Question of the Month: I have a question regarding sex and Spina Bifida. My girlfriend has Spina Bifida and she has difficulty with bladder control. She wonders if she can have sex with poor bladder control. Can you please provide me with some information regarding this?

I think your concern for your girlfriend is commendable. I hope you will use this answer and this website to help her feel more comfortable in your relationship. Good communication, understanding each others' feelings and concerns, and respecting each others' beliefs and choices are the most important part of a relationship. If a couple is mutually ready to explore their sexuality together, his or her Spina Bifida can be accommodated.

Almost all women with myelomeningocele have changes in the sensory and motor nerves involving the bladder and pelvic area. Many need assistance with bladder drainage and some with bowel emptying. Most of the time emptying the bladder with catheterization and emptying the bowel with and enema or suppository will allow for “accident-free” intercourse. Knowing that a little leakage of urine is harmless to both partners, you can show your girlfriend that a small accident is no big deal. Bowel leakage can be quickly cleaned away with a moist towel so it does not get into the vagina. If bowel contents accidentally get into the vagina, this can be cleaned out using a douche; however, douching is not routinely needed before or after sex. After sexual intercourse, the woman should again empty her bladder to decrease the risk of a urinary tract infection.

For those women who do not catheterize, they should also urinate before and after sex. If they still have significant urinary leakage during sex or frequent urinary tract infections, they should talk to a urologist about the possibility of urinary retention. Significant urinary retention is not good for the kidneys and a clean intermittent catheterization program may be warranted.

In Spina Bifida, the vagina and sex organs can also be involved. For women with Spina Bifida, sexual arousal may not always induce vaginal lubrication. Thus, it is important to have a lubricant available for the man and the woman to use. Some women with Spina Bifida can experience orgasms, more commonly if they have lower myelomeningocele levels (lumbar level or lower).

Like for any sexually active couple, safer sex is important for women with Spina Bifida. Barrier protection is necessary to prevent sexually transmitted diseases; however, latex barriers should be avoided. Non-latex condoms and other barrier contraceptives are available.

Spina Bifida may also affect the bones, joints, and muscles which may affect how the woman can move her hips and legs. Sometimes tightness of the muscles or contractures of the joints can affect the woman's comfort in certain positions. Patience, understanding, and communication can help the couple find the most comfortable position for both partners.

It is important to remember that sexually active women with Spina Bifida can become pregnant. Because 50% of all pregnancies are unplanned, any woman with Spina Bifida who is having sex should take 4mg of folate daily. This is 10 times the recommended dose for women without Spina Bifida and should not be taken in the form of 10 prenatal vitamins, which would provide too much of the other vitamins. Instead, folate-only vitamins are recommended.

Finally, while I answered questions about sex and Spina Bifida, the bigger picture of sexuality was not addressed. Women with Spina Bifida can have happy, healthy sexual relationships, with or without sexual intercourse. More information on both sexuality and sexual function is available in the Health Guide for Adults Living with Spina Bifida available from the Spina Bifida Association Marketplace Publications webpage.