Intimacy, Relationships, Aging, and Spinal Cord Injury
(and a little bit about sex)
Sex, aging and spinal cord injury. Too old, scared or tired to
think about them? You're probably not alone. And even if you are
still interested, where would you look?
Just as sex didn't end when the chair showed up, and life went on
after you turned forty or fifty, sex needn't stop or be less
important after a certain age. It may be different, but there's
no reason to think it can't be as good.
Keeping In Tune With the Big Picture
Just as we are now beginning to study the long term issues of
spinal cord injury, we are revisiting and rethinking what we view
as normal, appropriate and predictable about aging. Sexuality
issues are not unique to individuals with spinal cord injured and
changes in function can occur during the aging process, just as
they do with disabilities. Knowing what to expect and what the
risk factors are concerning sexuality, relationships and aging
can help us deal with complications when they arise.
Often, sexual problems are more of a symptom than the primary
issue. Depression, stress, anger, rage, low self esteem, life
changes or illness, can all affect sexual desire and physical
function. It helps to be aware of all possible causes, should
problems arise. Changing relationships, for example, can affect
sexuality. As we age, relationships change for many reasons.
• Children grow up, leave for college and take with them the
enormous daily focus of parenting. Couples left behind, face the
challenge of redefining themselves and possibly renegotiating the
meaning and purpose of their relationships. Problems that were
not addressed while children were still at home, may emerge.
• People retire and are suddenly faced with the task of
filling 40 to 50 hours worth of work and commuting time each
week, to say nothing of replacing the interest and purpose work
held. Our work serves greatly to define us as individuals, and
give us opportunities for social interaction and connection. When
we retire, we need to find ways to fill the time and to fill
• Couples move to new communities, or watch their children and
friends move and must establish new connections, new friendships
and find meaning and purpose in new activities.
• Financial or health conditions may change, leaving
individuals and couples the task of adjusting their lifestyles to
accommodate these changes.
Our lives consist of many stages, each with specific tasks,
purposes and opportunities; each with gains and losses. With
children gone, a new environment, different activities,
friendships or acquaintances, our challenge is to respond to the
changes and opportunities, not just mourn or react to them.
The point: life is not static and nothing remains the same. As we
age, we change. Who of us holds the same opinions we did when we
were younger? We're constantly questioning and reevaluating the
purpose and importance of our work, friends, money, family
leisure time, physical appearance, and other aspects of our
lives. Such reevaluation goes on for everyone, non-disabled and
disabled alike. Following injury we made many changes and altered
plans in response to our new circumstances. That adjustment can
serve us as we age. We may need to make more changes and plan for
others - such as the empty nest, retirement, relocation, loss of
friends or family, changes in health or finances to be prepared
for and diminish the impact of these changes on our sexual
relationships and functioning.
It’s Mostly Between The Ears
Much research points to the mind/body connection and the
importance of a positive outlook, healthy connections to others
and meaningful and organized activities as ways of maintaining
health and vitality as we age. If these things work for non-
disabled individuals as they age, surely they will work for
people with disabilities as well. What do we know of aging and
sex in the non-disabled population?
• We know that sex doesn't have to stop at any specific age.
• We know that state of mind is often more important than
physical function or decline. "The difference between sexually
satisfied and unsatisfied older couples is primarily one of
attitude," says Rail Schiavi, director of the Human Sexuality
Program at New York's Mount Sinai Medical Center. "Those who
don't cling to unrealistic notions find that sex provides just as
much pleasure as ever."
• We know that “aging well" refers more to quality than
quantity of life. Research shows that spinal cord injury may
cause us to age faster. Thus, positive mind set and realistic
expectations, important for the non-disabled, are crucial for the
spinal cord injured. "Life is 10 percent what you make it, 90
percent how you take it."
What stops people from having sex as they age are the same three
things which stop them from riding a bicycle —bad health,
thinking it looks silly, and no bicycle. Though sexual activity
usually slows, experts warn against "selling the bicycle." Sexual
response, like muscle strength, declines with disuse, and if you
stop, you may have trouble restarting whatever function you have.
For many, desire is the issue, and sometimes, drugs may be the
culprit. As we get older, we take more medications some of which
may be responsible for changes in sexual function. We must
closely monitor these drugs and their dosages, questioning
whether specific medications may be responsible for changes in
sexual function. Don't be embarrassed to ask your physician and
pharmacist about possible side effects to prescribed drugs.
You say drugs aren't the cause? Helen Singer Kaplan and Richard
Cogan of Cornell Medical Center have what might be good news—at
least on the horizon. They point to low testosterone levels being
responsible for a lost libido in many older women. In tiny doses,
the drug can spark a return of healthy desire to women who have
seemingly lost their interest. Testing with older men is
Age may change more than desire. With men, at about age 30,
erections require more direct penile stimulation for a longer
time and rigidity might not be the same. At menopause, women lose
fertility and may have trouble lubricating. Continued sexual
activity seems to deal with lubrication as well as hormones do.
Various medications, devices and prostheses may help enhance func
tion, induce erections and make intercourse possible.
Psychologist Mickey Ginsburg of Craig Hospital reports that for
former patients intercourse becomes less of an issue with time,
perhaps due to aging or time post-injury. "They're “not
complaining about the quality of their sex lives," he says, "it's
just that intercourse seems less important over time. Oral sex,
touching, and head massages are easier and more pleasurable. Pain
and discomfort relative to certain positions, or mobility in
general, seem to be the biggest changes over time."
Not all changes are negative however. According to Ginsburg,
there's more emphasis on clear and open communication about wants
and needs, and the quality and openness of the communication are
probably better than that of the non-disabled population.
Maintaining Balance is Essential
Care-giving is an important consideration in sexuality and spinal
cord injury. One common problem is the blending and confusion of
roles spouses typically experience when they try to be both lover
and caregiver. Both roles demand different mind-sets and
attitudes which often oppose one another. When an non-disabled
spouse tries to do all the care giving, sexual intimacy is one of
the first areas of the relationship to suffer. Fatigue, lack of
interest, resentment and difficulty switching from nurse to lover
are among the reasons given. Both spinal cord injured individuals
and their nondisabled partners report feeling treated like a
parent or child.
Relationships are at risk whenever equity and equality - about
finances, parenting, maintenance or planning are compromised and
one partner is heavily dependent upon the other. Certainly
relationships involving spinal cord injury fall into this
category. In a perfect world we might hire someone to do all the
care, but for those of us who don't live in that perfect world,
we must constantly monitor our emotions and feelings about care
giving and separate them from our feelings about sexuality.
Balance is essential. When one spouse is carrying most of the
load, or a spouse has no way to reciprocate, the balance is
upset. "It's very dangerous," says Dr. Nancy Crewe of the
University of Michigan. "If you're not going to have a peer
relationship, you're not going to have a sound marriage." A solid
sex life is hard enough to achieve in the best of marriages, let
alone in those that are on shaky ground. Indeed, what happens in
the bedroom usually reflects what's happening outside it.
Staying Active and in Control
As we age, we're more likely to suffer depression. That's the bad
news. The good news is aging gives us a continually broadening
base of experience to draw upon. Mental health professionals
agree that connection to others and
meaningful organized activity are key to avoiding depression, a
prime cause of sexual dysfunction. Having some control over
environment gives people the chance to avoid feeling helpless and
to assert themselves by making the decisions and choices that
will affect their lives.
In cases where minor chemical imbalances bring on depression, the
problem can be treated with medication. Unfortunately, some of
these medications can interfere with sexual function. The good
news is that animated, more spontaneous and happy partners - even
with severely impaired function - are more attractive and
desirable than depressed, withdrawn partners with normal sexual
What of those who are aging and single? Certainly as our
population ages, there are more older single Americans. What
applies to younger individuals or aging non-disabled people
applies to the older individuals dealing with paralysis -
positive self image, realistic assessment of capabilities and a
clear sense of purpose.
Staying as active and engaged as possible is important as we are
unlikely to meet many people in our empty houses or apartments.
Making the decision to stay interested in life, new things and
other people goes a long way toward making us attractive to
others, whether we are young or old, non-disabled or living with
Craig Hospital's Family Service Director Bonnie Sims says that
much of her postdischarge contact comes from single people who
meet someone and want information about function or fertility.
"Usually they want to know what's new on the market, whether
merchandise has changed and whether new options are available?"
In Sims' experience the issue is most often a matter of aging
with an injury rather than merely getting older.
Should you find someone, good news comes from Nancy Crewe. In a
study co-authored with James Krause, she found that relationships
begun following the
onset of paralysis were more successful than those formed prior
to injury, and more successful than those of the non-disabled
population overall. These couples reported high satisfaction with
their sex lives, social lives and living arrangements.
Choice and Change
Sexuality, sexual desire and sexual activity are all part of the
human experience, helping define, in part, who we are. Men and
women don't lose sexual needs as they age. In fact, the longer
you've been practicing, the more you know. Drawing upon a
lifetime of creativity which comes with SCI, you can shift your
repertoire and match a less rigorous lifestyle to a more relaxed
style of making love. You've given up enough to injury already.
You don't need to give up sex simply because you're aging or
Sexual Solutions. M. Castleman. Simon & Schuster, N. Y. 1980
The Joy of Sex. A. Comfort. Pocket Books, N. Y. 1972
Marital Relations and Spinal Cord Injury. N. Crewe, J. Krause.
Archives of Physical and Medical Rehabilitation 1988
The Fountain of Age. Friedan, B. Simon & Schuster N. Y. 1993
Sex in America. J.M. Schrof, B. Wagner. U.S. News & World Report
Labors of Love. J. Smith. Spinal Network Extra. 1990
The preceding article is provided by the Rehabilitation Research
and Training Center on Aging with Spinal Cord Injury, a joint
project of Craig Hospital in Englewood, Colorado, and the
Department of Rehabilitation Medicine at the University of
Colorado Health Sciences Center in Denver, Colorado. The Center
is funded by the National Institute on Disability Rehabilitation
and Research. For more information about this project, contact
the Research Department at Craig Hospital, 3425 South Clarkson,
Englewood, Colorado 80110. Telephone: (393) 780-8308.
This article appears in, and is reproduced with permission of
Life, a publication of
The National Spinal Cord Injury Association
545 Concord Avenue, Suite 29
Cambridge, Massachusetts 02138-1122