anonymous on August 30, 2011

Are there any birth control methods that are harmful to women with a spinal chord injury?

I have been a T8 paraplegic for three years, and have recently started a relationship that includes sex. I know I can get pregnant, but I don't know the best way to prevent it. Are there any birth control methods that are dangerous for women with spinal cord injury?

answered by Mitchell Tepper, PhD, MPH on August 30, 2011

You've asked a great question. Birth control considerations for a woman with spinal cord injury (SCI) are mostly the same as those for women without an injury...but there are a few additional things to think about.

I’m happy to offer you my thoughts, but I would also encourage you to talk with your doctor ⎼ or visit a local Planned Parenthoodfor a more personalized discussion based on your sexual history, age and other health conditions.

As always, condoms can help prevent well as reduce the risk of sexually transmitted diseases (STDs). If you and your new partner have previously been sexually active with others, there’s a chance that one or both of you have been exposed to common STDs, including gonorrhea and chlamydia, herpes 1 and 2, hepatitis B and C, syphilis or HIV. Condoms ⎼ if used properly ⎼ can significantly reduce the risk of transmission of a bacteria or virus, as well as the chances of getting pregnant.

That said, getting tested for STDs is a good idea. To learn more about STDs risks, symptoms, prevention and testing, you might want to browse our Expert Guide to STD Basics.

Hormonal contraceptives are another form of birth control. In addition or instead of relying on condoms for birth control,you may prefer:
  • Oral contraceptives (“the Pill”) that need to be taken every day
  • “The Patch,” which contains a week’s worth of hormonal birth control and transmits the hormones through the skin
  • “The Ring,” which contains a week’s worth of hormonal birth control and is inserted vaginally.

However, be aware that hormonal contraceptives that include estrogen may present an increased risk of deep vein thrombosis (blood clots) for women with SCI. Progestin-only pills may be be sure to speak with your doctor about the best birth control method for you and your specific circumstances. As well, depending on your own dexterity and/or the comfort you have with your partner, inserting “The Ring” may be difficult.

Limits to dexterity may also hamper your successful use of some other birth control methods like diaphragms, cervical caps and female condoms. Because these are all inserted into the vaginal cavity, these options may be a challenge for someone with SCI. Additionally, atrophy in the muscles surrounding the vagina as a result of SCI can compromise the fit and effectiveness of these methods. Your partner can assist with insertion if you're both comfortable with the situation...otherwise, you may want to pick an alternate form of birth control.

An intrauterine device (IUD) may be another possibility. However, women with loss of sensation cannot easily monitor themselves for a perforated uterus or infection that can occur with IUDs in rare cases.

More permanent surgical birth control options include tubal ligation for you...or vasectomy for your partner. These procedures provide permanent birth control and are best considered by people who know they never wish to have a child.

I wish you happiness and good health in your new relationship, as well as peace of mind about birth control in consultation with you doctor.

Related info:

Mitchell Tepper, PhD, MPH

Dr. Tepper directs sexual health education at An AASECT-certified sexuality educator and counselor, his areas of expertise include sexual dysfunctions, sexuality following disability or illness, pleasure and orgasm, relationships, and military and veteran couples' counseling. Dr. Tepper was educated at the University of Pennsylvania and Yale University.

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