19. Sexuality in SCI

Actionable Nuggets for SCI (2nd ed., 2013)

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). Issues often arise after discharge from the rehabilitation setting, some of which can be addressed in primary care, and others that require specialized expertise. 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, anejaculation, retrograde ejaculation, potential for fatherhood, reproductive technology options. Issues for women typically include: birth control, frequent urinary and yeast infections, menstrual irregularities, fertility, menopause, pregnancy and delivery. 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 individuals 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:

    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.

Additional references:

    Anderson, K.D., et al. (2007). The impact of spinal cord injury on sexual function: Concerns of the general population. Spinal Cord45(5): 328-337. http://dx.doi.org/10.1038/sj.sc.3101977
   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.
    Fisher, T.L., et al. (2002). Sexual health after spinal cord injury: a longitudinal study. Archives of Physical Medicine & Rehabilitation83(8): 1043-51. http://dx.doi.org/10.1053/apmr.2002.33654
    Julia, P.E., & Othman, A.S. (2011). Barriers to sexual activity: Counselling spinal cord injured women in Malaysia. Spinal Cord49(7): 791-4.
    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 Sterility92(4): 1333-6.
    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 Cord44(2): 95-105.
    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 Cord48(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 Andrology33(6): 861-4.
    Kreuter, M., Taft, C., Siosteen, A, Biering-Sorensen, F. (2011). Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord49(1): 154-60.
    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 Medicine6(2): 535-43.
    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 Medicine6(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 Medicine6(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 Injury15(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 Medicine27(2): 179-85.
    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 Health5(4): 306-17.
    Widerstrom-Noga, E.G., et al. (1999). Perceived difficulty in dealing with consequences of spinal cord injury. Archives of Physical Medicine & Rehabilitation80(5): 580-6.