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Review
. 2017 Winter;23(1):57-70.
doi: 10.1310/sci2301-57.

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Marcalee Alexander  1   2   3 , Frédérique Courtois  4   5 , Stacy Elliott  6   7 , Mitchell Tepper  8
Affiliations
Review

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Marcalee Alexander et al. Top Spinal Cord Inj Rehabil. 2017 Winter.

Abstract

Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre- and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.

Keywords: orgasm; satisfaction; sexual arousal; sexuality; spinal cord injury; women.

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Figures

Figure 1.
Figure 1.
International Standards for Autonomic Function after SCI.
See this image and copyright information in PMC

References

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    1. Alexander MS. Sexual health. Presented at the Nordic Spinal Cord Society Meeting; May 23, 2013; Helsinki, Finland.
    1. Elliott SL. . Sexuality and fertility after spinal cord injury. : Fehlings MG, Vaccaro A, Boakye M, . et al, Essentials of Spinal Cord Injury. New York: Thieme Medical Publishers; 2013: 143– 157.
    1. Novak PP, Mitchell MM.. Professional involvement in sexuality counseling for patients with spinal cord injuries. Am J Occup Ther. 1988; 42( 2): 105– 112. - PubMed
    1. Ducharme S, Gill KM.. Sexual values, training, and professional roles. J Head Trauma Rehabil. 1990; 5( 2): 38– 45.

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