SCI impairs messages from the brain to other parts of the body. Every SCI is unique depending on level and completeness of injury. Accompanying other functional changes resulting from SCI may be changes in sexual functioning. Some type of change in sexual function (ability to attain or maintain an erection, to lubricate, to ejaculation, to orgasm, to feel sensations in the genitals) is experienced by roughly 80-90% of people with SCI.

Likely changes in genital function have been associated with various levels and completeness of SCI. Changes in erectile function in men or changes in lubrication in women often result from SCI. For men with cervical SCI (broken necks) and other thoracic injuries above T10, erections are likely to result from direct stimulation to the penis or scrotum, and indirect stimulation to the penis from a full bladder, for example, or from stimulation to the anus or rectum. These are often referred to as "reflex" erections and are not always associated with sexual activity. Reflex erections are common during catheterization, bowel routines, and range of motion exercises of the legs and are beyond our control. Erections that result from messages sent from the brain are not likely in men with complete injuries above T10. In women with cervical SCI or complete SCI above T10, erection of the clitoris and lubrication of the vagina is likely to result from direct or indirect stimulation to the vulva (pubic area, clitoris, outer and inner lips, vagina) but is not likely from messages sent from the brain. For both men and women with injuries between L2 and S2, it is believed that sexual responses resulting from messages sent from the brain (psychogenic) and sexual responses resulting from direct or indirect stimulation to the genital area (reflexogenic) are likely, however they are not likely to be coordinated. In men with lesions below L2, seminal emission (the stage prior to ejaculation where sperm and seminal fluid is forced into the urethra) may accompany intense arousal. We cannot make valid generalizations about changes of sexual functioning when injury is between T10 and L2 or when injury is incomplete. In all cases, we need to rely on our own observations of our sexual function and assess our own ability. It is also helpful to learn how to talk about our sexual function with appropriate health professionals or our sexual partners.

While there are expected changes in sexual function based on the level of SCI, the ability to experience sexual satisfaction and orgasm after SCI has not been significantly related to level of injury. Factors associated with positive sexual adjustment include the level of sexual knowledge, openness and communication with partner, and time since injury. Time since injury is associated with a general increase in self-esteem and an increase in sexual self-esteem. Being familiar with our options will help in guiding further exploration of sexual issues with various members of the rehabilitation team or other specialists as needed.