Autonomic Dysreflexia doesn’t have to put a damper on your love life. The right approach can help you enjoy intimacy safely
Discussions about sexuality after a spinal cord injury (SCI) often focus on the emotional, relational and practical aspects of intimacy. However, there is one medical consideration that doesn’t always get the attention it deserves, and that is autonomic dysreflexia (AD).
For individuals with SCI at T6 and higher, AD is a genuine risk during sexual activity. The anxiety surrounding it can limit sexual expression in various ways. With the right knowledge and preparation, it doesn’t have to stand in the way of a fulfilling and satisfying sex life.
AD is the body’s exaggerated alarm response to a stimulus below the level of injury. Because the nervous system often struggles to regulate blood pressure the way it used to, blood pressure could rise suddenly while simultaneously causing irregular heartbeats.
Although AD is a common complication affecting a significant amount of individuals, it can be a very distressing experience, especially if you’re not sure what’s going on.
Sexual activity is one of the recognised triggers of AD due to blood pressure increases and occur commonly during stimulation and ejaculation in people injured above this level. Other common causes are a full bladder or bowel, physical pain below the level of injury, blocked catheters and infections.
Know the signs
Being able to recognise the signs is an important part of managing the risk. The most common symptom is a sudden pounding headache, which could be accompanied by flushing, sweating, and nasal congestion above the level of injury, along with goosebumps, blotchy skin or cold clammy skin below it.
Some individuals also report blurred vision, nausea, or a sense of unease that seems to arrive without explanation. It could also happen that AD occurs without noticeable symptoms, which is why having a plan in place is very important.
Know how to respond
If symptoms arise during sexual activity, the response is relatively straightforward. Stopping the activity, sitting upright rather than lying flat and loosening any tight clothing, binders, or compression garments will usually allow blood pressure to settle.
If the symptoms persist, this becomes a medical emergency and requires urgent attention. Individuals who experience AD regularly should also speak to their doctor about keeping appropriate medication accessible.
Preventing AD
Prevention, however, is the most effective approach, and it is often simpler than people expect. Emptying your bladder before sex removes the single most common trigger. Making this a consistent habit substantially reduces the likelihood of an episode.
Equally valuable is having the conversation with a healthcare professional to fully understand what is happening, so that both partners understand what may happen and what to do about it.
With a little bit of preparation, AD doesn’t have to be an obstacle to intimacy but could instead make relaxed intimacy possible.
When intimacy carries a known physical risk, avoidance becomes a natural response, and that avoidance might not be understood by a partner who has never been told about the fear.
Sex gradually stops, and both partners are left drawing their own conclusions about what has changed between them.
Although the process of learning about AD could make intimacy feel clinical or frightening initially, talking about it can assist with staying emotionally connected.
Learn more about AD and sexuality in the QASA Hidden Consequences of SCI booklet, and download the QASA AD Card to keep on hand.
