If I can’t ejaculate, I don’t need contraception.
Pregnancy isn’t the only reason to use contraception. Your SCI doesn’t protect you against STI’s!
What Is It?
What you learned in high school sex education still applies! When thinking about safe sex, you need to consider all types of sex including oral, manual, vaginal, and anal.
In order to understand how not to become pregnant, understanding the process of how to become pregnant is helpful. Conception consists of:
- Ovulation (an egg being released from the ovary of a woman)
- Fertilization (one sperm successfully enters into an egg, the egg then changes so that no other sperm can get in) and
- Implantation (the fertilized egg starts to make more cells and moves from the fallopian tube and attaches to the uterine lining where it will stay and grow for 40 weeks).
Contraception disrupts the process of letting the sperm and egg meet. Common methods of contraception are: condoms, birth control pills, patches, intrauterine devices (IUDs), rings and injections, spermicides, vasectomy (aka getting snipped) and tubal ligation (aka getting tubes tied).
Similarly, in order to understand how to protect against sexually transmitted infections (STIs), it is important to know the basics on how diseases are spread. Infections are spread through the direct contact of an infected person to a non-infected person through blood or body fluid. Sexual contact (oral, anal, and vaginal sex) is how STIs are spread. Common STIs are: Chlamydia, Gonorrhea, Genital Herpes, Syphilis, Trichomoniasis, Human Papillomavirus (HPV) and Hepatitis B &C.
What’s different now?
- Ejaculation may be affected so the chance of getting someone pregnant is lower, but not impossible.
- For sexually transmitted infection (STIs), the risk is the same with or without a spinal cord injury.
- See our Male Fertility chapter for more information
- Generally, unless there has been pelvic trauma, a woman’s reproductive system is unchanged because of spinal cord injury. Typically right after injury (while the spinal cord is in shock), your period stops for about 6 to 8 months and during this time pregnancy is unlikely. But once your period returns, your chances of becoming pregnant remain the same as before your injury.
- For sexually transmitted infections (STI), the risk is the same with or without a spinal cord injury.
What Can I Do?
Regular STI screenings are recommended every 6 months to 1 year and more frequently if you have different partners. Contraception methods are recommended to prevent infections and unwanted pregnancies.
For men, condoms are the most common method of birth control and the only one for STI prevention. They are most effective when applied properly. A vasectomy is a typically non-reversible method for birth control however, it does not protect against STI.
For women, there are a number of hormonal and non-hormonal methods of birth control available. Most of these options are suitable for women with a spinal cord injury; however, your level of injury and level of sensation are factors to consider. It is recommended to consult with your physiatrist or family physician about what options are most suitable for you. It’s also important to note that these methods can protect you from pregnancy but not STI.
What do I need to know?
How can I use a condom if I have limited hand function?
- Mouths and teeth are commonly used to open packages; CAUTION: if using this method to open a condom wrapper, be careful not to damage or tear the condom.
- When applying a condom you may need to use the heels of your hands to roll it down the shaft. A firm erection is also necessary.
- Have your partner help you.
I'm worried I'll feel even less with a condom on!
- 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.
I have erectile problems so using a condom is difficult.
How can I use a condom if I use an indwelling/foley catheter?
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)
Know where to find information about contraception and STI’s and know who your resources are (i.e. doctors, nurses, rehabilitation staff, the people at SHRS). Remember: There is a fine balance between taking risks, being safe and making choices so that sex can still be fun and pleasurable.
Who can help me?
- Options for Sexual Health: This organization offers sexual and reproductive health care information and education from a sex-positive perspective. No judgement here!
- BC Women’s Hospital Access clinic: Offers breast and cervical cancer screening for women with disabilities. This clinic has adapted beds and knowledge of spinal cord injury to enable safe and accessible support.
- STI SmartSex resource: A great resource about preventing sexually transmitted infections.
Chlamydia is the most commonly reported STI in Canada.
Gonorrhea has increased by 94% over the past 10 years.
Syphilis rates have increased across Canada in the past 15 years. 2010 Public Health Agency of Canada
Sex has many different functions like making babies, making connections and having fun—but it also comes with responsibility. Practicing safe sex and being informed about contraception options is an important part of keeping you healthy and able to enjoy your sexual life.
Check out the Video Playlist for this chapter.