Sexuality and Intimacy After Spinal Cord Injury | Talking About It: Partners, Dating, and Rebuilding Closeness

A four-part blog series for unitedspinal.org by Mitchell Tepper, PhD, MPH

Most of the sex people have after SCI happens between their ears and between two people, not between the sheets. How well we talk is often the biggest predictor of how well things go.

If you’re already in a relationship

Your relationship can survive after injury, and it can even grow stronger. Here’s what helps:

  • Plan the conversation. Don’t bring it up when you’re about to have sex, or when someone is tired, hungry, or rushed. Pick a calm, neutral time, like a drive or a quiet evening at home.
  • Say what you feel, not what they did. Instead of “You don’t think I’m attractive anymore,” try “I’m worried you don’t find me attractive anymore.” The first sounds like an accusation. The second invites a response.
  • Offer ideas as suggestions. “I read about something I’d like to try. Would you be open to it?” goes a lot further than a demand.
  • Give your partner time too. They have fears and questions of their own. Share this series with them.
  • Protect the romance from the caregiving. If your partner helps with bowel and bladder care, transfers, or dressing, it’s easy for the relationship to slide from equal partners to caregiver and patient. Talk openly about where the lines are. Some couples set aside certain times or tasks as “care” and keep others strictly for closeness.
  • Get help if you’re stuck. A sex therapist, counselor, or couples therapist who understands disability can help you get past rough spots.

If you’re looking for a partner

You can find one. A few honest truths:

  • You’ll need to make peace with changes in your body and how you see yourself. That takes time and is worth the effort.
  • Some people won’t see past the wheelchair. That’s their loss. It’s also not the whole story.
  • Rejection is part of dating for everyone. Try not to take it as a verdict on your whole future.
  • Online dating can be useful for meeting people and for getting to know someone before the first in-person meeting.

A simple exercise: explore your body, one hand-sized patch at a time

We can’t restore lost sensation. But we can find out where sensation still lives, and where new pleasure is hiding. This exercise works alone or with a partner, and it’s not just for people with SCI.

  1. Pick one area and one block of time. Say, from the shoulders up. For that time, focus only on that area. No plans to move on to sex.

  2. Work in hand-sized sections. Sensation can change within an inch or two.

  3. Try different touch. Stroking, rubbing, squeezing, light fingertip touch. Kissing, nibbling. Oils, lotions, a feather, silk, a vibrator. Notice whether stroking up feels different from stroking down or sideways.

  4. Use a simple rating system. Call out numbers: 0 for neutral, -1 to -3 for irritating to painful, +1 to +3 for okay, good, great. It keeps things clear and takes the guesswork and pressure off both people.

  5. Cover everywhere. Head, hair, face, ears, neck, chest, nipples, belly, back, buttocks, arms, hands, fingers, legs, feet, and toes. Notice anywhere that surprises you.

  6. Skip the goal. The point is closeness and pleasure, not performance or orgasm.

If you’re in a relationship, this kind of exploration can also help rebuild physical trust. Some couples find that bathing together or washing each other helps, especially when bowel or bladder accidents are a worry.

In the final post, I’ll get practical.

This series is educational and isn’t medical advice. Please talk with your own doctor about your individual situation.

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