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November 23, 2005 - Intimacy After SCI

The mysteries surrounding female orgasms after spinal cord injuries (SCI) are only beginning to be unraveled.  Despite the considerable amount of literature already published, the experiences of some paralyzed women prove how little we know: Though seemingly cut off from all feeling below the waist, some have found new sensations leading to orgasm during sex.

More mysterious still, some could have orgasms when touched in newly formed hypersensitive regions on the trunk or neck just above the region of injury.

One Philadelphia-area woman who was paralyzed from the waist down was overwhelmed to learn she would never walk again. She was 30, and single. She assumed she would never enjoy sex again either, though at the time it was a lesser concern. Ten years later she fell in love. The couple tried sex. "I was fulfilled, I had orgasms," she said. "It was like I was reborn."

Neurologist Barry Komisaruk of Rutgers University has been studying sex in paralyzed women for 10 years. Sometimes, the loss of sex was the most devastating and irreconcilable consequence of spinal-cord injury, he says, tearing apart relationships and families. "Doctors had told many of them their sex life was over because there's no pathway to the brain," Komisaruk said.

A behavioral neuroscientist, he started out studying the nervous systems of rats. In female rats, the vaginal stimulation from sex caused a cascade of hormonal changes and kicked in a painkilling effect more powerful than morphine. There could be a blockbuster drug in this, he reasoned, if he could decode the neurobiology of female rat sex.

He tried severing the three nerve pathways that connect the genitals to the brain--the pelvic, pudendal and hypogastric nerves. Oddly, the rats reacted to sexual stimulation as if their nerves were intact.

He discovered a new channel for sexual pleasure--the vagus nerve--which threads from the brain through the lungs, intestines and other internal organs, bypassing the spinal cord.

Could the vagus nerve also channel sexual sensations in humans? To find out, he decided to study women with complete spinal-cord injury.

He and colleague Beverly Whipple brought women into their lab and interviewed them. In their stories, recorded in a 1997 academic paper, most had shut down sexually at first.

In months or years, many of them began to experiment with sex, either to please a partner or because they were curious. Some discovered they could orgasm from sex; others found their nervous system had become reorganized, so they discovered new hypersensitive regions above their injury that could lead to orgasm.

"Some of the women who realized they still had sensation started crying," Komisaruk said. Until then, they had given up.

Komisaruk and his colleagues are now trying to change patient care to put more emphasis on the possibility of sex after spinal-cord injury. They're also planning more brain scanning to better understand orgasm and compare the male and female versions.

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