Sexual Dysfunction

Sexuality is an important element of a person’s life, which encompasses both emotional and physical types of intimacy [1]. A spinal cord injury (SCI) will affect a person’s sexual health and this may lead to problems such as a decline in life satisfaction, quality of life (QoL), and self-perception [1]. Amidst the top functions that a person with SCI strives to regain such as bladder and bowel functions, walking, arm/hand function, research has shown that sexual function was rated as either the first or second priority [2].  It has also been shown that the outcome of their overall rehabilitation and the major motivation factor in life is influenced significantly by a successful sexual rehabilitation [3].

A common sexual problem that occurs in males with SCI is erectile dysfunction (ED) [4].  ED is defined as the consistent or recurrent inability to attain and/or maintain an erection sufficient for sexual performance [5]. The vast majority of men with complete and incomplete SCI require treatment for ED [6]. Some treatments include sildenafil, intracavernous injections of papverine/alprostadil (Caverject), alprostadil/papaverine/phentolamine (“Triple Mix”), transurethral suppository (MUSE), surgically implanted prosthetic device (PPS) and vacuum erection devices (VED) [7].  Some other problems include impaired ejaculation and orgasmic perception [8].

Given the large ratio of male to female in persons with SCI, there is a relative lack of literature on sexuality in women with SCI [9-11].   This may also be partly due to the misconception that women are not as interested in sexual activity, and that their physiological sexual response is less affected by disability compared to men [12].   Most of the studies on sexual dysfunction in women with SCI are focused on fertility, pregnancy, menstruation, and childbirth [12-14].   For women, problems include positioning during foreplay and intercourse, vaginal lubrication, and spasticity during intercourse [11].  As well, problems with becoming psychologically aroused have been listed as a problem for women with SCI [11].

References:

1. Lombardi G, Macchiarella A, Cecconi F, Aito S, Del Poplo G. Sexual life of males over 50 years of age with spinal-cord lesions of at least 20 years. Spinal Cord 2008;46:679-83.

2. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma 2004;21:1371-83.

3. Reitz A, Tobe V, Knapp PA, Schurch B. Impact of spinal cord injury on sexual health and quality of life. Int J Impotence Res 2004;16:167-74.

4. Smith EM, Bodner DR. Sexual dysfunction after spinal cord injury. Urol Clin North Am 1993;20:535-42.

5. NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence. JAMA 1993;270:83-90.

6. Ramos AS, Samso JV. Specific aspects of erectile dysfunction in spinal cord injury. Int J Impot Res 2005;16:42-5.

7. Mittmann N, Craven BC, Gordon M, MacMillan DH, Hassouna M, Raynard W et al. Erectile dysfunction in spinal cord injury: a cost-utility analysis. J Rehabil Med 2005;37:358-64.

8. Brown DJ, Hill ST, Baker HW. Male fertility and sexual function after spinal cord injury. Prog Brain Res 2006;152:427-39.

9. Westgren N, Hultling C, Levi R, Seiger A, Westgren M. Sexuality in women with traumatic spinal cord injury. Acta Obstet Gynecol Scand 1997;76:977-83.

10. Black K, Sipski ML, Strauss SS. Sexual satisfaction and sexual drive in spinal cord injured women. J Spinal Cord Med 1998;21:240-4.

11. Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL. Spinal cord injury influences psychogenic as well as physical components of female sexual ability. Spinal Cord 2007;45:349-59.