Sex & SCI Part Six: Answers to the Questions I Had When I Was Newly Injured

Welcome back to this series on sex after spinal cord injury (SCI). I am super excited that you have joined me for part six of this series. As I mentioned in the first part of this series, I will now discuss contraceptives.

Contraceptives

There are many different contraceptives on the market, each with its own challenges for those with an SCI. Additionally, the medications that many of us need to take after sustaining an SCI may make hormonal-based contraceptives less successful in protecting against pregnancy.

I will discuss my knowledge of the specific challenges that each contraceptive on the market involves. However, it is crucial that you discuss your birth control options with your healthcare provider.

• Condoms: condoms can be up to 98% effective in preventing pregnancy. They are also the only form of birth control that protects you from sexually transmitted diseases (STDs). Therefore, to protect yourself from STDs, it is crucial that you use condoms regardless of whether you are using other forms of birth control. I refuse to sleep with someone unless they wear a condom. If they are not willing to wear one, then I promise they are not worth your time! The one challenge when using condoms that you need to remember is that if you have limited sensation in your genitals after your SCI, it may be more difficult for you to notice if the condom comes off. Keeping the lights on to some degree can help with this challenge, as you can watch to make sure the condom is in place. Also, suppose you have male genitalia and difficulty putting the condom on due to limited hand dexterity. In that case, your partner should know how to apply the condom correctly or you should know how to guide your partner in applying the condom correctly to your penis.
   
• Dental dams: dental dams are not a contraceptive used to protect against pregnancy. However, they are essential to use when you have oral sex to protect against STDs. They are latex or polyurethane sheets used to create a barrier between the mouth and vagina or anus during oral sex. Like condoms, if you have limited sensation in your genital area after your SCI, you may find it hard to detect if the dental dam comes off. Keeping the lights on will likely help with this issue. That way, you can see whether the dental dam is no longer in place. Additionally, suppose you have minimal hand function and find it challenging to apply the dental dam. In that case, it is essential that your partner understands
  how to apply the dental dam correctly or that you can guide your partner in applying the dental dam correctly to your vagina or anus.
   
• Birth control pills: the pill typically ranges from 91% to 99% effective in preventing pregnancy. The pill is the form of contraceptive that I use to protect me from pregnancy and reduce my menstrual cycle, making it easier to manage. However, it is important to note that the pill is associated with a higher risk of developing blood clots, regardless of whether you are non-disabled or have an SCI. Since your risk of experiencing a blood clot is higher due to having an SCI, especially within the first three months after your injury, you should not take the pill for at least three months after sustaining an SCI. After this time window, the pill may be an option for you, depending on your risk. For example, things like smoking, obesity, and being over the age of 35 increase your risk of blood clots as well. So, if you have an SCI and have other things that increase your risk of blood clots, your doctor may recommend using a different birth control option.
   
• Birth control patch: the patch is typically 92% to 99% effective in protecting you from pregnancy. However, the patch often delivers higher rates of estrogen than the pill. Therefore, research shows that the patch’s risk of causing dangerous blood clots in the legs and lungs is slightly higher than other contraceptives. It is crucial that you consider this research when determining whether the patch is a safe option for you after sustaining an SCI.
   
• NuvaRing: the NuvaRing is a vaginal ring you insert into your vagina yourself or with the help of someone else. You insert it, wear it for three weeks, take it out for one week, then insert a new one and repeat the process. The NuvaRing is 91% to 99.7% effective at preventing pregnancy. It would be best to think about several risks before you decide to use the NuvaRing when you have an SCI. First, this contraceptive also increases the risk of blood clots. So, due to the increased risk of blood clots resulting from your SCI, this is a significant risk to consider. Second, you may be at an increased risk of incorrect placement due to your SCI. If you have limited sensation, you may not feel whether the positioning of the ring is correct. Additionally, if you need someone’s help to insert the ring, they may not know whether they positioned it correctly, especially if you cannot tell them. Incorrect placement may increase the risk of infection, cause irritation, and may result in mild to severe autonomic dysreflexia.
   
• Intrauterine devices (IUDs): IUDs are plastic or copper T-shaped devices implanted into your uterus by a doctor. They stay implanted anywhere from three to ten years, depending on the device. They also need to be removed by a doctor. Some deliver female hormones and others do not. IUDs are typically over 99% effective in preventing pregnancy. Depending on the type of IUD, they may impact your menstrual cycle. IUDs increase your risk of experiencing pelvic inflammatory disease (in other words, an infection of female reproductive organs) more so than the other birth control methods on the market. Additionally, your risk of this disease increases when you are sexually active with multiple partners. An SCI may impact your ability to notice any pain due to a growing infection or if the IUD becomes displaced. As well, you could begin to experience mild to severe autonomic dysreflexia due to infection or displacement of the device. A small tear (perforation) is possible in rare cases, but you may not notice if you have limited sensation, which can be extremely dangerous. Also, you may experience a negative reaction to the hormones if you choose the hormonal IUD. Therefore, it is important to consider these concerns if you are interested in getting an IUD after experiencing an SCI.
   
• Implanted hormonal devices: hormonal implants are small rods that contain the female hormone progesterone and are implanted under the skin in the upper arm, by a doctor. You also need a doctor to take the implant out. They are over 99% effective at preventing pregnancy and last between three and five years. Although the risk of blood clots is lower than the pill and patch, there is still a risk to consider. Estrogen is typically related to more severe blood clots, so the risk of blood clots is lower because this device uses progesterone. However, it is still essential to consider this risk.
   
• Depo-Provera injection: the Depo shot is a hormonal injection given at your doctor’s office every twelve weeks. This form of birth control is 99% effective at preventing pregnancy. There are several concerns regarding this injection that you need to consider if you have an SCI. First, the Depo shot increases your risk of blood clots as much as lower-risk birth control pills. Second, Depo-Provera may cause a loss of bone mineral density that leads to osteoporosis, which is already one of the side effects of SCI. Lastly, the Depo shot may cause large amounts of weight gain, which could impact your ability to transfer or walk with braces successfully. Weight gain is already an issue for those with mobility issues, as losing weight can be made more difficult by mobility impairments. It is essential to consider these concerns when deciding whether the Depo shot is the right choice for you.

Conclusion

My goal with this blog was to answer some of your questions about contraceptives. I hope you have gained helpful information. I welcome you to check out the last blog in this series, where I will give you some final tips!

References

[1] Hess, M.J., & Hough, S. (2012). Impact of spinal cord injury on sexuality: Broad-based clinical practice intervention and practical application. The Journal of Spinal Cord Medicine, 35(4), 212-219. DOI: https://10.1179/2045772312Y.0000000025

Baylor College of Medicine. (2020, October). Research: Contraception. https://www.bcm.edu/research/research-centers/center-for-research-on-women-with-disabilities/a-to-z-directory/reproductive-health/contraception

Centers for Disease Control and Prevention. (2021, June 2). How to use a dental dam as a barrier for oral sex. https://www.cdc.gov/condomeffectiveness/Dental-dam-use.html

Craig Hospital. (2019). Sexual function for women after spinal cord injury. https://craighospital.org/uploads/Educational-PDFs/786.Sexual-Function-for-Women-After-Spinal-Cord-Injury.pdf

Drugs.com. (2020, August 21). NuvaRing side effects. https://www.drugs.com/sfx/nuvaring-side-effects.html

Ducharme, S. Birth control options for women with spinal cord injury. http://www.stanleyducharme.com/resources/birth-control-options-for-women-with-spinal-cord-injury.html

Ducharme, S. Sexual activity: Pressure vs. pleasure. http://www.stanleyducharme.com/resources/sexual-activity-pressure-vs-pleasure.html

Ehdaie, B., Mason, M.D., Peters, C.A., & Corbett, S.T. (2013). Transurethral placement of vaginal contraceptive device in a patient with neurogenic bladder: A case report and review of the literature. Journal of Pediatric Urology, 9(2), E107-E110. DOI: https://doi.org/10.1016/j.jpurol.2012.11.008

Healthwise Staff. (May 29, 2019). Hormonal birth control: Risk of blood clots. HealthLinkBC. https://www.healthlinkbc.ca/health-topics/tw9278

HealthyWA. Your indwelling catheter. Government of Western Australia Department of Health. https://www.healthywa.wa.gov.au/Articles/U_Z/Your-indwelling-urinary-catheter

Kaplan, C. (2010). Special issues in contraception: Caring for women with disabilities. Journal of Midwifery & Women Health, 51(6), 450-456. DOI: https://doi-org.cyber.usask.ca/10.1016/j.jmwh.2006.07.009 Mayo Clinic. (2021, June 15). Contraceptive implant. https://www.mayoclinic.org/tests-procedures/contraceptive-implant/about/pac-20393619

NuvaRing. (2020). You’ve got a lot on your mind: Why think about taking birth control everyday. https://www.nuvaring.com/