Sex After Spinal Cord Injury

Frankie’s hospital rehab team was surprised when he asked a few months into his rehabilitation about how sex would work now that he was quadriplegic. Those kinds of questions usually came later, they told him. (The Tyee is using Frankie’s first name only, on his request.)

But Frankie was only 31 at the time, and sex had been a highly enjoyable part of his life up to that point. His life had obviously changed forever after being paralyzed as a passenger in a car crash, but that didn’t mean that sex was any less important to him.

“They told me that it was different for everyone and that I should ‘self-explore,’” recalls Frankie. “But how can I when I can’t even undo my own pants?”

Sixteen years on, he appreciates the sex workers who have been an essential part of his quest for a restored sex life. He has been a client off and on at Victoria escort agency SweetVIPS for 15 years, one of the only wheelchair-accessible agencies in the region.

But a fixed income doesn’t allow for many sex worker visits. Frankie dreams of a day when sex work services for people like him could be funded as health benefits, no different than massage therapy or acupuncture.

Erection, orgasm and ejaculation are three distinct functions for people with Frankie’s kind of injury, which involved a break at the C5 vertebrae. Someone who is paralyzed may discover that they can get an erection but not ejaculate or can ejaculate without experiencing the pleasurable feelings of orgasm. Frankie says it took him five years after his accident before he was able to ejaculate again.

Having an active sex life is a constant challenge when you’re quadriplegic, says Frankie. But that’s not just because of the disability. It’s because sex is a taboo subject that few people are comfortable talking about at the best of times — and even less so when it involves someone with a disability.

“People with disabilities are presumed to be asexual,” he says. “But if sex is important for an able-bodied person, it’s just as important for us.”

Imagine how it feels to have to ask your care aide for the first time if they’d be willing to help you have sex, adds Frankie. That’s not just an awkward conversation, it’s potentially dangerous if the aide interprets that question as sexual harassment.

“One wrong word could fuck me up for even being able to have a caregiver, and the price of that would be having to live in an institution,” he says.

But getting the care aide’s support is essential for Frankie to be able to have sex. Whether he wants to hire a sex worker or have sex with a lover, they may not have the training or experience to be able to help Frankie with his other physical challenges. Frankie needs help to get dressed for a “date,” and to clean up afterwards.

Frankie mentioned a 2011 study from the Sexuality and Access Project, looking at people with disabilities and their caregivers — should they be able to help with sexual expression?

There is another group in Ontario currently preparing a followup study to determine if contemporary needs are similar. The end goal is to develop some type of training curriculum or certification to help caregivers and clients have those conversations and assist with sexual expression, where applicable.

For people with spinal injuries, sex can even be life-threatening. A sudden rise in blood pressure could trigger a stroke, says Frankie. He ended up in hospital after using erectile drugs that left him erect for more than six hours because of the way the drugs interacted with his spinal injury.

In other words, having sex is a big deal when you’re quadriplegic, and near-impossible without the right help. And it’s all really difficult to talk about.

“Even when you have a significant other in your life, there are lots of big questions to sort out on this one,” says Frankie.

“Do you ever masturbate, for instance? How will that work when you’re quadriplegic? Does that now become your significant other’s job?”

Frankie appreciates the work of Vancouver-based Sensual Solutions, which provides “intimacy coaches” for adults with disabilities.

“We believe that every adult, regardless of physical disability, challenge or injury, has the right to have access to explore and experience intimacy, self-love and full humanness,” the business notes on its website.

Frankie says he would like to have hired their intimacy coaches in the past but points out that disability and low income often go hand in hand. Funding sexual services as a health benefit for people with significant disabilities would address so much of the challenge of accessing sex, says Frankie.

“Here’s the twist to all of this: With the right partner, the right bed, the right support, I’ve actually had some of the best sex of my life since breaking my neck,” he says.

“People with disabilities are touch-starved at the best of times, and then came COVID,” he adds.

“Sex is one of the few affirmations that make life worth living. There are a lot of bad days when you’re quadriplegic; our lifespan was once measured in hours and days, now years. I’m just wanting to squeeze out moments of joy while I’m still here.”

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Pros News is a news group run by sex workers and their supporters. It highlights stories by pros and patrons, and shares health, business and technology knowledge. Pros News promotes local businesses so that they feel supported by this unique industry.