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.     

嗅鞘细胞治疗脊髓损伤的现状及移植途径

脊髓损伤是常见的神经系统创伤性疾病,是医学界研究的热点难题之一。随着车祸、高空坠落等高能量损伤的日益增多,其发病率和致残率呈逐年增高的趋势。本文通过对嗅鞘细胞和脊髓损伤的基础、临床研究及相关文献回顾,就嗅鞘细胞的特点、治疗脊髓损伤的研究现状和移植途径作一综述。     

Sexual Satisfaction in People with Spinal Cord Injury

The objective of this study is to extend knowledge regarding sexual satisfaction, comparing the findings among pre- and post-lesion periods and a control group. From Brazil, the participants were 90 men, of whom 40 had a spinal cord injury (SCI) and 50 had no physical disability. The instrument used was a structured open and closed–ended questionnaire. Of the 40 men with SCI, 29 had paraplegia and 11 had tetraplegia. The participants were asked about their level of sexual satisfaction: 72% of the control group declared themselves to be very satisfied; 80% of the men with SCI in the pre-lesion period also reported being very satisfied, while in the postlesion period this number fell to 47.5%. In the pre-lesion period and in the control group sexual satisfaction exhibited positive correlations with: sexual frequency; sexual stimulation; sexual desire and intensity of orgasm. Meanwhile, in the post-lesion period there were correlations between variables that are modified by the SCI: erection sufficient for penetration; reaching orgasm; achieving penetration and finding sex possible without penetration. Noteworthy, the study found that there are changes in the sexual satisfaction of men with SCI. In many cases this change results from the difficulty in maintaining a sex life similar to that experienced pre-lesion. Furthermore, new correlations with sexual satisfaction appear in the post-lesion period.     

Sexual Pursuits of Pleasure Among Men and Women with Spinal Cord Injuries

Following a spinal cord injury, sexual relationships, intimacy, and pleasure remain important pursuits for individuals. This literature review examines the subjective experiences of sexual intimacy for men and women with spinal cord injuries, as well as their intimate partners. Several themes emerged that span gender differences and nationality differences. Specifically, studies indicate that despite individual struggles with neutering internal and external perspectives, they can lead satisfying sex lives that may be more creative and mutually pleasurable than their sex lives prior to the injury. This review also provides suggestions to improve sex education and therapy following a spinal cord injury.     

The Experience of Military Sexual Trauma and Rehabilitation for Individuals with Spinal Cord Injury/Dysfunction

It has been well documented that spinal cord injury injury/dysfunction (SCI/D) can have a substantial impact upon psychological functioning. The complications that are produced by such an event include an array of physical issues (e.g., incontinence, impotence) to social difficulties (e.g., social resource access). Originally, the rehabilitation treatment focused on the physical impairment and psychological effects on the individual. For example, literature on sexuality after injury has examined the areas of the sexual response cycle, reproductive functioning, sexual behavior, and adjustment. Today, as the professional's awareness of the incidence of sexual trauma increases, assessing the impact of trauma history is an important healthcare consideration. Within the VA Healthcare System, military sexual trauma history is routinely screened. The complexities of working with individuals with SCI/D and sexual trauma can be challenging as some may lack effective verbal and social skills necessary for resolving interpersonal conflicts and advocacy. A pragmatic clinical model to utilize social skills deficit training is described in conjunction with specific sexual trauma treatment, as a way of increasing effective working relationships to maximize rehabilitation potential. Reprinted with permission from AASCIPSW, SCI Psychosocial Process.     

Sexuality After Injury: Interviews with Women After Traumatic Spinal Cord Injury

The aim of this study is to illuminate sexual experiences in women after traumatic spinal cord injury (SCI), including psychological, physical and social barriers that will have to be overcome to resume a sexually active life with a partner. Interviews with eight women were performed. The women were 20–43 years old, previously healthy, with experience of stable heterosexual relationships both before and after SCI. The interviews covered three main areas: 1. The first sexual contact after injury: expectations, concerns, outcome; 2. Communication with partner on sexual matters, before and after injury; and 3. Sexual activity after injury: limitations, compensatory strategies. In addition, advice from the women to newly injured and rehabilitation staff/counselors was requested. Results suggest a strong influence of pre-injury sexual behaviour on post-injury sexual adaptation. A positive attitude towards sexuality and good communicative skills seem to be of particular importance for a favourable outcome of sexual rehabilitation. Even under such circumstances, however, SCI as a rule leads to significant loss of sexual ability. A realistic approach is therefore recommended in counseling, taking the mourning of loss of function into consideration, and allowing the patients to express their grief. Thus, sexual rehabilitation programs need to address a dynamic process of mourning and coping, rather than merely teaching skills for having sexual intercourse after SCI.     

Semen Quality in Males with Spinal Cord Injury: Medical and Psychological Aspect

Lower paraplegia is an important medical condition that presents a significant life challenge. One important concern in male with lower paraplegia is the complications in reproductive function. Indeed, sexual function is confirmed for the interrelationship between sexual function and autonomic dysreflexia. Sexual and genital prognosis in adult paraplegics is a present focus and will be presented in this article.     

脊髓损伤住院病人的医疗和非医疗费用调查分析

目的调查脊髓损伤住院病人的医疗和非医疗费用的支付情况及其主要影响因素.对损伤后疾病负担做出基本估计,为残疾预防,促进与维护健康提供有价值的参考依据.方法以1998-2001年脊髓损伤康复科出院患者的原始资料为依据,自行设计费用调查问卷.资料应用SPSS完成.结果111例脊髓损伤住院病人医疗费用占总费用占58.03%,非医疗费用占41.97%.康复训练费用仅占医疗费用的12.86%.脊髓不完全性损伤费用多,康复治疗效果明显,患者的期望值高,因此住院时间较长.费用来源于公费、肇事责任方的患者平均住院日及费用无明显差异,自费患者住院天数、医疗费用明显减少.在脊髓损伤后非医疗费用中,陪护费占34.26%.结论遏止交通事故,工业伤害,减轻社会的总体负担;要逐步降低康复医院的药品费用的比重,提高康复训练中技术服务价值:应将脊髓损伤纳入重大疾病预防控制工作.     

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.     

Impact of Sperm Collection Methods on Sperm Parameters in Spinal Cord Injured Men and Compared to Normal Controls in ICSI Program

Background To determine and compare the effect of electro ejaculation (EE), Masturbations, Penile vibratory stimulation (PVS), Percutaneous Epididymal Sperm Aspiration (PESA) on the quality and quantity of sperm parameters in the aspect of assisted reproduction.Methods A retrospective study on collected semen of 89 spinal cords injured (SCI) men (EE = 70, Mast = 3, PVS = 6, PESA = 10 individuals) and 49 neurologically intact men (EE = 5, Mast = 14, PVS = 30) with different methods were included and intracytoplasmic sperm injection (ICSI) with homologue oocytes were performed.Results The quality and quantity of semen in SCI was significantly lower than neurologically intact men (P < 0.01), and showed reduction of sperm parameters in compare with normal group including; 23.19% in motility, 14.56 % in normal morphology, and 41.51%in viability (P < 0.001). Within normal group the EE method has significantly influence on sperm parameters (P < 0.01). In SCI group the morphology was severely impaired. Hyper leukocytes significantly increased (P < 0.01). The fertilization rate of EE/ICSI was 60% which was lower than other methods of semen collection (71.7%).Conclusions The EE method of semen collection compared with PVS and other methods of normal ejaculatory stimulation showed significantly lower grade of sperm parameters. EE/ICSI is effective in treating an ejaculatory infertility. For ejaculatory stimulation it is recommended to Consider PVS as the first line of treatment in SCI men. PESA can be considered when EE and PVS both fail to cause seminal emission.     

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.     

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。     

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。     

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.     

我国脊髓损伤患者延续性护理研究进展

介绍我国延续性护理在脊髓损伤患者中的发展状况,总结我国脊髓损伤延续性护理的开展内容、形式以及效果,指出脊髓损伤延续性护理发展中存在的主要问题,提出改进建议,并对脊髓损伤延续性护理的发展前景进行展望,旨在充分发挥延续性护理在脊髓损伤患者康复中的作用,促进其进一步的发展。     

外源性供氧和超氧化物歧化酶对脊髓损伤的保护作用

目的　观察外源性供氧和超氧化物歧化酶 (SOD)保护受损伤脊髓 ,促进其功能恢复的作用。方法　采用Allen’s法于兔L2 椎体水平造成急性脊髓损伤。对照组不予治疗 ,治疗组分别在伤后 3 0min开始给药。于伤后 12h ,测定脊髓组织丙二醛 (MDA)及SOD活性 ,四周后进行病理形态学观察。结果　联合应用外源性供氧和SOD ,在抑制MDA生成 ,增强SOD活性方面较单一用药显著 (P <0 0 5 )。伤后四周末外源性供氧组 (2 9± 1 1)级 ,SOD组 (2 8± 1 2 )级 ,联合用药组 (3 1± 0 8)级 ,对照组 (1 1± 0 9)级 ,三个治疗组的肌力恢复均好于对照组 (P <0 0 5 )。组织形态学检查联合用药组的病理改变较单一用药组轻。结论　脊髓损伤后早期外源性供氧和SOD协同作用 ,能有效抑制脊髓损伤后的脂质过氧化反应 ,对继发性脊髓损伤有保护作用。     

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.