The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life. One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed signi®cantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was signi®cantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not dier signi®cantly. SCI and TBI persons did not dier signi®cantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were signi®cantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to aect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.

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Study design: Cross-sectional, mail-back questionnaire study. Objectives: To describe women's experiences of sexual functioning and sex life after spinal cord injury (SCI). Setting: Sweden, Denmark, Norway, Finland, and Iceland. Methods: All community-living SCI women treated at spinal cord centres in Sweden, Denmark, Norway, Finland, and Iceland meeting inclusion criteria (n ¼ 963) were mailed the study-specific SCI Women Questionnaire. Out of the 532 respondents, 392 reported having had sex after injury and were thus included in the study. The included women had a mean age of 42 years (range 18-68) and a mean time since injury of 11 years (range 2-54). Results: The SCI women reported that the injury caused many changes in their sex life and affected many aspects of their sexuality negatively. Some changes were of a physical nature (for example, decreased, lost, or changed sensation; difficulties to achieve orgasm; bladder or bowel problems; and difficulties to move and position oneself) whereas other changes were of a psychological nature (for example, feeling unattractive or less attractive, having less self-confidence, and difficulties to meet or find a partner). Conclusion: Successful SCI rehabilitation requires a holistic approach, taking into account the patient's physical, psychological, and interpersonal circumstances. Given that many women with SCI remain sexually active but often experience less satisfaction after injury, it is important that rehabilitation efforts address this aspect of the patient's life. Our results elucidating strategies applied by women with SCI to compensate for loss of genital sensation and cope with physiological impairment during sexual activity may serve to help professionals in developing rehabilitation programmes for women with SCI. that the majority of women with SCI are dissatisfied with the amount and quality of information about sexual functioning and sex life provided at these centres. [3][4][5][6] Comparatively, few studies have investigated the sexual functioning and sex life of SCI women, as opposed to that of SCI men; however, a general finding is that most SCI women continue to be sexually active after injury, but to a lesser extent than before injury. 4,5,[7][8][9][10][11] It has also been shown that many SCI women have difficulty becoming psychologically as well as physically aroused. 12 Laboratory-based studies have provided detailed knowledge about how specific injury patterns affect specific aspects of the female sexual response. 13In-depth knowledge about how SCI women experience their sexual functioning and sex life may serve to improve the quality of information provided to these women, as well as to aid health professionals in their attempts to address the SCI women's sexual concerns. The purpose of this study was thus to describe SCI women's experiences of different aspects of sexual functioning and sex life after injury.

Results: 80% of the women with spinal cord injury had engaged in sex after the injury. Reasons for not wanting or not having the courage to be intimate and sexual were physical problems, low sexual desire, low self-esteem and feelings of being unattractive. The motivations of both the women with spinal cord injury and controls to engage in sexual activity were intimacy-based rather than primarily sexual. Being in the right mood both before and during sex to become receptive to sexual stimulation was important. Conclusion: For women who are able to overcome the physical restrictions and mental obstacles due to injury, it is possible to regain an active and positive sexual life together with a partner. Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes. INTRODUCTIONComparatively little research on sexuality in the spinal cord injury (SCI) population has focused specifically on sexual concerns of women. However, in the last 20 years there has been a growing acknowledgement of the sexual concerns of women with SCI. Despite this, the conveyance of this knowledge to the women with SCI appears to be insufficient (1-4).Studies have shown that most of the women investigated (65-80%) continue to be sexually active after the injury, but to a much lesser extent than before injury (1,(4)(5)(6)(7)(8). Also, satisfaction with sexual life is diminished in approximately 25% of the women (5, 9). Few studies have compared sexuality and sexual functioning in women with SCI with that of able-bodied women. One such study showed that women with SCI report significantly lower satisfaction with sexual life and lower sexual desire (10). A recent study found that sexual activity was lower among women with SCI, but the desire did not differ from controls (8). A Swedish study found that the importance of sexuality had decreased among women with tetraplegia, but not among those with paraplegia. The greatest physical obstacles for sexual activity were urinary leakage, problems with positioning and spasticity (11).Dissatisfaction with the quality and quantity of sexualityrelated rehabilitation services has been pointed out (1,3,4,12). Nosek et al. (2) found that women with disabilities received sexual information more seldom than did men.Multiple laboratory-based trials have yielded better understanding of the impact of SCI on the female sexual response (13-16). In a study with 62 women with SCI and 21 able-bodied controls, 44% of the SCI participants were orgasmic in the laboratory trial and 52% of them reported the ability to achieve orgasm, compared with 100% of the able-bodied controls (16).Positive self-image and self-esteem and feelings of being attractive to self and others are fundamental issues in sexual relations (9,(17)(18). Publications addressing these aspects of sexuality in women with SCI are limited (1,6,19).The purpose of this study was to describe physical, psychological and social aspects of sexual life in women with SCI.Four resea...

SummaryChanges in different aspects of sexuality were investigated and related to overall quality of life and physical, psychological and social adjustment in 73 SCI subjects, who were sexually active both before and after injury. Items on sexual interest and satisfaction were treated as one composite variable, the SIS scale, measuring sexual adjustment after injury.Despite severe genital dysfunction, more than half of the subjects (57%) rated their sexual relations after injury as satisfying or at least rather satisfying. The majority continued having intercourse, although many of them more seldom than before, and about half experienced orgasm.Sexual adjustment after injury was closely and positively correlated to frequency of intercourse, willingness to experiment with alternative sexual expressions and young age at injury. Physical and social independence and a high mood level were further positive determinants of sexual adaptation after injury, whereas the neurological level and completeness of injury showed no significant correlation with sexuality.It is suggested that sexual information and counselling should be integrated in the total care of the SCI patient to reduce the negative effects on sexuality, caused by the lnJury.