Effects of spina bifida on sexual function and bladder/bowel control

Sex and Spina Bifida

Many people with spina bifida get married, have great sex lives and have a family of their own.

The major obstacles to a happy sex life are:

- lack of confidence and self esteem
- not meeting people
- no car
- not seeing ‘sex’ as being possible
- incontinence
- gaining independence from your parents.


-The nerve damage in spina bifida that affects urinary and bowel functions may also affect sexual functioning.

-Some people with spina bifida have no feeling in the lower parts of their bodies.

-Males may have normal sexual function, but this is commonly affected to some degree. Satisfactory erections are often possible, but there is no ejaculation. Other types of sexual dysfunction are also possible.

-Females are generally less affected in their sexual functioning - some might not be able to produce their own lubrication.

-In males and females, altered genital sensation can affect - but does not prevent - arousal patterns and sexual functions.

-Orthopaedic problems, for example with lower limbs, can affect the ability to use some, but not all, sexual positions.

-Most males and females with spina bifida are fertile. Many of the issues surrounding conception in spina bifida are due to mechanical and anatomical difficulties in conceiving rather than a lack of fertility. There is access to assisted reproductive techniques. Consult your clinic about these.

-Since people with spina bifida often have latex allergies, you and your partner may need an alternative form of contraception to condoms. See your doctor for advice about forms of contraception.

-Some women with spina bifida have to deliver through caesarean section.


Spina bifida and bowel/bladder control
Control over urination requires functional nerves in the lower spine (sacral spinal cord). These nerves sense bladder fullness and transmit this message to the brain. In an older child or adult who has normal urinary control, the brain is able to inhibit the bladder from contracting until it is socially acceptable.

-In many children with spina bifida the nerves to the bladder that control this reflex voiding are damaged. Only about 5 to 10% of children with spina bifida have normal urinary control and are able to toilet train and void spontaneously.

-This means that the majority of children with spina bifida are at risk for poor urinary control and incontinence as well as damage to the kidneys and bladder.

-Lack of bladder control present two immediate dangers - infection and back pressure on the kidneys, without proper management, can lead to renal problems.

-Urodynamic studies or cystometrograms are done in children with spina bifida to evaluate bladder function.

-These studies involve placing a catheter into the bladder and filling the bladder with water. While this is done, the pressure in the bladder is continuously monitored.
-Normally, when the bladder pressure reaches a certain level, urine begins to leak around the catheter.
-Some children with spina bifida, however, tolerate very high pressures in their bladder without any urine leakage, with the result that urine can reflux up the ureters and damage the kidneys. These children are often managed with intermittent catheterization, antibiotics for infection, and occasionally other medications and/or surgery.