One way of a new beginning is forming relationships with other people. Within that selection of individuals, you may decide you want to begin a romantic relationship. This can be rekindling with a known partner or starting a completely new relationship. How you choose to proceed is with what is comfortable for you. As an individual in a committed relationship, you may be feeling uncertain about how your body will respond and perform or even how to move forward. If you are in a new relationship, you will want to know what will be different and what will be the same.
There are always questions about sexual relationships with neurological trauma or disease. The sexual response occurs in four phases. Men and women may move through the phases at different paces, as individuals have different timing of phase segments. The four phases are excitement, plateau, orgasm, and resolution.
In the first phase, which is excitement or desire, the body begins to have physical changes in the erogenous zones. These are areas where sexual desire and responses will occur. The body responds with increased muscle tension, quickened heart rate, blushing of the skin, breast enlargement and nipple changes, increased blood flow to the genitals and lubrication
of the sexual organs. These changes occur in both men and women but at different degrees.
If you have had a brain injury, parts of your brain may not respond as quickly or as much as before injury. It may take more time and stimulation to create a sexual desire. In others with brain injury, sexual excitement may be increased or occur with even just a slight arousal. For these individuals, you will need to learn to control your urges to an appropriate venue. With spinal cord injury, the responses may not appear below the level of injury. In neurological disease, arousal may be inconsistent.
Adaptions to neurological issues are possible with the use of the incorporation of different senses. You may find that you did not have an issue prior but now need additional stimulations such as more touching in erogenous areas such as ‘tickle spots,’ ears and mouth. More foreplay may be needed through visual stimulation, touch, smells, and word. You can explore these parts of your body and activities with your partner or alone. Remember, sexual actions are mostly psychological.
For individuals that find they are hypersexual or aroused in non-appropriate situations, you can utilize alternative thoughts. If the issue becomes a problem for you, medications are available to assist with control but not the elimination of desire.
The second phase of sexual response is arousal or plateau. These titles may seem contradictory, but they are the same. The intensity of sexual arousal is heightened and maintained (or plateau of waiting for the next step). In this phase, all the conditions of the excitement phase are greatly intensified.
Individuals with brain injury, stroke, spinal cord injury or neurological diseases with tone (spasticity) may have interference with increased muscle spasms. This can lead to difficulty with body positioning for sex. Muscle cramps can develop. You may find the timing is critical with tone. The best time for sex may be after therapy or exercise when your muscles are tired, making tone less apt to interfere. Medication can be used to relax tone but finding a position that works for you is the best option. Use pillows or body supports like liberator wedges to help your muscles find a position that works.
Orgasm or climax is the third phase. This is the shortest phase but also the most intense. Involuntary muscle contractions begin in the genitals but can also occur in the rest of your body. There is a release or euphoria that occurs. Individuals with sensation loss can achieve phantom orgasms above the level of injury through stimulation of the erogenous zones in the body where they do have sensation.
Often, Autonomic Dysreflexia (AD) can occur in any phase of sexual response but especially in the orgasm phase. Ironically, symptoms of AD and orgasm can overlap. If you are just getting used to sexual experiences, you will want to have your blood pressure monitored. In the orgasm phase, blood pressure and heart rate are increased, just as with AD, except these parameters will return to normal quickly. There may also be a body rash, just as with AD. Many individuals dismiss AD symptoms during sex. Therefore, it is important to know your typical blood pressure and to check it during sex. After a while, you will distinguish between AD and orgasm. I know, ‘what a way to kill the mood, Nurse Linda’ but it is important for your health. If AD is an issue, medication to control it can be used. AD will not prevent you from sexual experiences if treated.
The final phase is resolution. In this phase, the body returns to its normal state. There is a relaxed feeling and often fatigue. The length of this time varies by the individual until sex can be performed again.
If the sensation is diminished or absent, sexual satisfaction can still be achieved. There are some different options for men and women.
Erectile dysfunction for men is an issue in neurological injuries and diseases. The source is nerve communication, not the same as elderly men. Men may have reflex erections (above S2-4) or psychogenic erections (below S2-4), or a combination of both, that are unreliable for sexual intercourse. However, there are treatments. Oral medications such as sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are commonly used. Your healthcare professional should be consulted for the best medication choice for you.
If erectile medications are not the answer for you, some men will opt for intra-cavernosal medications such as alprostadil (Caverject). This is injected into either side or both sides of the penis for an erection. Vacuum devices increase blood flow to the penis to obtain an erection is also an option. In the past, some men opted for implantable rods for erection. These can still be obtained, but there are so many other options that these are less used today. Some functional electrical implants can also be used for sexual function in men.
It may come as a surprise that some women prefer a non-erect penis during sex. A technique called ‘stuffing’ is inserting a flaccid penis into the vagina. It is easier for the woman to manipulate the penis to the area where the most pleasure is gained.