In addition to the disability and the limits it imposes, the problem is of getting through to the minds of the able-bodies that SIP are people with the same kind of human desires and impulses. The disabled are people, and people are sexual. Much of our sense of personhood comes from our ability to play a sexual role. The person with disability first obstacle is self de-programming - rejecting the idea that he or she is not a potentially sexual person. The second is effective militancy - doing something about it. The ideal strategy is open discussion with other individuals or couples who share the same problem and counsel each other. In institutions SIP should demand that the matter be talked out. Almost all SIP can be made sexually functional with special counseling and a minimum of physical help. Virtually nobody is too disabled to derive some satisfaction and personal reinforcement from sex. 

When a SIP is unable to enjoy sex, the greatest obstacle to enjoyment usually is not the difficulty or impossibility of making particular movements, but the social convention that sex consists of putting the penis in the vagina and that all the rest of the rich range of human sexual responses oral, manual and skin stimulations are abnormal. That is the reason a SIP begin to think of himself as an invalid and distrust on his own personhood makes him suspect other peoples affection as pity. Once you overcome that, try and explore your sexuality. Learn the techniques and procedures for sexual exploration and fulfillment. Sexual expression has to be tailor-made for the individual and one has to try hard to achieve it. This is a challenge same as learning other skills of management of spinal cord injury. But sexual challenge is probably the one best worth accepting as one discovers that one is loving, lovable, interacting human being - a participant rather than an onlooker.

The perception of the sexual act in male comprises of erection, orgasm and ejaculation, and in the females the corresponding responses. This is called Penetrative Sex. In sexuality and disability, we redefined it as Participative Sex. 

The best way to put yourself and people at ease is communication. The partner with a disability needs to educate the other person about the ways in which his or her body is different, both the partners need to communicate about what they like, what seems to be working for them and any problems they might be having.

Practical Advice: Empty your bladder and bowel before having sex. Be careful in positioning yourself in a way that avoids too much friction or pressure, Use humor to help you cope unexpected situations, Negative thoughts and worries can prevent an erection from occurring. Avoid thinking of performance anxiety. 

The mechanism of erection are complex. When sexually aroused, a man's brain signals the muscles in the penis to relax and the blood vessels to expand. As more blood flows into the penis, the veins that normally allow blood to flow out of the organ become tightly compressed. The result of all this blood trapped blood is an erection. The consistent inability to maintain erection firm enough for satisfactory sexual intercourse is a common feature in case of SCI. This is because for a man to get erection, his brain must send signals along the spinal cord to tell the nerves in his penis that he is sexually aroused so that the mechanism of erection sets in. 

There are two types of erections 

Psychogenic-Transmitted by cortical (brain) stimulation and regulated by sympathetic nerves. It is poorly sustained and lasts briefly in case of SIP

Reflexic- It is well sustained and more powerful. Transmitted and integrated - by spinal centers. 

Loss of erection may be temporary, often lasting for only first few months after injury, although in men with a lesion below T12 the ability to achieve even a reflex erection may be permanently abolished. 

Suprasacral lesions:Reflex erection is possible. It is activated by stimulation procedure Squeezing of penis, Suprapubic tapping, Pulling of pubic hair etc. 

Sacral lesion:Weak and ill sustained erection. This requires additional maneuvers through the use of

Vacuum erection aids: A cylinder fits on penis and with a gadget vacuum is created by pumping all the air out of the cylinder. This stimulates blood flow to the area within few minutes and that results in erection. A rubber band is slipped on to the base of penis to maintain erection. A rubber band is slipped on to the base of penis to maintain erection. After intercourse, the rubber band can be removed and the penis becomes flaccid. • 

Intracavonosal injection of papavrine : 7.5 - l 10mg good erection for 30 minutes. But one has to learn injection under the guidance of a urologist. One should know the right area (Corpocavinosum) and be very particular about the dose. A little extra dose can be very dangerous as the erection does not subside for hours and the blood in the penis gets clotted and there would be no more erections in future by any method. In such a situation one must straight away rush to a doctor specially Urologist. 

MUSE- It is a tiny pellet which is to be inserted into the urethera with the help of an applicator available along with it. The applicator is inserted about one inch into the penis and then the plunger is being pressed to release the Muse. The pellet quickly melts by the body temperature allowing the medication to be absorbed into the penile tissue. It results in erection in 5-10 minutes. Muse must be stored in fridge.

Mini Press or Hypovase- It is a tablet prescribed to relax the internal sphincter. The main constituent of it being the chemical Prazosin. This medicine gives a proper erection along with it's normal effect of helping in evacuation of bladder due to relaxing of sphincter. The erection is more pronounced in the case of cervical injury cases. The factor that might inhibit erection is presence of Urinary tract infection (UTI). One should put an elastic band once the erection comes, for better results.

Penile Prosthesis:These implants come in two varieties. A surgeon may insert either an inflatable device that can be pumped up to cause an erection or semirigid rods that you can bend yourself either outward or close to your body. 

If your partner is non-disabled, she can straddle you, open the lips of her vagina and stuff your soft penis in, using her vaginal muscles to hold it in position. This may stimulate erection, but still if it does not, it may still be very pleasurable for both of you. 

Beside these devices & methods posture is very important. Male acts as a passive partner and female as an active partner and on top of the male. Legs can be supported by pillows.

If it is not possible to get the maintain an erection there are a range of artificial penises for use when penetration is desired. 

This imitation penis, which straps on the man's body with a elastic harness, may be solid or hollow so that flaccid penis can fit inside. The more sophisticated models can even squirt a warm fluid to stimulate ejaculation. Some even have a built-in vibrator. 

Those who do not have a partner or for whom sexual intercourse is not possible may need a device to assist masturbation. A vibrator can be used in these instances or to improve love-making 

Many a spinal cord injured people not only enjoy sex, but also experience orgasm. Although the orgasm may be and feel different from those they had before injury, but they are not necessarily less satisfying or intense. Some people say that other parts of their bodies appear to compensate with greater sensitivity for the lack of feeling in their paralyzed parts. It has been found that women with SCI have an alternative sensory path for orgasms coming through the vagus nerve, the I0th cranial nerve and which should not be affected by SCI. It is also likely that hormones released during intercourse play a major role in orgasm. 

 The brain plays a large part in the ability of ejaculate, and in SCI the brain - penis connection is lost. Thus ability to ejaculate return less frequently, although some men experience a `phantom orgasm', without ejaculation, when their partner reaches orgasm. However, many do have an orgasm with ejaculation through the use of vibrator. Finally, as everybody knows, ejaculation is only one reflex part of the orgasm and the rest is in the mind. A number of SIPS are capable of fathering children. Sperms can be obtained, if ejaculation can't be produced by normal masturbation, by the use of a powerful vibrator applied to the gland penis, or by electro-ejaculation, involving the introduction of electrodes into the rectum under anesthesia. The semen may then be introduced into the partner's vagina using AID/AIH equipments or a simple rubber tube - a technique which couples may learn to carry out for themselves without difficulty.

There is a considerable amount of research at present being conducted in the field of fertility of SCI.

For women however the essential sexual functions are unaltered, though there may be a decrease in lubrication of the vagina and they may have little or no sensation on the clitoris. In case of women the fertility is not affected by spinal injury, the periods may cease for a while after the injury but they would resume as earlier. They are fertile and thus women should think about contraception if in a sexual relationship. 

Autonomic Dysreflexia If one has a high lesion, sexual activity and especially ejaculation may bring on autonomic dysreflexia. If this happens, one should stop immediately, check all possible causes, sit upright if you have been laying down, and do not hesitate to call the doctor if any symptoms persist. Sublingual Nifadipine in emergency.