Sociology

Sexuality includes both emotional and physical aspects and may or may not involve a partner. For quadriplegics, a loss of sexual function does not mean a corresponding loss of sexuality.  Physically, for males with quadriplegia, their ability to have an erection or ejaculate may be affected. Motility rates of the sperm are considerably lower thus affecting the ability to father children. Emotionally, this impairment may result to a loss of self-esteem and a feeling of self-pity since men equate their masculinity with sexual functioning. On the other hand, it is physically easier for females to adapt or redefine their sexual role even with quadriplegia. They are still able to attract partners. Fertility is not usually affected since they are still able to menstruate. Emotionally, there would be a lack of self-esteem due to the general awareness to the change of their physical image.
There are various therapies for people suffering with quadriplegia. These therapies center on the development of their physical and emotional well-being.

Quadriplegia is an impairment that affects the spinal cord and means a loss of function to both arms and legs, even to the torso. For males, two aspects of his sexual function may be affected with the damage to the spinal cord. These are the ability to have an erection and to ejaculate. However, there are two types of erection that men with quadriplegia can have, psychogenic and reflex. A psychogenic erection takes place when a message is sent from the brain, such as having sexual thoughts, or seeing or hearing something stimulating or arousing. The latter occurs when there is direct physical contact to the penis or other erotic areas such as the ears, nipples or neck. A reflex erection is involuntary, thus it can occur without any sexual or stimulating thoughts. The most important factor affecting men with quadriplegia is to father children. The motility rate of the sperm is considerably lower compared to men without quadriplegia. Since this is often a main concern, artificial insemination with donor sperm is usually discussed to those who are interested in fathering children.

Throughout history, men have associated masculinity with sexual functioning. With the impairment, they may think less of themselves as men since they cannot have sex in the usual way before the impairment. When this realization strikes, self-esteem would suffer. They might feel like running away from a relationship with thoughts that their partner is staying with them only due to self-pity and that the partner would soon leave them for someone normal. This would eventually lead these people to decide to escape from the relationship first before the partner does. It is a mistake to assume this of course, thus time and trust are very important in keeping the relationship. Other males who are not in a relationship at the onset of impairment may find it hard to meet and attract a partner.

They may sometimes think that they will never meet someone and marry. These men may feel ashamed to go out and go to places where they can meet potential partners. They may direct a females lack or no interest due to the disability. This is a wrong assumption since after all, during the lifetime, with or without the impairment a man may be attracted to a woman who is not attracted to him.  Males with quadriplegia need to be encouraged to make the effort to continue to make social and business contacts, to meet new people, and develop new relationships. All personal traits need not be forgotten, such as grooming, dress, manner of speech and personal interests.

The difference with how the females and the males view sex independently play an important role in the relationship of a quadriplegic male and a normal female. Most females prioritize the emotional and romantic aspects of a relationship thus they may not be concerned with the males physical changes. The male, on the other hand, can learn to be romantic and intimate to his partner. The female may first blame herself for not being able to sexually arouse her partner, even with the knowledge that it is due to the spinal cord injury. On the other hand, the male needs only to reassure her that their relationship is satisfying him. They could learn to find ways to be romantic and intimate that will be sexually satisfying and fulfilling for both of them. In a relationship, resentment may occur due to jealousy. Insecurity following the impairment may lead to the male accusing the female of infidelity. There may be a stage of depression for both males and females in the relationship. Crying, anger, withdrawal, and a lack of interest in sex are some signs. The male may become verbally abusive to his partner, directing his anger of the situation to her. It is important that they undergo professional counseling when this persists to prevent any damage that this may cause to their relationship.

Females with quadriplegia need not worry about fertility as opposed to the males. They continue to have a normal reproductive cycle with the hormones unchanged.  Females continue to be sexually active, allowing them to receive and give sexual pleasure. Although at times, a low self-concept and poor body image may interfere with sexual behaviors.  Females can still have a normal pregnancy and in most cases a normal vaginal delivery. The major effect though is the ability to lubricate and the loss of sensation, which could take time to get used to new feelings in certain areas of the body. To some, this could be the back of the neck, nipple line and behind the ears. Some women do miss menstruation following the injury but will return to normal condition after 6 months to a year.
It is important to note that both male and female quadriplegics need support, understanding and assistance in developing their emotional well being. Thus various counseling methods have been used to assist them in coping with their everyday lives. Sexual therapy aids in the sexual development of quadriplegics. Mutual masturbation, hugging, oral stimulation of feeling areas, or any other form of conditions may be used to express sexuality. It is ideal for partners to use whatever activities, fantasies, artificial devices, and other sensual expressions that are acceptable and pleasurable to them. Sexual activity and the ability to remain sexually active still persist in both males and females. Thus, it is important to provide them with information about how their sexual response and sexual functioning can be affected with the impairment. Having to depend on others for help most of the time, the male and female quadriplegics may feel insecure, may lack self confidence and harbor a feeling of self pity.

They may feel frightened, anxious, confused and feel numb. There would be an initial stage of denial, anger and frustration followed by withdrawal. Depression may happen once the patient starts to alienate himherself from others. Family and friends would then need to help each other accept what cannot be changed. It is advisable for everyone to be involved and supportive to the rehabilitation process. This is not the time to bottle oneself inside and not ask others for help or receive help from others. Communication is vital to the acceptance of the impairment. It is imperative to always be honest, patient and open to one another. The quadriplegic, on the other hand, must remain positive at all times. Thoughts of I can instead of I cant should be the driving force to see things in a new light.

They can try to set realistic goals for themselves and evaluate these goals from time to time. Most importantly, they can try to do new things, and engage themselves in the company of positively-oriented peers. Nowadays, there are various activities, even sports that are specially designed for people who have suffered spinal cord injuries. Having quadriplegia is not the end of ones life. It may take time accepting the physical changes, but with proper treatment one can overcome the difficulties, performing normal day to day activities. There would be a readjustment period for the patient, family and friends. It is a process of give and take and once guidance, encouragement and happiness are given to the patient they would eventually get the feeling of acceptance, thus regaining their self-confidence. In the end, everyone in the household would have a harmonious and happy environment to live up in.