Spinal cord injury (SCI) affects an estimated 500,000 people in the United States, but only 20% of these are female. The relatively smaller number of women with SCI is part of the reason that the effect of SCI on sexuality is less well studied in women than in men. Another possible reason is that, since women with SCI remain fertile and capable of child-bearing, less attention has been given to their potential problems with sex.
Recently, however, there has been an increase in research on sexual function in women with SCI. Charlifue et. al (1) studied 231 women with SCI and found that 50% reported the ability to have orgasms using genital or combined genital and breast stimulation. Some women reported orgasms via stimulation above the level of injury. The authors did not say how many of the women who reported orgasm had complete injuries, but of the total group studied, 72% of those with tetraplegia and 77% of those with paraplegia described their injuries as complete. In a group of 25 women with SCI, Sipski and Alexander (2) found that 44% reported the ability to achieve orgasm, with no correlation between completeness of injury and orgasm. However, the number of subjects in this study was small.

Only a very few laboratory studies of orgasm in women with SCI have been reported. (3,4) Sipski et al. (5) used instruments to study the physiologic responses in 25 women with complete or incomplete SCI during self- or partner-stimulation. Fifty-two percent of the whole group achieved orgasm, and 36% of those with complete SCI were able to achieve orgasm.
It is noteworthy that the average time to achieve orgasm was longer for those with SCI (about 30 minutes) than for a control group of able-bodied women (about 15 minutes). Most of the women with SCI stimulated themselves in the clitoral and vaginal regions, similar to the able-bodied women in this laboratory study. Some used a vibrator. This study is important because it dispels the myth that women with complete SCI are not able to achieve orgasm with genital stimulation.

Women with SCI who have achieved orgasm do not need measuring devices to know when it has happened. Study subjects have reported different sensations, such as intense pleasure and release followed by intense relaxation. Some experience tingling in their legs or increased muscle tone followed by relaxation. Descriptions given by women with SCI are very similar to those given by able-bodied women.

Sexual activity may also produce signs and symptoms of autonomic dysreflexia, a condition that may involve sudden increases in blood pressure, headache, abnormal heart rate, and profuse sweating which can occur with SCI at or above the T6 level. Although blood pressure elevation may occur with sexual activity, dangerously high levels were not found by Sipski et. al (5) in their study.

Because sex is interconnected with psychology and the state of one's mind, "letting go" and enjoying all the pleasurable sensation received from and given to one's partner is more likely to lead to a feeling of orgasm or intense pleasure. Entering into the experience as a "whole body," regardless of any loss of outward sensation, helps to produce "inward" sensation. Hormonal responses and autonomic responses are much more important to sexual activity than are the erves that control our arms or legs.

Although orgasm is a pleasurable sensation, sexual enjoyment does not require achieving an orgasm. Pleasure from sex can come in many shapes and forms, and experimentation and good communication are the keys to a satisfying sex life.

Fertility

Menstruation usually ceases immediately after a SCI, but resumes within 1-12 months. Birth control is therefore necessary if the woman with SCI is sexually active and wishes to avoid pregnancy.

In the past, pregnancy and delivery were considered dangerous for women with SCI. Today, with careful management an excellent outcome for both mother and infant may be anticipated. Medical complications can include increased urinary tract infections, pressure sores, and spastiticy. To minimize the risk of urinary tract infections, women with SCI should avoid the use of indwelling catheters whenever possible.

The most serious potential complication of pregnancy and delivery in women with SCI is autonomic dysreflexia (see above). This condition can occur when sympathetic nerves are triggered by noxious stimuli below the lesion level, and can usually be treated by removal of the noxious stimulus and use of antihypertensive medication. When it is associated with labor and delivery, it is usually treated with regional or general anesthesia. Serious outcomes can result if physicians fail to recognize this condition when it occurs.

Another potential problem is the development of thromboembolic disease, in which blood vessels become blocked by clots. This is a danger due to the hypercoagulable state of the bloodstream during pregnancy and to the immobility produced by SCI, which may be exacerbated during pregnancy by the additional weight. However, few cases of deep vein thrombosis or pulmonary embolism (blockage of a blood vessel in the lung) during pregnancy have been reported. (6)
With high thoracic or cervical lesions, respiratory function may be impaired with the increased burden of pregnancy or the work of labor, requiring ventilatory support. The risk of pre-term delivery may be slightly increased. The mode of delivery is primarily determined by standard obstetrical indications. We reported a rate of cesarean delivery at the University of Washington Medical Center in a group of 11 women with SCI that was nearly identical to that of uninjured women at our medical center (23%), and similar to the national rate for women in general (about 25%). (7)