Sexual health and sexuality after SCI
A person with SCI will often still feel sexual urges and desires. Despite the complications of an SCI, maintaining pre-injury levels of sexual activity can greatly enhance post-injury quality of life.
What is sexual health and sexuality?
The World Health Organization defines sexual health as:
“a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
The World Health Organization defines sexuality as:
“…a central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviours, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors.”
How health professionals can help
Sexual and reproductive health, sexuality and intimacy should be considered an important part of a person’s healthcare and rehabilitation – regardless of whether they have an SCI.
Health professionals can support sexual health and sexuality in a person with SCI – as well as their partner/s and/or co-parents – by following a few core principles:
- Acknowledge that each person is unique, with their own identity, life experiences, relationships, needs and preferences.
- Use language that is inclusive, respectful, open and accessible to all individuals.
- Ensure that education and support for the person and their partner/s involves the entire multidisciplinary team and incorporates a biopsychosocial perspective.
- Consider sexual history as an important part of healthcare discussions, including desire, function, fertility and contraception, self-image and partnerships.
- Promote a sex-positive work culture and encourage clinicians to engage in professional development on sexual health, sexuality and SCI.
The Extended-PLISSIT model may be a good starting point for health professionals who are unsure of how to raise sexual health and sexuality in everyday consultations. The acronym PLISSIT stands for permission (P), limited information (LI), specific suggestions (SS) and intensive therapy (IT).
There are also other resources available for health professionals, people with SCI and partner/s which may be useful:
Alexander M, Courtois F, Elliott S, Tepper M. Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom. Topics In Spinal Cord Injury Rehabilitation [serial online]. Winter2017 2017;23(1):57-70. https://doi.org/10.1310%2Fsci2301-57
Bryant, C., Aplin, T., & Setchell, J. (2022). Sexuality Support After Spinal Cord Injury: What is Provided in Australian Practice Settings? Sexuality Support After Spinal Cord Injury. Sex Disabil, 40(3):409-423. doi: 10.1007/s11195-022-09756-w. https://pubmed.ncbi.nlm.nih.gov/35965947/
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. doi: 10.1080/09638288.2021.1937339.https://doi.org/10.1080/09638288.2021.1937339
Parker M, Yau M. Sexuality, Identity and Women with Spinal Cord Injury. Sexuality & Disability [serial online]. March 2012;30(1):15-27.
Stacy Elliott, Shea Hocaloski, Marie Carlson. (2017) A Multidisciplinary Approach to Sexual and Fertility Rehabilitation: The Sexual Rehabilitation Framework. Top Spinal Cord Injury Rehabilitation; 23 (1): 49–56. doi: https://doi.org/10.1310/sci2301-49
World Health Organisation Sexual health (who.int)