Life on Wheels (72 page)

Fifty-seven percent reported using personal assistance services for help with parenting; 54% reported that services were not available when needed; 46% reported that services were unreliable.

Forty-three percent reported difficulty finding housing.

Thirty-two percent reported facing discrimination.

Fourteen percent reported pressure to have a tubal ligation; 13% reported being urged to have an abortion.

Children of disabled parents tend to be more independent, learning to do appropriate tasks for themselves that are strenuous for the parent. For example, very young children can develop the ability to climb onto a wheelchair and maintain their balance. These children also tend to develop a deeper compassion for all people, drawing a lesson from the perspective they gain through their parents about not falling into assumptions about who people are based on their appearance.

Don’t be surprised if you find a lack of support for your decision to have a child. Unenlightened elements of society still imagine that a parent with a disability would put a child at risk by not being able to respond to an emergency or chase a child into a place where a wheelchair cannot go. Your family, friends, church members, or colleagues may withhold their support. In
Spinal Network
, a woman with mild cerebral palsy is quoted as recalling:

Children of disabled parents don’t know the difference. To them, a wheelchair is totally normal. They know that their parents function fully and love fully—doing all they can to provide a healthy upbringing.

The question of the man’s ability to produce a usable ejaculate is the obvious key to a couple’s ability to bear children. Among those with SCIs, women are usually capable of conceiving, carrying the fetus, and giving birth. The challenge rests with the man with an SCI.

Depending on the type and level of impact on the spinal cord, a disabled man may or may not be capable of ejaculation. The response from the head of the penis travels to a given portion of the spinal cord—between T10 and T12—independent of nerves traveling to the brain. It is a completely reflexive process.

Semen and sperm are two separate substances, combined at the very moment of ejaculation, which is initiated as a biochemical and nervous system response. Three discrete steps take place:

1. Emission is the step in which sperm and other fluids are secreted from the Cowper’s and prostate glands, the seminal vesicles, and from the testicles. These fluids assist the motility—the portion that is actively swimming—of the sperm, lubricate the movement of ejaculate through the urethra and out the penis, and include the sperm itself.

2. In the second stage, the bladder neck is closed to prevent semen from backing into the bladder during ejaculation. Disabled men with impaired nerve function might experience retrograde ejaculation, in which semen flows back into the bladder. The acid environment of the bladder and urine is a threat to semen, though, if urine is collected and sterilized, it can be possible to harvest semen from urine for artificial insemination.

3. Ejaculation is the forcible expulsion of the ejaculate, and the third step of the process. This occurs via the second to the fourth sacral segments. Complete injury in this area will usually preclude ejaculation.

For men with an SCI, there is less frequency of pregnancy. In a study at the Miami Project to Cure Paralysis, only 10% of men with an SCI who were able to ejaculate during intercourse succeeded in impregnating their mates.
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In men injured at a younger age, the maturation of their testicles may have been hampered. In others, it is possible that irreversible structural atrophy can occur as a result of their disability. Such changes are more likely to occur within six months of injury, if at all. There is a suspicion on the part of researchers that there might be hormonal abnormalities in spinal cord-injured men that affect sperm production.

A severe bladder infection can cause sterility. An infection can spread from the bladder to other genital passages and compromise reproductive capabilities. Marijuana smoking also has damaging effects on sperm. One cycle of sperm production takes three months, during which time you would want to recover from any present infection, take extra care with your bladder program, drink sufficient fluids, and abstain from any damaging substances.

Assuming there is no physiologic damage, there are products that can help produce an ejaculate. A vibrator can stimulate ejaculation. A product from MMG Healthcare uses a specific frequency and amplitude of vibration to induce ejaculation; the FertiCare vibrator. The manufacturer reports a high success rate of ejaculates. Overstimulation with a vibrator, however, can be a risk to tissues if used excessively. For example, FertiCare and MMG recommend sessions of three minutes with a pause of one minute, repeated up to five times.

With electroejaculation, a probe is inserted through the anus to directly stimulate the nerves that elicit the ejaculation response. Men with sensation may require anesthesia for the procedure. The duration and voltage must be carefully monitored to avoid burns. Those with higher spinal cord lesions might be at risk of autonomic dysreflexia. Ejaculation may not occur on the first attempt.

The issue is not limited to simply gaining ejaculate; it is also about the quality of the product. Spinal cord–injured men have been found to have a normal number of sperm; however, the sperm have lower survival rates and less capacity to make the swim all the way to the uterus and the egg. An average male has a sperm motility of 60%. In a study conducted by Nancy Brackett et al of the Miami Project to Cure Paralysis, spinal cord–injured men have been found to have rates ranging from 23.5% to 30.9%.
¹⁸

Temperature is thought to be a factor in potency. Consider the shape of the male genitalia, in which the scrotum hangs freely to allow the testicles to have plenty of air surrounding them for a cooling effect. Since disabled men sit most of the time, the testicles stay warmer. It has been postulated that this temperature difference compromises semen quality.

This view, however, is not without its detractors. Nancy Brackett reports:

Other factors suspected of affecting sperm motility, as discussed in the 1996 Brackett study,
¹⁸
include:

Methods of bladder management. Men using intermittent catheterization had better motility.

Infrequency of ejaculation. Intervals of less than one week but greater than 12 weeks resulted in ejaculates with lower sperm concentration or motility.

Hormonal changes. Although men with SCI have been found to have the same levels of testosterone—the male hormone—as uninjured men, some study subjects had elevated levels of follicle-simulating hormone and were found to have no sperm in their semen.

The quality of semen is apparently affected by the method of collection. In another study led by Nancy Brackett, the percentage of motile sperm was greater for study subjects who used vibratory stimulation as compared to electroejaculation, although the sperm counts were comparable.
¹⁹
They found that there is a larger component of retrograde ejaculate with electroejaculation—sperm that had been exposed to the destructive acid environment of the bladder. This seems to account for the difference.