Intimacy Research

We’re in the midst of a sexual revolution for people with spinal cord injuries and disorders.

By Kelly Rouba

The very thought of Valentine’s Day and the images of intimacy that come along with it might have unnerved most individuals with spinal cord injuries and disorders (SCI/D) more than a decade ago. But, since then, medical researchers have continued to make tremendous strides-enabling greater sexual intimacy and, quite possibly, making the coming holiday the most pleasurable one yet for lovers with disabilities.

“Over the past ten years, things have improved a lot,” said Dr. Graham Creasey, a principal investigator at the Cleveland FES Center in Ohio. “It’s really a much more optimistic picture than it used to be.”

According to Creasey, it was a commonly held belief at that time that individuals with SCI/D could not engage in sex. “[But] it really is possible for many people with spinal cord injuries [and disorders] to have children and to have a family and to have sex,” Creasey assures.

Stimulating Electricity

At the Cleveland FES Center, researchers often experiment with the use of functional electrical stimulation (FES) to produce movement in individuals with SCIs. Experiments and basic studies begin in the laboratory before individuals are tested, Creasey noted.

The center is a consortium of three institutions, the Department of Veteran Affairs, MetroHealth Medical Center, and Case Western Reserve University. It has about 26 principal investigators working onsite along with support staff and student researchers.

“We try and make it clear that when patients come to a place like this that it’s okay to talk about sex,” Creasey said.

Dr. Graham Creasey of the Cleveland FES Center says sexuality issues for males with spinal cord disorders are being addressed with drugs, implants and functional electrical stimulation.

One of the problems faced by some men with SCI/D is the inability to produce an erection, Creasey noted. While men with erectile dysfunction are often encouraged to try masturbation or various acts of foreplay to help correct the problem, Creasey said there are several medical treatments available if those techniques fail to work.

“Probably the newest thing is the functional electrical stimulation device (called VoCare), but it’s not the most widely used because it is a fairly big surgery,” Creasey said.

The device, which is a bladder stimulation system, is implanted surgically and can produce erections in men. “It has wires that connect to nerves at the base of the spine,” Creasey said, adding that a receiver is placed under the skin. A remote with three switches is used to operate the device and can create an erection within several minutes.

Commercialized by British Physiologist Giles Brindley in 1982, the device was introduced in Cleveland in 1992, Creasey said. Although the device is not commonly used in the US, it is more popular in Europe.

“By turning on the transmission, you can turn on an erection. It produces an erection in the majority of people who try it that way,” Creasey said, noting that the device is only FDA approved for controlling the bowel and bladder.

Before resorting to implanting the VoCare, most men turn to vibrators, medications, or even vacuum pumps to help them produce an erection, Creasey said.

“Things like Viagra have made a big difference,” he said, adding that the medication can make an erection last longer.

Drugs, like Papaverine or Prostaglandin, which are injected into the base of the penis have also been proven to help, Creasey said. “Within a minute or two, it produces an erection that can last for several hours and it can actually be longer and stronger than a normal erection.”

Although pumps aren’t always effective at creating a strong erection, they do offer an alternative to drugs and medically implanted devices, he said.

Focus on Females

While it may seem that much of what is now available to enable individuals with SCI/D to engage in better sex is geared towards meeting the needs of men, Creasey said that is because “80 percent of people with spine injuries have been male.” However, researchers, like Dr. Marca Sipski, are now beginning to focus more on meeting the needs of women with SCI/D as well.

Sipski, who is the director of Neuroscience Research and professor of Physical Medicine and Rehabilitation at the University of Alabama School of Medicine, first noticed a lack of educational material on sexual function in women when she was a resident about 20 years ago.

“There was nothing there in the literature, specifically in regards to women and sexual function,” said Sipski, who began conducting her own research in 1992.

Sipski is now in the process of working with women who have either an SCI/D or multiple sclerosis for two different studies funded by grants through the National Institutes of Health. “One study is looking at the impact of medications that affect the sympathetic nervous system,” Sipski said, adding “I’m also studying the effect of two different treatments on orgasm.”

For the study on orgasms, Sipski is using a FertiCare vibrator and an Eros Therapy device. “[The Eros] is a device that is FDA approved to treat orgasmic dysfunction in able-bodied women,” she said.

Although Sipski expects to complete the studies by 2008, she is still looking for more women participants.

Since a lot of research tends to focus on the physical aspects of sexuality, Creasey said it is important to remember that the emotional side also plays an integral part in intimacy. “A very big part of [sexuality] is how people see themselves,” Creasey said, adding, “You’re still the same person after you’ve had a spinal injury.”

Kevin Sullivan, an inpatient acute rehabilitation recreational therapist at the MetroHealth Rehabilitation Institute of Ohio, said that individuals must first ask themselves where they are in terms of sexuality. Sullivan, who suffered a spinal cord injury after an auto accident in 1985, said that being able to communicate with both doctors and sexual partners is also vital to having a healthy sex life. “Being a wheelchair user, you do not accomplish very much unless you are able to communicate what your needs and desires are,” Sullivan said. While Sullivan believes it’s not impossible to have a healthy sex life after injury and illness, he cautioned, “You’ll never get satisfaction from someone else until you’re satisfied with yourself. You’ve got to be confident in your own sexuality and even in your gender identity.”

To participate in the studies being conducting by Dr. Marca Sipski, please call 866-706-5545.

Kelly Rouba is a freelance writer who lives in New Jersey.