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.     

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.     

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.     

Relevant Resources for Sexuality and Spinal Cord Injury

Sexuality and Disability -     

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.     

If not the Disability, then what? Barriers to Reclaiming Sexuality Following Spinal Cord Injury

Human sexuality has been medicalized and largely reduced to its physical components. This has led to a focus on the performative part of sexuality, and to a lack of interest in its social component. Men with spinal cord injury often report an unsatisfying sexual life, with limited chances to express their sexuality. This study shows that sociocultural barriers may be as disabling as physical impairment. The participants of this qualitative study felt that several barriers compromised their right to a satisfying sexual life, including certain social beliefs and attitudes (e.g. social disapproval and exclusive notion of sexuality), lack of employment, inappropriate personal assistance and inaccessibility among others. Impairment per se was not viewed as a barrier, since the new situation assumed status of normality. It is suggested that changes in education as well as the removal of physical barriers may positively influence societal attitudes and make sexuality more “accessible” to disabled people.     

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。     

Experiences of Parents with Spinal Cord Injury

Parenting is a rewarding challenge to be experienced by any adult, regardless of ability. This small scale qualitative study seeks to understand the experiences of parents with spinal cord injury (SCI) and their use of aids and adaptations in caring for their young children. Twelve parents with SCI were interviewed at either Toronto Rehabilitation Institute in Toronto, or in their homes. Data were analyzed using a grounded theory thematic approach. Themes identified included: (1) Psychosocial Aspect of Parenting, (2) Social Attitudes, (3) Division of Labour, (4) Physical Aspect of Parenting, and (5) Resources and Services. These themes enabled the development of an emerging model for managing childcare. Findings led to recommendations for parents with SCI, healthcare providers, and manufacturers of assistive technology to provide strategies for managing child care, improve access and availability of resources, services, and products.     

The Sexual Health Needs of Women with Spinal Cord Injury: A Qualitative Study

Sexual health as an important aspect of reproductive health, is a foundation for physical and emotional health which also affects couples and families’ wellbeing. Furthermore, disability could impact couple’s sexual relationships. Studies show that people with physical disability receive less sexual education which in turn exposes them to a higher risk for sexually transmitted infections. This qualitative study explored the sexual needs of women with spinal cord injury (SCI) aged 18–55 years old living in Tehran. In depth and individual semi-structured interviews were hold for data collection until data saturation was reached. They were recruited from the Organization of Welfare and Protection Center of Spinal Cord Disables of Iran. In this study 23 individuals were chosen using purposive sampling. The collected data was analyzed using the content analysis approach suggested by Graneheim and Lundman. The sexual health needs of women with SCI was explained in two themes and nine categories. The themes were “physical rehabilitation” and “couples’ sexual consultation”. The categories of the first theme were “resolving physical problems contributing to sexual relationships” and “complementary medicine application”. The categories of the second theme were “the husband’s emotional support”, “concentration”, “protecting sexual health”, “the need for having sexual relationships”, “diminishing factors for unpleasant sexual relationships”, “paying attention to wife’s readiness to start sexual relationships” and “decreasing factors that suppress spouse’s sexual desire”. This study showed that women with spinal cord injury require sexual rehabilitation. They overcome their physical problems with the help of complementary medicine and sexual counselling around the aforementioned categories for promoting the quality of their sexual health.     

Sexual Dysfunction Following Spinal Cord Injury: the Experiences of Malaysian Women

The aim of the study is to assess the changes in sexual life and sexual function in women after spinal cord injury using the validated Malay Version of Female Sexual Function Index. Thirty-three women with spinal cord injury from the Spinal Rehabilitation Unit of a tertiary hospital in Malaysia participated in this study. A comparison was made between this group of women and a control group comprising 34 women matched for age and marital status. The findings showed that 40% of the women continued to have sexual activity after injury. Frequency of sexual activity and desire was lower among women with spinal cord injury, but the ability to achieve arousal, lubrication, orgasm and overall sexual satisfaction did not differ from those of the control group. These findings imply that it is possible for women with spinal cord injury to have an active, satisfying sexual life in spite of changes in sexuality caused by the injury.     

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.     

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.     

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.     

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.     

The Impact of Urinary Incontinence on Sexual Function and Sexual Satisfaction in Women with Spinal Cord Injury

Sexual function is a major concern for many individuals following spinal cord injury (SCI). Sexuality after SCI is a complex issue that is influenced by a number of social, psychological and physiological factors, including urinary incontinence (UI). To examine the experience of sexuality for women with SCI, to determine the impact of UI on sexual function and sexual satisfaction in these women, and to identify their main concerns regarding UI and sexuality. Using a phenomenological approach, seven in-depth interviews combining the interview guide approach and standardized open-ended questions were conducted. Two main categories were identified: Sexuality and the impact of UI on sexuality. Related themes were uncovered within each category. Both categories revealed emerging themes including 13 for sexuality and 10 for the impact of UI on sexuality. Five additional themes relevant to the research question but that did not fit into the initial categories were also identified. Intimacy and the sexual experience were negatively affected by UI as a result of SCI, and by an excessive concern about autonomic dysreflexia. There is a significant shortage of information available for women with SCI regarding sexual function in general, but more specifically, a lack of information on sexual function as it relates to UI. Future research should focus on creating resources to assist in this area which may improve the quality of life for these individuals.     

Carbohydrate Considerations for Athletes with a Spinal Cord Injury

The Paralympic movement is growing in popularity, resulting in increased numbers of athletes with a spinal cord injury (SCI) competing in various sport disciplines. Athletes with an SCI require specialized recommendations to promote health and to maximize performance, as evidenced by their metabolic and physiological adaptations. Nutrition is a key factor for optimal performance; however, scientifically supported nutritional recommendations are limited. This review summarizes the current knowledge regarding the importance of carbohydrates (CHO) for health and performance in athletes with an SCI. Factors possibly affecting CHO needs, such as muscle atrophy, reduced energy expenditure, and secondary complications are analyzed comprehensively. Furthermore, a model calculation for CHO requirements during an endurance event is provided. Along with assessing the effectiveness of CHO supplementation in the athletic population with SCI, the evaluation of their CHO intake from the available research supplies background to current practices. Finally, future directions are identified. In conclusion, the direct transfer of CHO guidelines from able-bodied (AB) athletes to athletes with an SCI does not seem to be reasonable. Based on the critical role of CHOs in exercise performance, establishing recommendations for athletes with an SCI should be the overall objective for prospective research.     

兔脊髓缺血再灌注损伤实验的护理

目的探讨新西兰兔动物模型在脊髓缺血再灌注损伤建立过程的护理配合,以保证手术的顺利进行。方法新西兰大白兔18只,随机分成三组,每组6只,分为缺血再灌注组、乌司他丁后处理组及假手术组。所有参与实验的新西兰大白免术前、术中和术后均实施严格的整体护理。结果18只实验动物均顺利建立脊髓缺血再灌注损伤模型,术后48h均存活,顺利完成实验。结论在脊髓缺血再灌注损伤手术中实施严格的护理措施有利于动物手术的顺利实施。     

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。