19. Sexuality and SCI

Actionable Nuggets for SCI (3rd ed., 2016)

Sexual activity, sexual function and reproductive issues should be addressed as part of an annual examination.

The Problem:

Depending on lesion level, a variety of disruptions to sexuality, sexual functioning and fertility may occur after spinal cord injury (SCI).  The majority of individuals with SCI report that sexual function is important to quality of life, and have had at least one sexual relationship post-injury.

Evidence-based Best Practice:

The family physician should be prepared to have candid preliminary discussions about issues and expectations regarding sexual functioning and reproduction. Body image, sexual identity and options for sexual expression are issues for both sexes. Issues for men typically include: erectile dysfunction, ejaculatory dysfunction and potential for fatherhood. Issues for women typically include: birth control, urinary and yeast infections, vaginal lubrication, menstrual irregularities, fertility, pregnancy & delivery, and menopause. Family physicians may wish to refer to a rehabilitation specialist for expert information on sexual and reproductive options.

There is evidence in favour of safety and effectiveness of Phosphodiesterase-5 inhibitors (PDE5i; eg., Viagra) for sexual dysfunction in men with SCI. Screening for cancer of sexual and reproductive organs should follow standard guidelines, but has been shown to be significantly below guideline levels. There is also increased risk for sexual abuse of patients with SCI who are dependent upon others (such as attendants or family members) for personal care.

Key reference:

Courtois, F. & Charvier, K. (2015). Sexual dysfunction in patients with spinal cord lesions. Handbook of Clinical Neurology, 130, 225-45.

Additional References (chronological order):

    Ibrahim, E., Lynne, C. M., & Brackett, N. L. (2016). Male fertility following spinal cord injury : an update. Andrology, 4, 13–26. http://doi.org/10.1111/andr.12119
    Ferreiro-velasco, M. E., Barrera, S. S. De, & Arias-pardo, A. I. (2015). Sexual satisfaction in women with spinal cord injuries. Spinal Cord, 53(October 2014), 557–560. http://doi.org/10.1038/sc.2015.53
    Charvier, K., Carrier, S., & Journel, N. M. (2013). C LINICAL A PPROACH TO S EXUAL D YSFUNCTIONS. Functi, 3(1), 59–81.
    Hartshorn, C., Castro, E. D., & Adams, J. (2013). “ SI-SRH ” – a new model to manage sexual health following a spinal cord injury : our experience. Journal of Clinical Nursing, 22, 3541–3548. http://doi.org/10.1111/jocn.12449
    Biering-sørensen, I., Hansen, R. B., & Biering-sørensen, F. (2012). Sexual function in a traumatic spinal cord injured population 10 – 45 years after injury. Journal of Rehabilitation Medicine, 44, 926–931. http://doi.org/10.2340/16501977-1057
    Hess, M. J., & Hough, S. (2012). Impact of spinal cord injury on sexuality : Broad-based clinical practice intervention and practical application. The Academy of Spinal Cord Injury Professionals, 35(4), 211–218.
    Parker, M. G., & Yau, M. K. (2012). Sexuality , Identity and Women with Spinal Cord Injury. Sex and Disability, 30, 15–27. http://doi.org/10.1007/s11195-011-9222-8
    Rahimi-movaghar, V., & Vaccaro, A. R. (2012). Management of Sexual Disorders in Spinal Cord Injured Patients. Acta Medica Iranica, 50(5), 295–299.
    Rizio, N., Tran, C., & Sorenson, M. (2012). Efficacy and satisfaction rates of oral PDE5is in the treatment of erectile dysfunction secondary to spinal cord injury : A review of literature. The Journal of Spinal Cord Medicine, 35(4), 219–226.
    Julia, P.E., & Othman, A.S. (2011). Barriers to sexual activity: Counselling spinal cord injured women in Malaysia. Spinal Cord, 49(7), 791-4.
    Kreuter, M., Taft, C., Siosteen, A, Biering-Sorensen, F. (2011). Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord, 49(1), 154-60.
    Sheldon, A.P., Renwick, R., & Yoshida, K.K. (2011). Exploring body image and self-concept of men with acquired spinal cord injuries. American Journal of Men’s Health, 5(4), 306-17.
    Middleton, J.W., De Wolfe, A., Cameron, I.D., Elliott, S., McBride, K., Breen, S., & Abramson, C. (2010). Sexual health following spinal cord injury. In: Eng JJ, Teasell, R.W., Miller, R.C., Wolfe, D.L., Townsen, A.F., Hsieh, J.T.C., Connolly, S.J. et al. editors. Spinal Cord Injury Rehabilitation Evidence, Version 3.0 Vancouver, 1-67.
    Consortium for Spinal Cord Medicine (2010). Sexuality and reproductive health in adults with spinal cord injury: A clinical practice guideline for health care providers. Washington, DC: Paralyzed Veterans of America.
    Kennedy, P., Sherlock, O., McClelland, M, Short, D., Royle, J., & Wilson, C. (2010). A multi-centre study of the community needs of people with spinal cord injuries: The first 18 months. Spinal Cord, 48(1), 15-20.
    Khorrami, M.H., Javid, A., Moshtagi, D. Nourimahdavi, K., Mortazavi, A. & Zia, H.R. (2010). Sildenafil efficacy in erectile dysfunction secondary to spinal cord injury depends on the level of cord injuries. International Journal of Andrology, 33(6), 861-4.
    Kanto, S., Uto, H., Toya, M, Ohnuma, T., Arai, Y, & Kyono, K. (2009). Fresh testicular sperm retrieved from men with spinal cord injury retains equal fecundity to that from men with obstructive azoospermia via intracytoplasmic sperm injection. Fertility and Sterility, 92(4), 1333-6.
    Lombardi, G., Macchiarella, A., Cecconi, F., & Del Popolo, G. (2009). Ten-year follow-up of sildenafil use in spinal cord-injured patients with erectile dysfunction. Journal of Sexual Medicine, 6(12), 3449-57.
    Lombardi, G., Macchiarella, A., Cecconi, F., & Del Popolo, G. (2009). Ten years of phosphodiesterase type 5 inhibitors in spinal cord injured patients. Journal of Sexual Medicine, 6(5), 1248-58.
    Mona, L.R., et al. (2009). Prescription for pleasure: Exploring sex-positive approaches in women with spinal cord injury. Topics in Spinal Cord Injury, 15(1), 15-28.
    Ohl, D.A., Quallich, S.A., Sonksen, J., Brackett, N.L., Lynne, C.M. (2009). Anejaculation: An electrifying approach. Seminars in Reproductive Medicine, 27(2), 179-85.
    Lombardi, G., Macchiarella, A., Cecconi, F., & Del Popolo, G. (2008). Efficacy and safety of medium and long-term tadalafil use in spinal cord patients with erectile dysfunction. Journal of Sexual Medicine, 6(2), 535-43.
    Anderson, K.D., et al. (2007). The impact of spinal cord injury on sexual function: Concerns of the general population. Spinal Cord, 45(5), 328-337. http://dx.doi.org/10.1038/sj.sc.3101977
    Kennedy, P., Lude, P., & Taylor, N. (2006). Quality of life, social participation, appraisals and coping post spinal cord injury: a review of four community samples. Spinal Cord, 44(2), 95-105. http://dx.doi.org/10.1038/sj.sc.3101787
    Fisher, T.L., et al. (2002). Sexual health after spinal cord injury: a longitudinal study. Archives of Physical Medicine & Rehabilitation, 83(8), 1043-51. http://dx.doi.org/10.1053/apmr.2002.33654
    Widerstrom-Noga, E.G., et al. (1999). Perceived difficulty in dealing with consequences of spinal cord injury. Archives of Physical Medicine & Rehabilitation, 80(5), 580-6. http://dx.doi.org/10.1016/S0003-9993(99)90203-4