Expressing sexuality is an important part of life, whether the person has a spinal cord injury (SCI) or not. This study investigated the sexual activity before and after SCI, the difficulties, and adjustments made by these people in relation to their sexuality. This is a qualitative study conducted with 14 people with SCI through semi-structured interviews, which we analyzed in light of pertinent literature and organized into three themes: sexual activity before and after SCI; difficulties in performing sexual activities; and adjustments in sexual activity after SCI. We conclude that, although there may be many difficulties, with the partner's support they can get sexual satisfaction and adapt to the new reality. Nonetheless, it is necessary and essential that the patient receive guidance about the possible changes and adaptive methods, and nurses can play a critical role in this process.