Most of the recent developments in sexuality and fertility after spinal cord injury focus on male sexual function. Several medical and surgical techniques have been developed for treating erectile dysfunction resulting from spinal cord injury.

On the medical front, medications to treat impotence – especially Viagra, which has received a great deal of attention in the press – may be very effective for some men with spinal cord injury, making genital intercourse possible. Another recent development is the use of a suction pump that can be applied to the penis to help create an erection. Surgical techniques include two types of penile implant, one that keeps the penis in a semi-erect condition and another that uses a miniature internal pump to create a full artificial erection. Unfortunately, the pumps have not been very successful, because they are susceptible to mechanical failure.

Treatment of infertility in men with spinal cord injury has improved greatly. There are various methods of inducing ejaculation in men with spinal cord injury, to obtain sperm for artificial insemination or in vitro fertilization. A testicular biopsy, in which a small piece of testicular tissue is removed, can also be used to collect sperm cells directly from the testes.

Perhaps the most disturbing aspect of sexual dysfunction after spinal cord injury, for both men and women, is the loss of genital sensation. This sensory loss is a direct result of damage to nerve fibers carrying sensory information between the genitals and the brain through the spinal cord. Unfortunately, no way is yet available to repair these nerve fibers. However, research is underway in many laboratories.

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Many people go through a period of emotional shock following a paralyzing spinal cord injury. This may include a period of disbelief (“This can’t be real, this can’t be happening to me”) and distrust in the doctors’ diagnosis or prognosis (“They must be mistaken. This is only temporary. I just need time to heal.”). Professionals often speak of this reaction as denial, and indeed some patients literally deny that they are impaired. In our experience, however, this type of total denial is quite rare. More typically, patients deny the permanence of their injuries and deny the impact the injuries will undoubtedly have on every aspect of their lives. The positive, flip side of this phenomenon is hope. Hope for recovery is normal and emotionally adaptive, even while recognizing the likelihood that some of your limitations will be permanent. And in fact, medical advances may one day lead to partial or total cures for the paralysis of spinal cord injury.

Lark developed incomplete C5-6 quadriplegia after a diving accident. Soon after her hospitalization, some of the staff asked her if she’d like to meet with a former patient who could act as a role model for her. She declined. “You don’t know that I won’t recover,” she said. “Why should 1 make myself miserable now when I don’t know what recovery there will be? I can wait two years and be miserable then!” She rejected a “disabled role model,” feeling that her denial at that point, combined with hope, helped her cope emotionally and motivated her efforts at rehabilitation.

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