Sexuality and Women with Spinal Cord Injury

Women with spinal cord injury (SCI) have unique concerns and problems related to their sexuality. The purpose of this study is to assess sexual issues in women with SCI, for better management and rehabilitation of such patients. Consequently, 40 such women were interviewed based on a standardized questionnaire. Evaluation of sexual activity, medical problems most significantly interfering with sexual activity, menstruation, pregnancy, child bearing and relationships was done. Interest in sex and importance of sex in lives did not change significantly after SCI. The key concerns after SCI were sexual, bladder and bowel dysfunctions, bed sores, pain, spasticity and satisfaction of partner and cultural taboos. Only, 30% women had received information on sexual matters, that too to isolated problems. There is a distinctive need for clinical attention, education, research and development around gynaecological/reproductive, sexual and urogenital issues unique to women with SCI in India.     

Training the Interdisciplinary Team in Sexuality Rehabilitation Following Spinal Cord Injury: A Needs Assessment

Historically, the management of sexuality issues in spinal cord injury rehabilitation has received scant attention as a staff training issue. This has occurred despite evidence in the literature identifying significant barriers to the provision of sexuality rehabilitation. This paper reports on a needs assessment conducted within an Australian spinal cord injury rehabilitation service to identify the training needs of staff in relation to client sexuality. Using the Knowledge, Comfort, Approach and Attitudes Towards Sexuality Scale (KCAASS), a previously developed theoretical model and questionnaire, 90 multidisciplinary staff were surveyed. A combination of open and closed questioning techniques were used. While the findings suggest some differences between disciplines, the training needs of the interdisciplinary team were surprisingly similar. Knowledge is required in the areas of counselling, professional boundary setting, fertility and assistive devices while specific training is needed to promote staff comfort in dealing with personal approaches from clients.     

The Effectiveness of a Sexuality Training Program for the Interdisciplinary Spinal Cord Injury Rehabilitation Team

While there is evidence to support consideration of client sexuality needs in the provision of rehabilitation services to people with spinal cord injury (SCI), the interdisciplinary team rarely receives training in this area. The current study aimed to examine the effectiveness of a consumer-driven sexuality training program in improving staff knowledge, comfort (general and personal) and attitudes. Using a local needs assessment to identify training needs and the Permission, Limited Information, Specific Suggestions and Intensive Therapy (PLISSIT) model as a training framework, a sexuality training program was developed in one Australian SCI service. A randomized controlled trial was conducted and significant improvement was found in all domains for the treatment group – Knowledge(χ²= 46.141, p< 0.001), Comfort (χ²= 23.338, p< 0.001), Approach(χ²= 23.925, p< 0.001) and Attitude (χ²= 15.235, p< 0.001) compared to the control group. Changes were found to be maintained at three month follow-up – Knowledge (Z=−5.116, p< 0.001), Comfort (Z=−3.953, p< 0.001), Approach (Z=−4.103, p< 0.001) and Attitudes (Z=−2.655, p< 0.001). These results support the use of an individualized needs-based sexuality training program in fostering staff knowledge, comfort and attitudinal change in an interdisciplinary SCI rehabilitation service.     

The Development of a Scale to Assess the Training Needs of Professionals in Providing Sexuality Rehabilitation Following Spinal Cord Injury

The training needs of rehabilitation professionals in the area of sexuality and sexual function, particularly following spinal cord injury (SCI) has received little attention in the literature. Specifically, there is negligible theoretical discussion related to staff training needs, as well as a paucity of standardised scales to measure these needs. A conceptual model was developed encompassing staff knowledge, comfort, and attitudes towards sexuality following SCI. Using this model, a scale was developed, evaluated, and refined. Factor analysis supported the construct validity of the scale in measuring the existing conceptual model outlined but highlighted the existence of a separate construct related to personal approaches from clients. The subsequently named Knowledge, Comfort, Approach and Attitudes towards Sexuality Scale (KCAASS) demonstrated high levels of internal consistency across the four conceptual domains. The KCAASS has utility for rehabilitation facilities interested in identifying and targeting training initiatives related to addressing client sexuality needs following SCI.     

半横断模型与脊髓损伤修复

随着交通和建筑事故的增多，脊髓半切伤综合征的病人也越来越多见，以往大多数学者都集中于挤压伤或打击伤模型，但由于这些模型与临床上的半切伤受力及损伤机制明显不同。所以建立和研究半切模型中脊髓损伤的变化机制，对于临床有很重大的现实意义。本文对半横断模型与脊髓损伤修复之间关系的研究进展进行综述。     

Discussion Guide for the Sexually Explicit Educational Video Sexuality Reborn: Sexuality Following Spinal Cord Injury

The use of sexually explicit media in education is a sensitive teaching area because of the range of adverse reactions sexually graphic images may evoke. The person planning to use a sexually explicit video needs to create a safe environment with time for discussion and they must be prepared to facilitate discussion that will elicit reactions and help viewers deal with them. This paper provides clear goals, objectives, rationale, and guidelines for using Sexuality Reborn. It also provides recommended topics for discussion including references to the key scenes, discussion questions, and comments.     

Women with Complete Spinal Cord Injury: A Phenomenological Study of Sexuality and Relationship Experiences

The phenomenological study described in this paper examines the sexuality and relationship lived experiences of 15 adult women who sustained complete spinal cord injury between the levels of T6 and L2 verified by a physiatrist. Audiotaped, semi-structured interviews were conducted by an interdisciplinary team of investigators. A set of themes and sequentially consistent patterns emerged from post-injury data that were labelled: Cognitive-genital dissociation, sexual disenfranchisement, sexual exploration, and sexuality reintegration. Sexuality and relationship issues in women with complete SCI are discussed, and indications for future studies and educational implications are presented.     

Long Term Vocational Adjustment After Spinal Cord Injury: Implications for Occupational Therapists

Sixty persons with spinal cord injury were interviewed an average of 11 years after the onset of disability. They answered questions concerning their sense of identity, knowledge of self and social environment, and ability to cope with vocational decision making and other problems. These questions were part of a standardised scale of Vocational Identity. The results of this study indicate that persons experiencing high levels of well-being also reported high levels of Vocational Identity. Other variables, which were found to be important correlates of well-being in a previous study by Decker and Schulz (1985), were also associated with Vocational Identity. Implications for occupational therapists are discussed.     

Sexual Rehabilitation for Men with Spinal Cord Injury: Preliminary Report on a Behavioral Strategy

Training of the perineal muscles was attempted in our centers on the basis of our previous findings indicating that when the appropriate source of stimulation is used, subjects exhibit peaks of activity suggesting a rehabilitation potential. Muscular training was considered because pressure stimulation of the glans penis triggers contractions of perineal muscles which propel the blood throughout the penis to ensure optimal tumescence. The technique was combined with biofeedback and home exercises and was tested on 10 patients initially presenting erectile difficulty but maintaining perineal innervation. The results showed significant improvements in average and maximal tumescence and maintenance of these improvements. The results are discussed in terms of their clinical application to a cognitive-behavioral approach to sexual dysfunction in spinal cord-injured men.     

Sexual Responsiveness in Women with Spinal Cord Injuries: Differential Effects of Anxiety-Eliciting Stimulation

Sexual dysfunction is a common problem in women after spinal cord injuries (SCIs). Recently, the use of anxiety-provoking stimulation has been explored as a means of improving sexual responses in able-bodied sexually functional and dysfunctional women. In this laboratory-based study, we assessed the sexual and autonomic responses of women with SCIs with varying degrees of preservation of sympathetic innervation to their genitals to respond to anxiety-provoking audiovisual (AV) stimulation. Subjects were 45 women with SCIs and 11 able-bodied women. For purposes of analysis, SCI subjects were grouped on the basis of the degree of preservation of sensation in the T11-L2 dermatomes. Results revealed that women with low sensory scores in these dermatomes achieved higher vaginal pulse amplitude (VPA) responses to audiovisual erotic stimulation after anxiety preexposure than after neutral preexposure; however, women with SCIs and the greatest degree of preservation of sensory function in the T11-L2 dermatomes, as well as able-bodied controls, did not. Moreover, these same 2 groups of subjects had a decrease in VPA responses during baseline periods in which an anxiety-provoking video sequence was shown, but not during the neutral sequence. It is concluded that these findings are due to the proximity of sensory and autonomic neurologic elements in the spinal cord. Moreover, they demonstrate the differential effects of sympathetic stimulation on genital sexual arousal.     

气垫导轨脊髓撞击损伤试验模型的设计

目的：建立一种合理的脊髓损伤模型,以进行脊髓损伤基础研究。方法：采用气垫导轨固定撞锤轨道,改变撞击方向,改进精确定位方式。结果：改进后可有效避免撞击的二次损伤,方便了控制的改进。结论：气垫导轨式脊髓撞击损伤试验模型制作简单经济,容易实现,便于推广,具有一定的应用价值。     

Use of Sexually Explicit Films in Spinal Cord Injury Rehabilitation Programs

Sexual Attitude Reassessment (SAR) seminars, popular in the 1970s for use in progressive spinal cord injury (SCI) rehabilitation programs, have lost favor. The practice, however, of using only one sexually explicit film (SEF) as the primary method of providing sexuality education has taken its place. The use of SEFs is a sensitive teaching issue. Used properly, a SEF may facilitate a more receptive attitude toward sexuality and SCI. Used inappropriately, a SEF may result in adverse reactions. This paper reviews the theoretical rationale for using SEFs, the traditional use of SEFs in SARs that focus on attitudes and values, and empirical studies of the use of SEF. Recommendation is made for a paradigm shift from a general focus on changing attitudes and values to a more targeted focus on improving judgments of self-efficacy when using one SEF. Theoretical support is given based on observational learning and social cognitive theory.     

Sexuality, Identity and Women with Spinal Cord Injury

Sexuality is an integral component of every individual’s identity. The literature offers limited information about the sexuality and sexual identity of women with spinal cord injury (SCI), beyond the physiological and neurological aspects. The qualitative study described in this paper aimed to explore the experiences and perceptions of a small sample of adult women with SCI regarding their sexuality post-injury. Semi-structured interviews were conducted with four women, which were audio-taped and then transcribed. Thematic analysis was adopted for analyzing the narrative data. Themes that were identified include: factors facilitating positive sexual adjustment, barriers to sexuality post-injury and lack of sexual education in the rehabilitation process. Women with SCI echoed the need to be recognized as sexual beings, despite disability. Health professionals must be willing to discuss issues of a sexual nature and need an understanding of how illness or disability may impact on sexuality, in order to adequately assist individuals with physical disabilities address sexual and intimacy issues.     

Providing Comprehensive Sexual Health Care in Spinal Cord Injury Rehabilitation: Implementation and Evaluation of a New Curriculum for Health Care Professionals

A grant from the Paralyzed Veterans of America funded the development, implementation, and evaluation of a three-day interdisciplinary continuing education and training program in comprehensive sexual health care. The program was targeted toward health care professionals working in spinal cord injury (SCI) rehabilitation. The major goal of the program was to offer participants an opportunity to increase the knowledge, comfort, and skills necessary to understand and manage the sexual health care needs of people with SCI. The curriculum included clearly stated goals, behavioral objectives in operational terms, and multiple quantitative and qualitative program evaluations. In addition, the comprehensive curriculum incorporated extensive skills training including state-of-the-art standardized patient training techniques. Evaluation results indicated statistically significant and qualitatively important positive gains in knowledge, comfort, and skills. The five month follow-up study indicated that skills learned over the three-day workshop were successfully transferred to the work environment.     

中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月(平均26.5个月)随访,切口均一期愈合,骨折愈合时间:6～14个月(平均9.5个月)。术后并发症:肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义(P<0.05)。术后神经损伤按照ASIA分级:B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。     

中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗

目的探讨中上胸椎骨折脱位合并脊髓不完全性损伤的手术治疗方法及疗效。方法 2006年4月至2010年3月,采用后路减压植骨融合长节段椎弓根钉内固定治疗中上胸椎骨折脱位合并脊髓不完全性损伤患者15例,观察术前、术后随访的X线及CT片,比较伤椎的Cobb角、椎体高度和神经损伤的变化情况。结果 15例患者均获12～48个月（平均26.5个月）随访,切口均一期愈合,骨折愈合时间：6～14个月（平均9.5个月）。术后并发症：肺部感染1例,深静脉血栓l例,均经处理后痊愈,无内固定失效发生。术前和术后在伤椎的Cobb角、椎体高度丢失方面进行比较,差异有统计学意义（P〈0.05）。术后神经损伤按照ASIA分级：B级2例改善为C级,1例改善为D级;C级5例改善为D级,2例改善为E级;D级3例均改善为E级,无加重患者。结论中上胸椎骨折脱位合并脊髓不完全性损伤采用后路减压植骨融合长节段椎弓根钉内固定治疗可获得满意疗效,把握手术时机以及术中仔细操作是成功的关键。     

Spinal Cord Injury and Sexuality in Married or Partnered Men: Activities, Function, Needs, and Predictors of Sexual Adjustment

The sexual behaviors, functioning, needs, and sexual satisfaction levels of men with spinal cord injuries (SCI) were studied. A sample of 50 men with SCI (median age = 50; median age at injury = 25.0), either married or in a committed relationship, responded to an anonymous survey of a large southern California regional spinal injury rehabilitation center. Multiple regression analyses indicated that perceived partner satisfaction, relationship quality, and sexual desire were significant predictors of sexual satisfaction and behavior. Erectile function, level of genital sensation, and orgasmic capacity all varied widely in the sample, as well. However, none of these variables were significantly related to sexual satisfaction. A varied sexual repertoire was independently related to sexual satisfaction and behavior, but did not offer additional predictive power. Results suggest that for married or partnered men with SCI, relationship factors including partner satisfaction and relationship quality are significantly and positively related to sexual satisfaction. Married or partnered men with SCI who report low relationship satisfaction, have difficulty satisfying their partner, and/or report low sexual desire may benefit from assessments and interventions that address these issues.     

Barriers to Leisure-Time Physical Activities in Individuals with Spinal Cord Injury

This study investigated the personal, environmental, and activity barriers to leisure-time physical activities (LTPAs) among individuals with spinal cord injury (SCI). A survey instrument was administered to 85 participants with SCI. Personal barriers to LTPAs included issues involving motivation, pain, scheduling, and financial resources. Environmental barriers marked the issues regarding availability and accessibility to specialized programs, activities, and professional services. Activity barriers included limitations in equipment, training, and personal skills required by the selected activities. Significant negative correlations were found between these barriers and the levels of physical activity and satisfaction with physical activity. While working with clients with SCI, occupational therapists should identify those LTPA barriers and possible solutions in order to establish individualized action plans for enhancing participation in LTPAs.     

Postinjury Marriage to Men with Spinal Cord Injury: Women's Perspectives on Making a Commitment

No previous research seems to have examined why able-bodied women might choose to marry men with a significant, permanent physical impairment. This exploratory study employed a grounded theory methodology to examine the courtship experiences of 8 able-bodied women who made postinjury marital commitments to men with a spinal cord injury (SCI). A tentative model of relationship development integrated salient factors which emerged from the data. Contrary to what one might expect to find based on maladaptive motivations attributed to nondisabled mates by some authors, the present findings suggest a substantial overlap with existing models of courtship. There were evident, though, significant individual factors and external social forces influencing relationship development in the context of disability. Participants described their mates as positively adjusted to their disability and as demonstrating autonomous attitudes which, along with personality variables, were considered important elements of attraction. Participants revealed: an openness to a relationship with a partner with SCI; prior personal experience with disability; flexibility regarding role performance; acceptance of disability and need for assistance; an attitude aimed at fostering their partner's independence; and, resiliency when faced with social disapproval.