Sexual activity

Sexual activity includes a range of physical and emotional activities that individuals may engage in alone or with others to express or experience sexuality. This can involve physical touch, sexual intercourse, use of sexual aids, sexual communication or interaction, emotional or psychological intimacy, and other forms of sexual expression. For many people, sexuality is an important part of identity. Every person’s experience with sexuality and intimacy is unique. After an SCI, sexual experiences may change, but they can still be meaningful, satisfying, and pleasurable. With the right support and information, individuals can continue to experience fulfilling sexual lives.

Health professional role

Health professionals play a vital role in normalising discussions, offering tailored education, and helping navigate any challenges. Information and advice can consider both the facilitators and barriers to sexual activity. These may include:

Physical and practical considerations

Functional abilities

• Assessing the person’s ability to perform tasks related to sexual activity.
• Using assistive technology or adaptive tools to support independence or comfort during sexual activity.

Transfers

Planning how to transfer safely onto different surfaces used for sexual activity, considering:

• Height, distance, and firmness of the surface.
• Techniques or aids to assist with transfers.

Clothing management

Strategies for dressing and undressing, including:

• How to prepare for sexual activity e.g., techniques or aids to assist with undressing, support required, or undressing as part of foreplay.
• Re-dressing afterward.

Positioning

Safe and comfortable positioning options, taking into account:

• Skin risks from pressure, friction, prolonged positioning or use of assistive aids.
• Risk of joint or soft tissue injury, especially where range of motion or sensation is limited.
• Techniques and assistive technology for positioning:
  • This includes teaching the individual, their support worker and/or partner, where appropriate. Assist the individual to understand their options and discuss their individual situation.
  • Features of beds and wheelchairs that may support sexual activity, such as the use of head lift on beds and removable armrests or height adjustability on wheelchairs.
  • Positioning resources such as Positioning handout (SCI BC), Positioning with partners (Mount Sinai Hospital), Sexual positions for women and men (Regain That Feeling) and 5 disability inclusive sex positions to spice up the bedroom (The Mighty) are a starting point for discussion and individualised problem-solving.

Managing secondary health conditions during sexual activity 

Autonomic dysreflexia and pain

• Sexual activity can sometimes trigger pain or autonomic dysreflexia, particularly in people with injuries at or above T6.
• If symptoms occur, the person should stop and seek medical advice.

Spasticity

• Gentle stretching or positioning limbs in a low stretch posture prior to sexual activity, may help manage spasticity.
• It may be possible to adjust medication timing to manage spasticity during sexual activity.

Continence management

Bowel and bladder management strategies can help prevent unplanned leakage and maintain health during sexual activity. Strategies may include:

• Emptying the bowel and/or bladder beforehand
• Using securement devices for indwelling catheters
• Temporarily removing an indwelling urethral catheter if clinically appropriate
• Covering the catheter or leg bag for comfort or discretion
• Cleaning thoroughly after sexual activity to reduce the risk of urinary tract infections.

Skin

People with reduced sensation should be especially cautious about skin care during sexual activity. Consider:

• The effects of friction, shear, and pressure during movement, prolonged positioning or when positioned on firm surfaces.
• Using silk or satin sheets to reduce friction.
• Being mindful when using sexual devices that can cause pressure or vibration such as penile vacuum pumps, penile constriction bands, vibrators, or nipple clamps. These may cause pressure, friction, or restrict circulation, especially in areas with altered sensation both externally and internally.

Support from others

Formal supports

Some people may require help from support workers with:

• Setting up a space for sexual activity
• Assisting with positioning, clothing, or using assistive devices

Support should align with the provider policies, consent procedures, risk assessments, and manual handling practices. Training for support staff may be required and can be determined in collaboration with the multidisciplinary team. 

Informal supports

• Health professionals can also help educate family members or partners (with consent), tailoring the approach based on the person’s preferences and support needs.