Sexual arousal and orgasm in women: Effects of spinal cord injury

Abstract

Sexual disorders are common in women; however, the neurological basis of female sexual response has not been adequately investigated. This information is necessary to characterize the impact of various neurological disorders on sexual arousal in women and to develop appropriate management strategies for sexual dysfunction. To assess the spinal mediation of sexually stimulated genital vasocongestion in women, we conducted two laboratory‐based, controlled analyses: (1) of women's genital, subjective, and autonomic responses to audiovisual erotic and audiovisual erotic combined with manual genital stimulation; and (2) of women's ability to achieve orgasm. Subjects included 68 premenopausal women with spinal cord injuries (SCIs) and 21 able‐bodied, age‐matched controls. Results indicated that preservation of sensory function in the T11‐L2 dermatomes is associated with psychogenically mediated genital vasocongestion. Less than 50% of women with SCIs were able to achieve orgasm, compared with 100% of able‐bodied women (p = 0.001). Only 17% of women with complete lower motor neuron dysfunction affecting the S2‐S5 spinal segments were able to achieve orgasm, compared with 59% of women with other levels and degrees of SCIs (p = 0.048). Time to orgasm was significantly increased in women with SCIs compared with able‐bodied controls (p = 0.049). Independent raters were unable to differentiate between subjective descriptions of orgasm from SCI women compared with controls. This information should be used when counseling women with spinal dysfunction about their sexual potential. Ann Neurol 2001;49:35–44

Sexual issues in a sample of women with spinal cord injury

“…The majority of women who reached an orgasm claimed to do so less frequently, with greater difficulty, and they described it as less pleasurable than before the injury. Sipski 3,13,14 publishes similar percentages in several of her studies, and congruent to our findings, does not find any relationship with neurological levels nor the ASIA grade. In one of their studies, Spiski et al 14 found that women with SCI require more time and more intense stimulation to reach orgasm than the women in the control group, yet the subjective characteristics of the orgasm did not vary between the two groups nor with respect to their previous experiences.…”

“…Jackson and Wadley 11 in their report suggest that subjects with incomplete injury were more likely to report orgasm than those with complete injury. Sipski 3,13 does not find any relationship with neurological levels nor the ASIA grade, although in another study 14 reported that an intact sacral reflex arc is necessary for experiencing orgasm through direct genital stimulation.…”

Spinal cord injury influences psychogenic as well as physical components of female sexual ability

“…14,16,17 The presence of genital sensation, indicative of sparing of the sacral reflex arc, significantly influences the likelihood of achieving orgasm. As mentioned previously, a more detailed analysis of orgasm in our study population will be presented and discussed in a forthcoming paper.…”

“…Later studies indicated that preservation of sensory input to the T11-L2 dermatomes was associated with the ability to experience psychogenic genital vasocongestion. 14,15 It is thought that approximately 50% of women with SCI have the ability to experience orgasm postinjury, 14,16,17 although there is a longer latency to reach orgasm. 14 One important component, however, appears to be sparing of the sacral reflex arc.…”

“…A complete lower motor neuron lesion affecting S2-S5 greatly reduces the likelihood of experiencing orgasm. 14 Although laboratory-based studies are essential for evaluating and quantitating physiologic sexual responses, they involve invasive, intravaginal measurements. Many women with SCI may choose not to participate in such studies owing to shyness, embarrassment, or inhibitions (self-imposed, social, or cultural).…”