Paralysis itself doesn't affect a woman's libido or her need to express herself sexually, nor does it affect her ability to conceive a child. Generally speaking, sexuality in the paralyzed female is less affected than in the male; it is physically easier for the woman to adapt her sexual role, even though it may be more passive than that of a non-disabled woman. The main difference in sexual functioning between women with disabilities and those without can be accounted for by the difficulties women with disabilities have in finding a romantic partner. Their level of sexual desire may be the same, but the level of activity is generally less because fewer women with disabilities have partners.
There are no physiological changes after paralysis that prevent women from engaging in sexual activity. Positioning can be an issue but can usually be accommodated. Autonomic dysreflexia can be anticipated and controlled. Many women experience a loss of vaginal muscle control and many are unable to produce vaginal lubrication. Both problems are likely the result of the interruption in normal nerve signals from the brain to the genital area. There is no remedy for muscle loss. Lubrication, of course, can be augmented.
Typically, lubrication occurs as a psychogenic (mental) and reflex (physical) response to something sexually stimulating or arousing. It has been suggested that lubrication in women is the physiological equivalent of the erection in the male, and is probably innervated in the same way. Women can substitute water-based (never oil-based, such as Vaseline)lubricants such as K-Y Jelly.
Low sex drive is common among women with paralysis; indeed, it is reported among all women. Meanwhile, Viagra was clinically tested by a group of women with spinal cord injuries; almost all reported that the drug stimulated arousal. In some, it enhanced lubrication and sensation during intercourse.
In some conditions of paralysis, such as multiple sclerosis, cognitive problems can undermine sexuality. People with short-term memory or concentration loss may drift off during sexual activities in a way that can be disheartening to the partner. It requires love and patience, with lots of communication, to bring this out in the open and to seek the needed psychological or medical treatment.
Women who are paralyzed often fear bowel and bladder accidents during times of intimacy. There are a number of ways to reduce the chance of accidents. The first is to limit fluid intake if a sexual encounter is planned. Women who use intermittent catheterization should empty the bladder before beginning sexual activity. Women who use a suprapubic or Foley catheter find that taping the catheter tube to the thigh or abdomen keeps it out of the way. The Foley can be left in during sexual intercourse because, unknown to many men and even women, the urethra (urinary opening) is separate from the vagina.
The best way to avoid a bowel accident is to establish a consistent bowel program. Women may also want to avoid eating right before engaging in sexual activity. With good communication, an occasional bladder or bowel accident won't destroy a rewarding sex life.
Orgasm: Sexual success is often measured, wrongly, by whether or not partners achieve orgasm. A woman with paralysis, like men with similar levels of function, can achieve what is described as a normal orgasm if there is some residual pelvic innervation. Dr. Marca Sipski of the University of Alabama/Birmingham School of Medicine thinks paralyzed women retain an orgasm reflex that requires no brain input. The ability to achieve orgasm seems unrelated to the degree of neurological impairment in women with lesions down to T5 level; her research indicates the potential is still there, but women may give up trying to have orgasms because they lack the ability to feel touch in the genital area.
A small body of research suggests that women with SCI can achieve orgasm using a clitoral vacuum suction device (Eros device), FDA approved to treat female orgasmic dysfunction. The device increases blood flow, thus creating clitoral engorgement; this in turn may increase vaginal lubrication and heighten orgasm response.
Some paralyzed men and women, with practice and focused thought, are able to experience a "phantom orgasm," through reassignment of sexual response; this involves mentally intensifying an existing sensation from one portion of their body and reassigning the sensation to the genitals.
Women with paraplegia ortetraplegia who are of childbearing age usually regain their menstrual cycle; nearly 50 percent do not miss a single period following injury. Pregnancy is possible and generally not a health risk. While most paralyzed women can have normal vaginal deliveries, certain complications of pregnancy are possible, including increased urinary tract infections, pressure sores and spasticity. Autonomic dysreflexia (AD) is a serious risk during labor for those with injuries above T6 (see page 125).Also, loss of sensation in the pelvic area can prevent the woman from knowing that labor has begun.
Another potential risk of pregnancy is the development of thromboembolism, in which blood vessels become blocked by clots. With high thoracic or cervical lesions, respiratory function may be impaired with the increased burden of pregnancy or the work of labor, requiring ventilator support.
Women with disabilities often do not receive adequate healthcare services. For example, routine pelvic exams are not done due to lack of awareness of the need, problems getting onto the exam table, or not being able to find a doctor with knowledge about their disability. Providers might wrongly assume that women with disabilities are not having sex,especially if their disability is severe, and therefore may neglect to screen these women for sexually transmitted diseases (STDs) or even perform a full pelvic exam. Unfortunately, some healthcare providers even suggest to women with disabilities that they abstain from sex and not bear children, even if they can conceive children.
Breast health: Women with disabilities must be aware that they are among the one in eight women who will get breast cancer. Screening is essential. Women with limited use of their arms and hands may need to perform exams using alternate positions or with the help of an attendant or family member. In the clinic, getting a wheelchair in the door is the easy part; services or programs provided to patients with disabilities must be equal to those provided for persons without disabilities.
Birth control: since paralysis does not usually affect fertility in the female, contraception is important. There are also some special considerations. Oral contraceptives are linked to inflammation and clots in blood vessels, and the risk of these is greater with SCI. Intrauterine devices cannot always be felt in the paralyzed woman and may cause undetected complications. Use of diaphragms and spermicides can be difficult for those with impaired hand dexterity.
Sexuality does not disappear after paralysis. Explore sexuality with an open heart and an open mind.
Sources: The Center for Research on Women with Disabilities, Spain Rehabilitation Center, Paralyzed Veterans of America