Spinal cord injury (SCI) has a significant impact on the emotional and physical components that contribute to sexuality. Sexuality is a complex concept that allows humans to care for another and be loved, it allows us to be excited, and in essence be physically connected to another. Very few studies have been conducted on this topic in women with spinal cord injuries. Reasons for this include that eighty percent of all spinal cord injuries occur in men and the physical aspects of sexual function in men are dramatically affected by spinal cord injuries interfering with both erections and ejaculation. Women with a SCI, on the other hand, are relatively unaffected regarding the physical act of sex with little problems in becoming pregnant, carrying a child, and delivery of a child. Understanding that sexuality is considered a cornerstone aspect of a person’s life and that there are no treatment plans that are recognized as best practice in addressing sexuality for women with a SCI, rehabilitation physicians along with their treatment teams must incorporate an individualized plan of care that addresses this issue.
It is essential for medical providers and women with a spinal cord injury to understand what is currently known about the effect of a SCI on a woman’s sexuality. Sexuality again refers to the sexual expression that involves interplay between neurological, physical, and psychosocial factors of the injured.
Studies indicate that women with SCI place more importance on being in the ‘right mood’ to experience sexual pleasure during sexual activity than non-injured women. This can be explained by examining the neurological and psychological aspects of spinal cord injured women that relate to sexual function. Sexual arousal requires both psychogenic and reflex pathways to allow for vaginal lubrication.
Vaginal lubrication derived from psychogenic pathways from the brain to the vagina arises from mental imagery or fantasy. Psychogenic pathways may be intact in a woman with an incomplete spinal cord injury or in women with spinal cord injuries below L2. Sexual arousal related to reflex pathways refers to lubrication that result from genital stimulation and this requires intact S2, S3, and S4 nerve root segments. In other words, most women with a SCI will be able to achieve lubrication with genital stimulation. Achieving orgasm can only be achieved in approximately half of women with SCI and it has been shown by studies that orgasms in spinal cord injured women require prolonged genital stimulation. This may be explained by the fact that achieving orgasm is augmented by neurological pathways from the brain to the vagina and clitoris that are disrupted in complete spinal cord injuries or partially disrupted with incomplete spinal cord injuries. This influence is likely the factor that accounts for the fact that mood and relaxation become significantly more important in women with spinal cord injuries.
Understanding the increased significance of mood and relaxation in sexual relations in women with SCI it is important for the medical treatment team and woman with a spinal cord injury to understand the physical barriers that may interfere with pleasurable sexual activity.
Spinal cord injured women have unique physical problems that may interfere with their desire to pursue sexual relationships with others. The fear of urinary incontinence and bowel incontinence during sexual relations may interfere with mood and relaxation required for pleasurable sexual activity. Understanding that these issues can generally be controlled with planned encounters rather than spontaneous encounters, spinal cord injured women will need to be emboldened to discuss their plans with established and prospective partners.
Problematic spasticity in women can prevent positions necessary for sexual intercourse and spasticity may cause pain that interferes with the relaxation and mood required for pleasurable sexual activity. Oral medications such as baclofen and Valium may be useful in treating spasticity interfering with sexual function. In other women with severe spasticity, intrathecal baclofen pump therapy may be required to assist with sexual positioning understanding that this treatment may interfere with the neurological pathways required to achieve orgasm.
Autonomic dysreflexia is a potentially life threating medical condition for spinal cord injured patients with injuries above T6. It results in severe increase in blood pressure that may lead to strokes or other hypertensive conditions. Ten percent of women with spinal cord injuries above T6 report autonomic dysreflexia with sexual intercourse. Women with this problem may need Procardia Sublingual to abort dysreflexia or may benefit from the off-labeled use of oral mecamylamine.
During acute rehabilitation medical providers must have a treatment plan for women to discuss the implications of their injury as it relates to their sexuality. Women must understand that there is a need for a sexual counselor familiar with spinal cord injuries because sexual needs change as one ages with a disabling condition and as relationships change or evolve over time. Interaction with other women who have suffered spinal cord injuries is important and an emphasis on romantic lifetime relationships must be stressed.
Sexual counseling involving both the woman with a spinal cord injury and their chosen partner is essential to assist the couple in achieving a mutually pleasurable sexual relationship. The couple must understand each other’s needs and both should understand that seventy-five percent of women pre-injury preferred penis-vagina intercourse but post-injury, women prefer kissing.
An Academic Physician Life Care Planner is essential for providing a life care plan for all the necessary and appropriate care now and into the future to address the neurological, physical, and psychosocial aspects related to sexuality. Medications, supplies, assistive devices, and sexual counseling must be included in the life care plan of a women who has suffered a spinal cord injury to their life expectancy.
Read Creating a Safe Home Environment after SCI
http://www.nature.com/sc/journal/v44/n4/full/3101844a.html
http://www.ingentaconnect.com/content/mjl/sreh/2008/00000040/00000001/art00010
http://www.nature.com/sc/journal/v45/n5/full/3101979a.html
http://www.nature.com/sc/journal/v43/n1/full/3101657a.html
Academic Physician Life Care Planner Greg Vigna
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