Contraception

• Lots of people say that condoms decrease sensation even more and they don’t want to use them.
• You can look for condoms that are textured on the inside.
• You can look for condoms that are advertised as thinner.

• Try erection enhancement aids (described in our Sexuality 201 chapter) and know your body (learn more in our Male Fertility chapter).
• If engaging in vaginal sex, your partner can wear a female condom.
• Engage in other types of sexual play!

Using a condom is still possible, you just need to take a few extra steps:

• Fold the catheter over the tip of the penis, leaving about an inch of slack to keep the catheter from pulling or kinking.
• Place the condom over the penis and folded over catheter.
• Use paper tape to hold the catheter in place on the lower abdomen (in between the hip and the groin).
• If you are able to tolerate it, you can disconnect from the drainage bag and cap the catheter temporarily. (NOTE: Not recommended for men with small bladder capacity as overfilling of the bladder can cause autonomic dysreflexia).

One hormone – progestin, acts to suppress ovulation and thicken cervical mucus, making it more difficult for sperm to get through and also thins the lining of the uterus making it less hospitable for implantation.

• Because progestin only contraceptives do not contain estrogen, they may be a good option for women who have contraindications to the combined methods of birth control, such as those with a history of stroke, migraines with aura, or those who smoke.
• Progestin only contraceptives are more likely to cause irregular bleeding which may be a drawback for women who find this unpredictability an inconvenience.

Progestin-Only Hormonal Contraception Options

Pill – Take one pill every day at the exact same time. The pill must be taken continuously without any breaks. This is due to the short action of progesterone; after taking a pill, all the hormone is used up by your body within 24 hours. A missed pill by more than 3 hours requires back up contraception and intercourse within the 48 hours after this may result in pregnancy.

• Requires some hand/arm dexterity to handle pills.
• May cause weight gain (approx. 1-2kg per year of use due to appetite stimulation, may be important issue for those needing assistance with transfers).
• May not work well for those who find it difficult to adhere to a regular schedule due to stringent dosing times.

Depo-Provera – An injection given by a healthcare professional into a muscle, every 12-13 weeks.

• Associated with decreased bone mineral density, most rapidly during the first two years of use, this is largely reversible after one year of discontinuation. Women with SCI are already at higher risk for osteoporosis below their level of injury. Calcium and Vitamin D supplementation is highly recommended.
• May cause irregular bleeding initially.
• 55-70% of women will stop getting their period after 12-24 months.
• Must be able to tolerate injections.
• May cause weight gain (approx. 1-2kg per year of use due to appetite stimulation), may be important issue for those needing assistance with transfers.
• Slower return to fertility when compared to other methods, approximately 10 months from last injection.

A small T shaped device inserted into the uterus by a healthcare professional. This is a long acting reversible form of contraception which can stay in place for 3-10 years depending on the device.

• There has been some misinformation based on older studies which reported that IUD’s pose an increased risk for pelvic inflammatory disease (PID).
• It has now been shown through more recent and higher quality studies that the risk for PID among IUD users is actually the same or less when compared to women without an IUD.
• If you are prone to Autonomic Dysreflexia this may be a risk for you during insertion of the IUD and should be discussed with your Doctor.
• Insertion lasts approximately 5 minutes and can be painful in some women with sensitive cervixes- taking ibuprofen before the procedure can help.
• After the initial insertion, some cramping and irregular spotting is expected which should settle out within 3 months.
• A very convenient form of birth control for women in monogamous relationships with no need for condom use.
• If you have decreased pelvic sensation, you may not be able to feel the symptoms of rare complications such as perforation(1/1000 risk), infection, or ectopic pregnancy. Speak with your provider about having an ultrasound approximately 6 weeks after insertion to check for correct placement.
• There is an approximate 5% risk of expulsion – your IUD falling out.

IUD Options

Hormonal IUD (Ex. Mirena, Jaydess) – Prevents pregnancy for 3-5 years depending on device. A small amount of progesterone is slowly and locally released in the uterus. This causes the cervical mucus to thicken, blocking sperm from entering, it also thins the uterus lining making it less hospitable for implantation. The amount of hormone is less than in other forms such as patches, pills, or the shot.

• • 50% of women will experience amenorrhea in 1 year, this may be beneficial for women who find changing pads and tampons burdensome.
  • May also cause irregular and light periods which may be an advantage or disadvantage depending on the woman.
  • Improves symptoms of endometriosis (cramping and painful periods).

Copper IUD (Ex. Flexi T380, Liberte) – Prevents pregnancy for 5-10 years depending on device. Prevents pregnancy by interfering with sperm movement, egg fertilization, and changing the environment within the uterus to make it less likely sperm will survive.

• Periods may be heavier (approximately 50% increase in blood loss), longer, or more uncomfortable, particularly in the first several cycles after insertion.
• May not be a good choice if you have a history of anemia due to risk of heavy periods.
• Can be used as emergency contraception if inserted within 7 days of unprotected sex.

• If partner cannot apply the condom, would require some hand dexterity for woman to apply.

Female Condom – Made from a soft plastic with two flexible rings at each end. The closed end is inserted inside the vagina and the open end partially covers the outer lips/labia.

• Requires some hand/arm dexterity to insert.

Diaphragm – A rubber dome shaped device, initially fitted by a clinician. Placed high in the vagina over the cervix and used in conjunction with a spermicide. It may be left in place for 24 hours.

• This is no longer a common form of birth control, check with your accessible clinic to determine if this service is available.
• Requires hand/arm dexterity to insert, must be fitted by clinician.

Vasectomy – A permanent method of birth control available for Men. The procedure is done in a clinic where the vas deferens from each testicle is sealed so that sperm cannot enter the semen. Often covered by medical insurance.

Tubal Ligation – A permanent surgical method of birth control for women, where the fallopian tubes are cut, blocked or tied so an egg may not pass from the ovaries into the fallopian tubes for fertilization.

• Depending on your overall health status, the procedure may be more risky due to spinal cord injury related factors, ie – Decreased lung function, Autonomic Dysreflexia.

• If you plan to use basal body temperature as a way to track your cycle, this may be unreliable due to a possible difficulty your body may have in regulating temperature. Frequent urinary tract infections may also cause temperature fluctuations.

Withdrawal – When a penis is removed from a vagina before ejaculation occurs. Even if pulled out in time, pregnancy can still happen. 22 out of 100 couples who use this method will become pregnant.

• This method completely relies on your partner and their degree of self-control.

Abstinence – Can mean different things to different people. To prevent pregnancy with this method, no penis to vaginal sexual activity occurs, and no sperm come in contact with a vagina.

Lactational Amenorrhea – A method available to exclusively breastfeeding individuals who have not started menstruating, breastfeeding alters hormones needed to trigger ovulation. 2 out of 100 couples who use this method will become pregnant within the first 6 months based on typical use.

• Less effective in women weighing 165 to 176 pounds (75-80 kg) and not effective in women over 176 pounds.

Ella (Ulipristal Acetate) Pill – Available by prescription, this pill works by disrupting the way progesterone works in your body. It prevents or delays ovulation and may also prevent implantation of an egg by changing the lining of the uterus. Can be taken up to 5 days after an episode of unprotected intercourse, with efficacy declining the longer you wait.

• It is slightly more effective over a longer period of time than the progestin only emergency contraceptive pills and is thought to be equally effective for those who have a higher BMI.

Copper IUD – Inserted within the first 7 days after sexual intercourse, may prevent fertilization or implantation. This is the most effective method of emergency contraception.

• Considerations stated previously for IUD’s also apply here: Periods may be heavier (approximately 50% increase in blood loss), longer, or more uncomfortable, and may not be a good choice if you have a history of anemia due to risk of heavy periods.

Websites

Sex and U – an evidence-based resource on sexual health for Canadians by the Society of Obstetricians and Gynecologists of Canada (SOGC).

Options for Sexual Health – Health clinics located across BC.

Health Link BC 

Society of Obstetricians and Gynaecologists of Canada (SOGC)

Books

Women’s Health Issues in Spinal Cord Medicine: Principles and Practice (2^nd ed.) – Lin, Vernon W. (2010) New York, NY: Demos Medical Publishing.

Menstrual Suppression in Special Circumstances – Yolanda A. Kirkham, Melanie P. Ornstein, Anjali Aggarwal, Sarah McQuillan, (2014). Journal of Obstetrics and Gynaecology Canada, Volume 36. doi: http://dx.doi.org/10.1016/S1701-2163(15)30442-4

Intrauterine contraception: Devices, candidates, and selection. Dean, G.,& Goldberg, A., (2017). Uptodate.

Other Resources

Combined Hormonal Contraceptives (PDF) – Nurses and Nurse Practitioners of BC 

Progestin-Only Hormonal Contraceptives (PDF) – Nurses and Nurse Practitioners of BC 

Canadian Contraception Consensus (PDF) – SOGC Clinical Practice Guidelines