Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Abstract

Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre-and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.

Sexual Matters of Couples with Spinal Cord Injury Attending a Sexual Health Clinic in Tehran, Iran

“…Although the current study subjects showed low scores in most aspects of marital interactions, the partners with SCI were significantly different from the ones without SCI in EMS, MA, and BI. Similar to the current study subjects, other people with SCI in the studies worldwide also got lower scores in sexual activity and reported lower satisfaction compared with those of their control groups (2,5,28).…”

“…Sexuality is important to people with spinal cord injury (SCI), regardless of their disabilities (1). Studies point out that couples with SCI are often sexually overlooked in rehabilitation centers (2)(3)(4)(5). Annually, 20 -50 per million individuals experience SCI worldwide, but in Iran this rate is higher (40 -50/million); in other words, more than 3000 people experience SCI every year (6).…”

International spinal cord injury male sexual function and female sexual and reproductive function basic data sets—version 2.0

“…One reason for this may be that clinicians do not consistently evaluate patients' interest in sexual activity and their concerns and do not obtain detailed information about patients' sexual dysfunctions. This is unfortunate, because as more reports are published with regards to improving sexual responsiveness, 9 it is important to have a standardized reporting system and in published research studies, there are often wide variations in the information provided to the readers. 10 More importantly, it is useful to have a standard system to address and track improvement or decline in the sexual function of persons with SCI or SCD.…”

Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study

“…Growing research is focusing on instrumental approaches to manage ED. It is worth noting that among the problems facing patients with SCI, spasticity significantly contributes to ED [11,12,13,14]. Spasticity develops gradually over several months after SCI, is strictly associated with hyperreflexia and excessive muscle spasms, and involves also pelvic floor muscles [11,12,13,14].…”

“…It is worth noting that among the problems facing patients with SCI, spasticity significantly contributes to ED [11,12,13,14]. Spasticity develops gradually over several months after SCI, is strictly associated with hyperreflexia and excessive muscle spasms, and involves also pelvic floor muscles [11,12,13,14]. Thus, spasticity may affect: (1) positioning and mobility that are necessary for sexual intercourse, and (2) activation, strength, time of force development, and control of the pelvic floor muscles that are involved in erectile and ejaculation functions, with spasms during penetration [11,12,13,14].…”