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Low Sexual Desire after Spinal Cord Injury

by Stanley Ducharme, Ph.D.

It has only been in the last two decades that sex researchers have began to understand and study the phenomena of low sex drive. In fact, low sexual desire, otherwise known as hypoactive sexual desire, was not even classified as a sexual problem until the 1980s. Before that, most people thought it was normal if a person was not interested in sex.

Back in the 1960s and 1970s, Master’s and Johnson, the founders of sex therapy, never included problems of sexual desire in their initial studies of human sexuality. The early work of those pioneers focused exclusively on the function or dysfunction of the genitalia. Their lack of attention on desire related difficulties, left large numbers of people who had no interest in sex out in the cold.

Once the sexual revolution of that era began, people with low sexual drive didn’t stay quiet for long however. By the 1980s, approximately one third of the individuals or couples who sought help at sex therapy clinics presented with problems related to low sexual desire. People with these problems began to feel that something was just not right. They started seeking an answer as to why they weren’t interested in sex.

My own experience as a sex therapist has been similar. There has been an increase in people reporting an absence of sexual drive or desire. Many of the individuals seen in the sex therapy clinic in my own institution complain of having no interest in sex. Many times, they come to the clinic because they have concerns about their relationship or because of pressure from their partner. At other times however, they realize that they are missing something that has been important in their lives. They are not satisfied in just ignoring the problem.

There is no doubt that sexual desire disorders due to medical conditions, disability and drugs are on the rise. This increased prevalence is due, at least in part, to increased life expectancy of Americans over the last two decades. Some researchers would estimate that life expectancy in this country has increased by over 30% since the 1980s. The result is that more elderly people feel entitled to a good sex life and are looking for sexual health care.

In many ways, the same can be said of people with a physical disability such as spinal cord injury, (SCI).  As in the general population, life expectancy with a spinal cord injury has steadily increased and the focus has gradually shifted to long term quality of life issues such as relationships, work and leisure time. As they should, people with a spinal cord injury also feel that having a positive sexual life is important and seek health care services aimed at improving their sexual functioning and satisfaction.

For a significant number of people with SCI however, sexual interest and desire remains low for prolonged periods of time. In the past, people were not overly concerned about this lack of interest. Most often, it was considered to be a result of depression or seen as natural if the individual has an injury. People with SCI seldom mentioned it to their doctors and even if they did, the doctors tended to show little empathy with few solutions or available remedies. In general, feeling good about one’s sexuality and being sexual was not considered a priority for a person with a spinal injury.

Today the situation has changed. Low sex drive is a problem for many people with SCI. It’s not something that people are willing to accept so easily. They want a better sex life and want to have a satisfying and fulfilling relationship with another person. They miss the sexual life and sexual pleasure that they previously enjoyed and want to have it back!

There are many reasons, both physical and psychological, why interest in sex may be reduced after a SCI. On a physical level, studies have shown that testosterone levels after injury are reduced in up to 70-80% of men with SCI. Testosterone levels are also frequently lowered for women after SCI, but much less is known as to how this affects their overall well being and sexual appetite.

CoupleFor men with SCI who have reduced testosterone levels, a lowered sexual drive is only one symptom. They also may experience fatigue, diminished muscle mass, dry skin, loss of energy, moodiness and reduced bone density. Today, testosterone replacement therapy is frequently considered after SCI and provides multiple benefits including an increase in libido and a positive sense of well being. Hormone replacement therapy is often provided by endocrinologists and monitored by regularly scheduled blood tests.

For people with SCI who lack an interest in sex, this may be the first place to turn. Primary care doctors, rehabilitation doctors, urologists and endocrinologists can all order the necessary blood work to determine if testosterone levels are adequate or if androgen replacement therapy might be a consideration. Since testosterone plays such an important role in overall health, this is something that should be discussed with your doctor.

Another area to explore for an individual with a low sex drive is if medications may be a contributing factor. For example, most anti-depressants have a profound impact on sexual interest as well as sexual functioning for both men and women. Other medications that can affect sexual drive may be medications for spasms, blood pressure, heart problems, brain injury and other neurological difficulties.

In addition medications such as Propecia, steroids and birth control pills as well as withdrawal from drugs such as cocaine can significantly impact a person’s sexual drive and functioning. Unfortunately, some of these sexual side effects can last for months or years after the medication has been discontinued.

As for psychological issues, emotional factors can also contribute to having no sexual interest. These issues may include depression, fears of failing, fears of rejection and concerns as to how another person will react to your body after the injury. Many guys are fearful that they will not be able to satisfy a woman after injury and feel that they would prefer to avoid sex rather than feel embarrassed by problems in the bedroom.

All of these issues are common after an injury. It takes courage and confidence to face these fears and to do something that will reduce them.  Most of these fears are unrealistic and the result of negative and distorted thinking. Changing your thinking is always the first step in changing how you feel. Sharing them with another person is also a good way to get a reality check and is helpful in replacing negative thinking with more positive thoughts.

In conclusion, having no interest in sex is not necessarily normal and not something that you have to accept. It may be a symptom of a hormone deficiency, a medication side effect or a psychological issue. Either way, if having a stronger sexual drive seems more like the person you want to be, it may be worth checking out what the problem is. It may be some work to get to the bottom of the problem or in finding the right doctor but the results may be well worth the effort.

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