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SEXUALITY, SEX DRIVE, AND SEX ACTS FOR PEOPLE WITH SPINAL CORD INJURY
Spinal cord injury often affects one or more physiological aspects of sexual function, by interrupting nerve pathways necessary for penile erection and ejaculation, vaginal lubrication, genital sensation, orgasm, and muscle control. The psychological effects of spinal cord injury on body image, self-esteem, and social relationships can change one's experience of sexuality, perhaps compounding or magnifying any physical dysfunction.
Sex after spinal cord injury can be better understood - and improved - by distinguishing between sexuality, sex drive, and sex acts. Roberta Trieschmann provides clear distinctions between these aspects of sexual experience, which we summarize here.
Sexuality refers to a dynamic process that includes aspects of self-concept and identity, social relationships, and specific sexual behaviors. Sexuality is the sum of the expression of romantic, loving, and sexual feelings, including one's gender identity, sexual orientation, physical attractiveness, communication of sexual interest, sex role behavior, and sexual activities. Sexuality includes the sex drive and sex acts, but it is much more than these. Looking at your sex life in terms of sexuality may be helpful in dealing with sexual changes after spinal cord injury and in increasing your ability to maintain a satisfactory sex life with your spouse or partner or to attract and interact with potential new partners.
Sex drive refers to the biologically based urge or need for sexual expression and satisfaction. Sex is a primary drive, just like hunger or thirst. Normally, the sex drive and potential avenues for its expression exist throughout the life span, but they can be impaired by both physical and psychological factors. Spinal cord injury may affect intensity of sex drive but generally does not eliminate it. Sex drive is sometimes referred to as libido, or sexual interest. This can include sexual fantasies, dreams, and interest in erotic books or movies, even in the absence of sex acts.
Sex acts are behaviors involving primarily the erogenous zones and genitals, requiring motor activity and producing sensual/sexual pleasure. Despite the cultural emphasis on the importance or primacy of sexual intercourse, the variety of sex acts is almost infinite. When intercourse is made difficult or unsatisfying, perhaps by erectile dysfunction or positioning problems after spinal cord injury, sexual satisfaction can be enhanced by experimenting with a variety of different sex acts.
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