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Hormonal changes that alter sexual function may take place after SCI; levels of prolactin heighten, women temporarily stop menstruating (amenorrhea), and men experience reduced levels of testosterone.SCI can lead to significant insecurities, which have repercussions for sexuality and self-image.Neural plasticity may account for increases in sensitivity in parts of the body that have not lost sensation, so people often find newly sensitive erotic areas of the skin in erogenous zones or near borders between areas of preserved and lost sensation.

All dermatomes below the level of injury to the spinal cord may lose sensation.

Body image and other insecurities affect sexual function, and have profound repercussions on self-esteem and self-concept.

SCI causes difficulties in romantic partnerships, due to problems with sexual function and to other stresses introduced by the injury and disability, but many of those with SCI have fulfilling relationships and marriages.

In people with incomplete injury, some or all of the spinal tracts involved in sexual responses remain intact, allowing, for example, orgasms like those of uninjured people.

In 1960, in one of the earliest studies to look at orgasm and SCI, the term phantom orgasm was coined to describe women's perception of orgasmic sensations despite SCI—but subsequent studies have suggested the experience is not merely psychological.

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Input from the psychogenic pathway is sympathetic, and most of the time it sends inhibitory signals that prevent the physical arousal response; in response to sexual stimulation, excitatory signals are increased and inhibition is reduced.

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