The following aspects of sexual functioning are likely to be affected when a complete spinal cord injury has occurred in men:
- Genital sensation or orgasm. For women and men with spinal cord injuries that are complete at any level, there is not likely to be any genital sensation or orgasm. Some people learn to transfer erotic feelings from other parts of their bodies that do have sensation.
- Erotic mental and physical feelings. A complete injury does not rule out erotic sexual feelings. Many people are able to shift their source of eroticism so that the brain receives sexual signals from parts of the body other than the genitals. The brain learns to react sexually to pleasurable touching in other areas of the body, such as the ear lobes and the back of the neck.
- Erection to touch (reflex erections). Men who have injuries that are T10 and above are likely to experience uncontrolled reflex in response to touch on the penis. This occurs because the reflex arc (from the penis to the lower part of the spinal cord and back again) functions independently of the brain. This type of erection is often welcomed by men with spinal cord injury since it means they can get an erection for sexual activity. Sometimes men with SCI are unhappy with reflex erections because it may happen when they do not want it to – during a catheterization or anytime when the penis is touched. For some men with SCI, the reflex erection may not be completely reliable or may not last long enough for some type of sexual activity. In these cases, a form of erection enhancement may be used.
- Mental erection. Reflex erection to touch is not possible when an injury occurs in the lower part of the spinal cord (below T10). However, mental stimulation such as a sexual thought or fantasy can lead to some enlargement of the penis. Some seminal fluid may flow. After this emission of seminal fluid, the erection is usually lost. Men who have a complete SCI below T10 generally choose to use some form of erection enhancement.
- Ejaculation. Most men with a spinal cord injury experience some disruption in ejaculation, however, there can be much variation between individuals.