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| Sexuality in Spinal Cord Injury | |
| Spinal Cord Injury (SCI) in one of the worst forms of affliction known to
mankind. SCI most often involves young people, between the ages of 15 and 50
years, partly because of their mobility and fast travel. Compared to the
early 20th Century, when the average life expectancy was 18 months, today a
person with SCI can hope for a normal life expectancy. Thus, the focus has
now shifted to the “Quality of Life” and in this context sexuality becomes a
major concern. Till recently the topic of sexual health was considered a private matter and rarely discussed even by the professionals. This was partly due to lack of knowledge and expertise among the specialists and partly due to the hesitancy and discomfort felt by the professionals when attempting to discuss such issues with the patient. In the first few months after SCI, it’s quite natural for a person not to have any sexual feelings owing to overwhelming physical changes. The process of “Coming to terms” takes and requires a great deal of will-power, understanding, faith, love and support of all the concerned persons to help the patient to start seeing the light again. It is more of a psychological than a physical process. Sexual concerns, dormant until now, resurface again as soon as one is adapted to the new way of life. Here self-image and self-concept derive strength from sexual-self. Understanding the changed sexuality and the ability to get the best out of the situation determines how one shall adapt to the new Image. While recovering, it is natural for a person to feel depressed, angry, dejected and inadequate. It is at this stage that one has to act by providing information and knowledge about sexuality on one hand and by sharing and alleviating his worries and concerns on the other. Talking to peer-counselors and fellow patients makes one hopeful. Talking and sharing with the spouse restores intimacy and faith. It is well known now that couples together can achieve much better results by greater understanding of the changed needs. So, as soon as a person is stable, initial concerns regarding sexuality are stirred. However, the approach needs to be highly individualized based on the patient’s educational socio-economic and culture background. We allow each person to move at his own pace, for sexuality is a highly sensitive and personal matter. We allow ourselves to be there, to fulfill their needs, without imposing our views on them Provision for information and published literature, the latest advances in sexual health of SCI persons, and information as to what all can be done is made available, to start with. As most of the people with SCI are young, we do not encounter other causes of erectile dysfunction in the majority of patients. So, evaluation is quite limited. A trial with oral sildenafil acetate, if successful, is a good starting point. Intera-cavernosal self-injection treatment and vacuum erection device (VED) are now commonly used methods. Local acting Alrostadial gel is helpful in certain cases. Only when simpler methods fail or are not acceptable or, rarely, is some other cause of dysfunction is suspected, is a penile implant considered. By and far, most patients with SCI respond to simple methods that are acceptable and cost effective. Today approach to sexuality in SCI persons is holistic. It is based upon improving one’s self-concept and self-image, sexual-self, sensuality, and the ability to interact and related to the opposite sex. It is not just about merely achieving an erection and an orgasm. Today most people with SCI can hope to achieve sexual satisfaction and look forward to a healthier life. Dr. Dinesh Suman Urologist, ISIC |
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