Physical changes to expect If the disability is the result of a neurologic lesion such as a spinal cord injury, women might expect to have changes in sensations in the vaginal area, which might cause them to become either less or more sensitive. Vaginal dryness caused by reduced lubrication may also be a problem. Men may have difficulty or an inability to get an erection, and may notice less sensation in the penis. They may also note difficulty with ejaculation. Depending on how much of the spinal column is involved, spasticity might cause cramping of the adductor muscles of the thighs, making them difficult to separate.
Pain syndromes can make response unpredictable, making what once felt stimulating now feel painful.
Bladder or bowel continence can cause embarrassment and anxiety, and an indwelling catheter may lessen sexual interest. In addition, weakness, fatigue, and breathing difficulties can also be barriers to sex as it used to be. Less easy to document are the psychological factors. Stress, depression, and grief are all barriers to decreased interest and often create performance anxiety. The pressures of not being able to work, or of being seen as a burden also take their toll on a couple's sex life.