Talk:Sexuality after spinal cord injury

Peer review
It has been a sincere pleasure helping to peer-review this article. I'm not finished, but it is getting late and I will have to return on another day. I really don't do any type of review without 'helping' and editing so I hope you have found my edits helpful; if not feel free to revert anything you would like.

Your sources are astounding. If only there was this much information on every health and medical topic available-may there is but you certainly were able to locate what you needed. I did have a question about the Mayo Clinic reference:


 * The Mayo Clinic (May 2011). Mayo Clinic's Guide to Living with a Spinal Cord Injury. ReadHowYouWant.com. ISBN 978-1-4587-5865-1.

At first glance, I thought it wasn't that worthwhile and then I realized that it may end up being the best resource in the article for a number of reasons. First, most people are not going access those medical texts that you used for most of your content. Second, it is written in non-technical, accessible language that you don't need a degree to be able to read. So if in the more formal, standardized FA review process you need some support in retaining this particular reference, let me know. I will be there for you if you need me. My reason for even bringing it up is that I have had content and references reverted when I have tried to use information from the Mayo clinic. So I trust this won't be a problem for the editor that does the final FA review. Ping me, Best Regards,
 *  Bfpage &#124;leave a message 02:34, 22 November 2015 (UTC)

Comments and further peer review
- Is "Tertiary sexual dysfunction" a real term used in the sources or is it a label that you have used to describe the other consequences of SCI?
 * Yes, I saw it in at least one source, more IIRC.  delldot   &nabla;.  04:37, 20 December 2015 (UTC)

- Spasticity is mentioned in the article and in all the right places. Do you think it would be appropriate to mention that spasticity can be treated in a couple of ways. Do any of the sources mention treating people with SCI to reduce spasms during sexual activity?
 * It mentions stretching and massage in the "Considerations for sexual activity" section, do you think that's enough? Or should I mention treatments like Baclofen as well?  It would be no trouble to find a source for that.  delldot   &nabla;.  04:37, 20 December 2015 (UTC)

I ran the article through the semi automated peer reviewer. I don't really think you need to do anything according to this report:

Suggestions generated by an automatic JavaScript program, and might not be applicable for the article in question. *Please expand the lead to conform with guidelines at Lead. The article should have an appropriate number of paragraphs as is shown on WP:LEAD, and should adequately summarize the article.[?] *Consider adding more links to the article; per Manual of Style (links) and Build the web, create links to relevant articles.[?] *If there is not a free use image in the top right corner of the article, please try to find and include one.[?] *You may wish to consider adding an appropriate infobox for this article, if one exists relating to the topic of the article. [?] (Note that there might not be an applicable infobox; remember that these suggestions are not generated manually) *This article may need to undergo summary style, where a series of appropriate subpages are used. For example, if the article is United States, then an appropriate subpage would be History of the United States, such that a summary of the subpage exists on the mother article, while the subpage goes into more detail.[?] *Please ensure that the article has gone through a thorough copyediting so that it exemplifies some of Wikipedia's best work. See also User:Tony1/How to satisfy Criterion 1a.[?] You may wish to browse through User:AndyZ/Suggestions for further ideas.
 *  Bfpage &#124;leave a message 03:26, 28 November 2015 (UTC)


 * I've concluded my part in the peer review process. We may want to wait a bit and see if any other editors want to take a look at the article. I like it very much and the information is very valuable to readers. It really is a neglected topic and you have done a great job in pulling all the information together in one place. The Very Best of Regards,
 *  Bfpage &#124;leave a message 04:03, 3 December 2015 (UTC)
 * Oh jeez, I'm so sorry Bfpage, I can't believe I didn't notice this until just now. Thank you for the work you put in both editing and reviewing, I'll make sure to address these asap.   delldot   &nabla;.  04:15, 20 December 2015 (UTC)

Sexuality or Sex after SCI - what is this article really about?
This article is almost exclusively about the physical and physiological effects of SCI on the physical act of sexual intercourse. It barely addresses the psycho-social-spiritual aspects of sexuality - which is about far more than simply the mechanics of coitus after breaking one's spine. The first paragraph of Human sexuality is a fairly decent summary of the range of different things that relate to sexuality. In short, it's a very significant component of a person's identity. Either expand the article to cover the full spectrum of "sexuality" or move the page to Sex after spinal cord injury. -- Roger (Dodger67) (talk) 21:31, 6 December 2015 (UTC)
 * I agree there is a potential problem with the title. The term "sexuality" immediately brings to mind sexual orientation, which is not likely to change after a spinal cord injury - though expression of it could, in ways discussed in this article.  Perhaps it would be better at sexual function after spinal cord injury?  EdChem (talk) 06:20, 19 December 2015 (UTC)
 * Thanks for the input Roger (Dodger67) and EdChem, I'm sorry I failed to notice your comments until just now! I put a lot of thought into the title, and went with "sexuality" for a couple reasons:
 * It's what most sources use (see the references and bibliography), at least when you look at more general reviews.
 * It's more encompassing, so if the title were "sexual function" it would make less sense to include the discussion of relationships, insecurities and psychosocial effects, sexual satisfaction (e.g. as a function of trust and closeness) and the social content in the "Changes in sexual practices" and "Education and counseling" sections.
 * I think the idea to convey is that sexuality (in its broad meaning, i.e. "not just sexual behaviors but also sex drive, relationships, self-image,[3] reproduction, sexual orientation, and gender expression" in the first section) is profoundly affected by the loss of sexual function usually found in SCI. Rather than taking content out I think I like Dodger's idea of expanding content related to other aspects of sexuality than just function.  However, I do think the article should retain a heavy focus on function, since the loss thereof is the reason for the other effects like those on relationships and self-image. I can also clarify or expand upon the definition of sexuality under "Sexuality and quality of life".  Thoughts?  delldot   &nabla;.  04:33, 20 December 2015 (UTC)
 * Yes please expand the scope of the article. Sexuality is a very broad concept, so this article should attempt to cover it broadly. Even issues such as the recent controversy over Kylie Jenner using a wheelchair as a prop in "glamour" photographs is relevant. Please also take a look at Sexuality and disability, because this article should be focussed on SCI, rather than disability in general. Perhaps some content could be moved between these articles. Roger (Dodger67) (talk) 07:44, 20 December 2015 (UTC)
 * Ok, Dodger67, I will work on it. I think the Jenner thing would be more relevant to Sexuality and disability, since it is not specific to SCI. Is there particular content in this article you find not to be SCI-specific? I don't necessarily have a problem with moving it.  I think the focus on the sexual dysfunction that results from SCI is appropriate since that's not common to many other disabilities. I'll ping you when I've added more.  Thanks for the comments!  delldot   &nabla;.  08:13, 20 December 2015 (UTC)


 * @user:delldot I really like what you've done so far! There's one aspect I'm personally quite interested in (I have spina bifida - it's analogous to being born with an SCI), but it has just a passing mention so far; the effect of age at time of injury. An SCI acquired during infancy or early childhood surely has a different effect on developing sexuality than injury during adolescence, early adulthood or later in life. I have no idea if sufficient literature exists to properly describe this topic. Roger (Dodger67) (talk) 07:11, 21 December 2015 (UTC)
 * Thanks Dodger67! I was getting close to pinging you.  Yeah, I think that's a key thing about SCI that merits discussion beyond general sexuality and disability--it happens in the middle of life  (most commonly to people aged 16-30 IIRC) and represents a profound change. But yeah, it happens to kids too and as you say that would look different.  I did see a couple brief mentions of childhood SCI, just the ones I included under education and in the society section.  But I can look for more.  I don't know if pediatrics merits its own section or if I should include it in another section--guess it depends what I find.  delldot   &nabla;.  07:35, 21 December 2015 (UTC)
 * I think alerting relevant WikiProjects (Disability, Sexuality, Medicine) might recruit some useful contributions, sources and opinions. Roger (Dodger67) (talk) 09:19, 21 December 2015 (UTC)
 * I did when I started the peer review, and I will when I submit it to FAC, but I don't want people to get sick of hearing about it! delldot   &nabla;.  03:59, 22 December 2015 (UTC)

What do you think Dodger67? I think I've addressed the pediatric angle as best I could, there just isn't that much published. EdChem, I clarified the definition of sexuality in the lead and the first section, hopefully that clears up confusion about the meaning. Further thoughts? delldot  &nabla;.  08:47, 24 December 2015 (UTC)
 * Hi delldot, I really like it! I've found a few more sources relevant to the pediatric/adolescent situation;
 * http://dx.doi.org/10.1016/S1052-2263(98)00005-1
 * http://dx.doi.org/10.1542/peds.2006-1115
 * http://dx.doi.org/10.1177/030802269806100612
 * http://dx.doi.org/10.1111/j.1440-1754.1992.tb02629.x
 * Roger (Dodger67) (talk) 13:50, 24 December 2015 (UTC)
 * Nice! I made a few additions.  I can't get the earlier ones, and my understanding is that reviews younger than 5 years old are preferred (although maybe an exception would be made for an area with such little research?). Can you get any ones from the 90's Dodger67? I actually happened across a few more while trying to track these down, so I'll read those too.  delldot   &nabla;.  08:09, 25 December 2015 (UTC)
 * I think that section is pretty well fleshed out now, any more thoughts before I take it to FAC? Thanks a ton for all the help and advice so far BTW!  delldot   &nabla;.  03:06, 28 December 2015 (UTC)

Sexuality and orientation
I understand the desirability of the broader focus for the article, which is fine... but I still feel uncomfortable. At this moment, the first two sentences read:
 * Changes usually occur in a person's sexuality after a spinal cord injury, but many people with a spinal cord injury (SCI) are able to have satisfying sex lives. Sexuality refers not just to sexual practices but to a complex array of factors including cultural, social, psychological, and emotional influences that contribute to a person's core identity.

The definition of sexuality begins by associating the term with sexual orientation. Gays and lesbians often encounter prejudice and homophobia predicated on the belief that sexual orientation is some sort of choice and can be changed by effort or force of will. Now, with a sensitivity to such claims, look at these two sentences. SCI can change sexuality and by implication, "change" people from gay to straight or vice versa or other orientations. The additional sentence broadens the interpretation from just orientation, but still allows it. I suggest that a better start would clearly indicate changes in capabilities, societal and cultural expectations (such as that the prejudiced view that the disabled are essentially asexual) but does not leave open the idea that orientation, likely a part of core identity, is open to or likely to change. EdChem (talk) 04:28, 28 December 2015 (UTC)
 * Ah, ok, I see what you're saying. I worded the first sentence that way because of the convention of having the title in bold, but I would rather have "Spinal cord injury has profound implications for sexuality" or something. Maybe I could get away with bolding that whole thing? I don't think I can coherently cram all the info you suggest into the first couple sentences.  Would it fix the problem to merely add orientation to the second sentence, viz "Sexuality refers not just to sexual practices or orientation but to a complex array of factors..."? Thanks for the input, EdChem.   delldot   &nabla;.  08:16, 28 December 2015 (UTC)
 * It's not essential to have the exact title phrase in the lead, it's just a convention, not a rule, so feel free to rephrase it but then also do not bold it. The convention is actually relevant to topics that have a definitive title or proper name rather than articles with descriptive titles. I would use the term "affect" rather than "change". It's not the person's sexuality itself that changes, it's the experience and expression of their sexuality that is affected. Roger (Dodger67) (talk) 08:42, 28 December 2015 (UTC)
 * Oh, ok, removed the bold and went with 'has profound implications for' rather than 'affects', but that would work too. I think this is actually a much better lead sentence now. Does this work for you EdChem? delldot   &nabla;.  21:58, 28 December 2015 (UTC)
 * Soooo, I think I want to go ahead and bring this to FAC. But if either of you have more input we can of course keep improving it, either here or there. Thanks for all the time you've taken so far!  delldot   &nabla;.  22:13, 29 December 2015 (UTC)

As I write, the first two sentences read:


 * Spinal cord injury has profound implications for sexuality, but many people with a spinal cord injury (SCI) are able to have satisfying sex lives. Sexuality refers not just to sexual practices but to a complex array of factors including cultural, social, psychological, and emotional influences that contribute to a person's core identity.

I wonder if a better formulation (and also more positive) might be something like:


 * Many people with a spinal cord injury (SCI) enjoy sex lives which are both satisfying and fulfilling, despite their physical limitations. Such injuries affect not only sexual practices but also a complex array of cultural, social, psychological, and emotional factors which influence each individual's core identity - all of which are facets of the term sexuality in its broadest sense.

I prefer putting the positive experience of their lives ahead of the limitations of their injuries. Removing the word sexuality from the first sense avoids evoking the limited meaning of sexuality = sexual orientation, and providing the definition before the label creates the frame we want before the term itself evokes a different frame. Thoughts? EdChem (talk) 03:15, 30 December 2015 (UTC)
 * I like the idea of being positive, but I think for the very first sentence it's important to introduce the idea that SCI causes sexual dysfunction first, which is, to be real, why there's an article about it in the first place. I think it makes more sense to have "here is the problem this article is about, but many people are satisfied" rather than reversed. I don't mind leaving the mention of sexuality until the second sentence but honestly I don't think there's really much danger of the confusion with orientation, particularly now that the 'changes' concern is addressed.  How about:

"Spinal cord injury (SCI) usually causes sexual dysfunction, but many people with SCI enjoy satisfying sex lives. Sexuality in its broadest sense refers not just to sexual practices but to a complex array of cultural, social, psychological, and emotional factors which influence each individual's core identity."


 * I like the improvements in writing style you've made that cut out wording. What do you say EdChem?  delldot   &nabla;.  03:55, 30 December 2015 (UTC)
 * On being positive, how about:

"Despite spinal cord injury (SCI) causing sexual dysfunction, many people with SCI enjoy satisfying sex lives."


 * There has been an advertising campaign here in Australia focused on the capabilities of people rather than their limitations with the slogan "Don't dis my ability", and I feel that spirit is desirable here - people with SCIs have enjoyable sex lives despite limitations rather than limitations constrain people with SCIs but some manage enjoyable sex lives nevertheless (an exaggeration, I know). EdChem (talk) 10:49, 30 December 2015 (UTC)
 * Definitely looks like we're getting closer! I think the noun + -ing construction is awkward, how about 'While SCI causes'? I'm certainly sympathetic to a disability rights perspective, but I think the only objective of the article should be to be as informative and clear as possible, don't you? I think it's better for clarity to set out the seriousness of the condition and establish the dysfunction first.  I don't think most disabled people would feel 'dissed' by a factual appraisal of the condition, as long as it's not overstated. What do you think?  delldot   &nabla;.  00:35, 31 December 2015 (UTC)
 * I agree that clarity and being informative are important, and believe that we can be compassionate at the same time. To that end, your "While" formulation is better than I had suggested or what was there before, in my opinion.  Good job!  EdChem (talk) 07:02, 31 December 2015 (UTC)
 * Consensus is beautiful. Sweet, well I'm gonna take this to FAC, further input is of course welcome. Thanks for everything!  delldot   &nabla;.  19:47, 31 December 2015 (UTC)
 * You seem to use the word "many" a lot. In the first sentence you say "...many people with SCI are able to have satisfying sex lives." At another part not too far from this one, you say "Many people with SCI have satisfying sex lives, and many experience sexual arousal and orgasm." I feel as though you should try to find other words or statistics to replace the word.Stacey Umeozulu (talk) 23:20, 3 February 2017 (UTC)

Citation formatting errors
There are a few markup errors. Citation 33 and 95 aren't linked and there are problems with "Ohl, D.A.; Bennett, C.J. (29 June 2013).", "Verhaagen, J.; McDonald III, J.W. (31 December 2012)."Wein, A.J.; Kavoussi, L.R.; Novick, A.C.; Partin, A.W.; Peters, C.A. (28 September 2011)." and "Field-Fote, E. (26 March 2009)." in the bibliography. (The problems could be related). Graham Beards (talk) 21:32, 31 December 2015 (UTC)
 * Ah, thanks for pointing these out. Fixed 33 and 95, took out the unused Verhaagen. Added a ref to Ohl et al back in (must have gotten lost in editing). Are the problems just that they didn't have anything in the refs linking to them, or was there something more?  Thanks again!  delldot   &nabla;.  22:09, 31 December 2015 (UTC)
 * They all look fine now with regard to the mark up. I haven't scrutinised them for formatting consistency or compliance with WP:MEDRS; this will no doubt be checked at FAC. All the best. Graham Beards (talk) 22:24, 31 December 2015 (UTC)

A possible addition?
I think the section Sexuality after spinal cord injury would benefit from a statistic, or some short explanation, about the rate of successful births among women with SCI. Is that rate lower than the general population, and if so, by how much? I'm particularly curious about the rates of stillbirths and miscarriages. I don't know if that data exists. If it does, I think it would fit in quite nicely somewhere in the second paragraph of the section I linked above.

I read this whole article last night and just love it. I love knowing there's a detailed, well-researched article about such an important, but generally under-represented topic. I also sent it along to a friend who is in school to be an OT and likes to work with people with SCI. She's extremely competent, but I don't think she's ever thought much about this topic either, even though she's in the field. Thank you for all your hard work. Fantastic job! Bobnorwal (talk) 13:55, 3 February 2017 (UTC)


 * I can see how fertility and childbirth follows on from sexuality, but I'd be reluctant to make such an addition to a Featured Article. I think there is actually a gap for an entire article about fertility and fecundity after SCI. BTW Fertility is far more affected by SCI in males than females. Roger (Dodger67) (talk) 14:15, 3 February 2017 (UTC)


 * I like what you're saying about the subject maybe having its own article. I had a similar thought. The section I linked to already does talk about childbirth, starting with the sentence beginning "Anesthesia is used for labor and delivery..." so I figured adding a couple more sentences couldn't hurt. However, I'd also be totally on board with having a separate article on the topic. If it's really not an issue, and thus it hasn't been written about much, maybe just a quick mention or section in a related article would be in order. But what article? And do you know of any sources to support such a section? Bobnorwal (talk) 17:23, 3 February 2017 (UTC)

Picture is Unnecessary Social Commentary, Seemingly Random
Honestly, can we get a picture that doesn't have a social message on the shirt of one of the subjects? Jersey John (talk) 16:10, 3 February 2017 (UTC)


 * Woman in wheelchair holding hands.jpg


 * Roger (Dodger67) (talk) 17:38, 3 February 2017 (UTC)

--Agreed; the Black Lives Matter stuff is an unnecessary distraction from the actual subject of the article. Save that for a BLM-related article. 64.134.244.157 (talk) 00:01, 4 February 2017 (UTC)

--Also agreed. Wikipedia articles should be politically neutral. The present picture is, in my opinion, inappropriate promotion of the BLM narrative.


 * 216.152.18.131 (talk) 06:35, 26 January 2021 (UTC)


 * As an ASIA-A paraplegic myself, the image is incredibly insulting on so many levels. First of all, we are not tokens for your political movements.  Secondly, the vast majority of paralytics are men, and SCI more severely degrades the sexual of function of men.  Specifically, the entire industry in this area is focused on achieving and maintaining an erection sufficient for penetrative sex.  This is not represented in the image at all.  That woman has a visible adam's apple (is obviously trans) implying that the only course of action for a male paralytic is to give up on his masculine potency and take the womanly role.  VERY INSULTING. 2600:8801:9A00:7B05:6C70:6CB:DC60:47A (talk) 12:09, 28 April 2022 (UTC)
 * Image changed as I suggested way back in 2017. Roger (Dodger67) (talk) 14:41, 28 April 2022 (UTC)
 * It's still a trans woman coupled with an able-bodied man, ie. a male who has presumable accepted the passive sexual role. This is THE OPPOSITE of the intent of this entire field of medicine and research.  Stop punching paralytics in the dick with your shoehorned intersectionality. 2600:8801:9A00:7B05:6C70:6CB:DC60:47A (talk) 15:55, 28 April 2022 (UTC)

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