Can I still have sex if I've injured my spine?

Q. What advice can you give about sex after a spinal cord injury?

A. It will not always be easy. The sudden changes that accompany spinal cord injury can mean that physical and psychological trauma can make people feel overwhelmed and undesirable, and impact self-esteem.

After such an injury, one may not feel sexual or have much interest in sexual activity at first, and in fact even later, some people may not want an active sex life. Some may choose masturbation only, others want to have sex with a partner.

If you have decided to be sexual and to what extent, it is advisable to explore self play in order to understand how your body responds since your injury, what feels different, what feels good, what you want to improve and how to best communicate to a partner about how to give you pleasure.

The desire to have sex is often further strained because your partner often takes the role of nurse as well as lover. But attending therapy sessions as well as doctor's check-ups together may help to make you feel that you are in this together and the opportunity to discuss medical options that will be satisfying and mutually agreeable. Depending on the extent of the spinal cord injury, your mobility and sexual desires, the options may vary.

There are many considerations related to your sexual health including but not limited to future fertility/conception options, ability to carry a pregnancy to term, sexual pleasure options such as vibratory stimulation, injections for erections, performance enhancers, continuing medical treatments, mobility and ability to have sex in different positions.

Medical advances and technology, research and rehabilitation programmes have improved, with the aim to ensure that people with spinal cord injuries are best able to have fulfilling sexual and reproductive health.

Coming to terms with the injury is necessary, and you may require the assistance of a therapist working together with your primary doctors to assist you make the adjustment and to take the lead to a healthy transition.

• Dr Tlaleng Mofokeng (MBChB), sexual and reproductive health practice, DISA Clinic, 011-886-2286, visit safersex.co.za.

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