: Increased moisture related to the use of menstrual products can risk skin breakdown.
  • Bladder management: Catheter users may need more frequent hygiene practices during menstruation.
  • Product choice: External products (e.g. pads or absorbent reusable underwear) may be easier to manage. Consider hand function and the role of support workers.
  • Cycle tracking: Period and ovulation tracking apps can support planning and symptom management.
  • Contraception options: These can help regulate or reduce menstrual bleeding and pain, offering more predictable and manageable cycles for people with SCI. However, certain options can increase the risk of developing venous thrombo-embolism (VTE) and therefore require a thorough assessment of an individual’s risk factors first.
  • Autonomic dysreflexia: Menstruation can trigger autonomic dysreflexia in people with injuries at or above T6.

Resources

Sexual and reproductive health following spinal cord injury
SCIRE Professional: Spinal Cord Injury Research Evidence

Fertility following spinal cord injury
New South Wales Government Agency for Clinical Innovation (NSW ACI)

Sexuality and reproductive health in adults with spinal cord injury: what you should know
Consortium for Spinal Cord Medicine

SCI sexual health
Spinal Cord Injury British Colombia (SCI BC)

Sexuality after spinal cord injury
Mount Sinai Hospital

Sexuality and sexual functioning after SCI
Model Systems Knowledge Translation Centre (MSKTC)

Sexuality and fertility following spinal cord injury
Spinal Cord Injuries Australia (SCIA)

References

Agency for Clinical Innovation. (2017). Fertility following spinal cord injury. NSW Government. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0006/600855/ACI-Fertility-following-spinal-injury.pdf

Agency for Clinical Innovation. (2014). Sexuality following spinal cord injury: A guideline for health professionals. NSW Government. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0004/349051/ACI-Spinal-sexuality-guideline.pdf

Alexander, M., Courtois, F., Elliott, S., & Tepper, M. (2017). Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom. Topics in spinal cord injury rehabilitation, 23(1), 57-70. https://doi.org/10.1310/sci2301-57

Australian Government Department of Health and Aged Care. (n.d.). About sexual health. Retrieved May 24, 2025, from https://www.health.gov.au/topics/sexual-health/about

Bryant, C., Aplin, T., & Setchell, J. (2022). Sexuality Support After Spinal Cord Injury: What is Provided in Australian Practice Settings? Sexuality and Disability, 40(3), 409-423. https://doi.org/10.1007/s11195-022-09756-w

Bryant, C., Gustafsson, L., Aplin, T., & Setchell, J. (2021). Supporting sexuality after spinal cord injury: A scoping review of non-medical approaches. Disabil Rehabil, 44(19):5669-5682. https://doi.org/10.1080/09638288.2021.1937339 

Earle, S., O’Dell, L., Davies, A., & Williams, R. (2020). Views and experiences of sex, sexuality and relationships following spinal cord injury: A systematic review and narrative synthesis of the qualitative literature. Sexuality and Disability, 38(4), 567–595. https://doi.org/10.1007/s11195-020-09653-0

Elliott, S., Hocaloski, S., & Carlson, M. (2017). A Multidisciplinary Approach to Sexual and Fertility Rehabilitation: The Sexual Rehabilitation Framework. Topics in spinal cord injury rehabilitation, 23(1), 49-56. https://doi.org/10.1310/sci2301-49

Elliott, S., & Querée, M. (2018). Sexual and reproductive health following spinal cord injury. In J. J. Eng, R. W. Teasell, W. C. Miller, D. L. Wolfe, A. F. Townson, J. T. C. Hsieh, S. J. Connolly, V. K. Noonan, E. Loh, S. Sproule, A. McIntyre, & M. Querée (Eds.), Spinal cord injury rehabilitation evidence (Version 6.0, pp. 1–133). SCIRE Project. https://scireproject.com/wp-content/uploads/2022/04/SCIRE-Sexual-Health-Version-6-chapter_Nov.23.18-v.FINAL-2.pdf

Lynch, C., & Fortune, T. (2019). Applying an Occupational Lens to Thinking About and Addressing Sexuality. Sexuality and Disability, 37(2), 145-159. https://doi.org/10.1007/s11195-019-09566-7

Henke, A. M., Billington, Z. J., & Gater, D. R., Jr (2022). Autonomic Dysfunction and Management after Spinal Cord Injury: A Narrative Review. Journal of personalized medicine, 12(7), 1110. https://doi.org/10.3390/jpm12071110

Paralyzed Veterans of America. (2012). Sexuality and reproductive health in adults with spinal cord injury: A clinical practice guideline for health care professionals. https://pva.org/wp-content/uploads/2021/09/sexuality-consumer-cpg-2012.pdf

Parker, M. G., & Yau, M. K. (2012). Sexuality, Identity and Women with Spinal Cord Injury. Sexuality and Disability, 30(1), 15-27. https://doi.org/10.1007/s11195-011-9222-8

Taylor, B., Davis, S. The Extended PLISSIT Model for Addressing the Sexual Wellbeing of Individuals with an Acquired Disability or Chronic Illness. Sex Disabil 25, 135–139 (2007). https://doi.org/10.1007/s11195-007-9044-x

World Health Organization. (n.d.). Sexual health. Retrieved May 24, 2025, from https://www.who.int/health-topics/sexual-health#tab=tab_2