Spinal cord injury and women's sexual life: case-control study

Factors affecting sexual health in individuals with spinal cord injury: A systematic scoping review

PURPOSE

This study aims to review the literature to explore some factors affecting sexual and partnership adjustment in individuals with spinal cord injury (SCI).

METHODS

This study was based on the methodological framework of scoping reviews, including 3 methodological steps: (1) identifying relevant studies (searching for related studies); (2) selecting related studies; (3) collecting key findings, summarizing, and reporting the results. The electronic databases were searched including Medline (PubMed), Scopus, Web of Science, Embase, and Cochrane Library. Studies were included if they reported data about the related factors of sexual and partnership adjustment in individuals with SCI. No limitations were considered in terms of time or methodology of the search.

RESULTS

After the full-text screening, 52 studies were included from the year of 1978 - 2019 with various methodologies. The present review demonstrated that proper sexual health among individuals with SCI is related to several factors including the anatomical factor, level of the injury, completeness of the injury, psycho-social factor, socio-economic status, and type of relationship.

CONCLUSION

With consideration of factors affecting sexual and partnership adjustment in individuals with SCI, a better estimation of sexual health can be achieved in clinical to improve the relationship and quality of life.

Women's sexual health improvement: sexual quality of life and pelvic floor muscle assessment in asymptomatic women

Introduction

Problems related to the quality of sexual life in gynecological practice are usually neglected. This study aimed to highlight the significance of this area of concern and evaluate the usefulness of tools, such as patient-reported outcomes (PROs) and pelvic floor examination, to improve women's sexual wellbeing and to identify predictors of poor quality of sexual life during the well-woman annual visit.

Methods

A cross-sectional study was designed to examine 300 healthy women to determine whether the sexual quality of life (SQOL) questionnaire (on electronic devices) and pelvic floor muscle assessment (the vulva, anus, muscles, and periurethral (VAMP) protocol) of asymptomatic women during the annual bimanual examination (BME) help differentiate patients who would benefit from discussing sexual problems with a gynecologist. Dyspareunia was an exclusion criterion.

Results

The majority of subjects experienced high sexual wellbeing (82.0% with SQOL score of ≥84), with a mean of 85.7 points. SQOL scores were lower for psychiatric disorders or symptoms (37.0% of subjects), although they did not correlate with age, BMI, parity, contraception use, history of vulvovaginal symptoms, neurosurgical/orthopedic problems, and rectal, bowel, or bladder symptoms. Patients with dyspareunia (16.0% of participants, although they denied it during the face-to-face consultation) had a 3.6 times higher prevalence of low or moderate quality of sexual life. The VAMP protocol score was low in asymptomatic women, 33.0% met positive criteria (VAMP+, NRS ≥3) for pelvic floor dysfunction (overactivity), although at borderline levels. VAMP+ was positively correlated with chronic pain and genitourinary symptoms, but neither with dyspareunia nor incontinence, and was unrelated to the SQOL score (p = 0.151).

Conclusion

Women's sexual health is a global health priority. Finding a way to start a discussion with an asymptomatic patient is crucial to increasing patients' interest in disclosing a sexual health problem to be resolved. PROs or simple questions about sexual wellbeing direct the discussion mainly toward the at-risk group for sexual deterioration: those with mental health problems and women with dyspareunia. Dyspareunia is considered a predictor of decreased quality of sexual life, a major sexual disorder that should not be overlooked. Gynecological consultation should resolve concerns, identify the problem, and refer for professional sexual care if still needed.

Dyadic adjustment and the relationship between sexual self-consciousness and sexual dysfunction in individuals with spinal cord injuries: A descriptive study

PURPOSE

This study was conducted to determine the dyadic adjustment between individuals with SCI and their spouses and the relationship between their sexual self-consciousness and sexual life and to evaluate it according to the objectification theory.

METHOD

This descriptive and cross-sectional study was conducted with 131 married individuals with SCI registered in the physical therapy and rehabilitation outpatient clinic of a university hospital between February 2020 and April 2021. The data of the study were collected using a Descriptive Information Form, the American Spinal Injury Association Impairment Scale (ASIA), the Dyadic Adjustment Scale (DAS), the Sexual Self-Consciousness Scale (SSCS), and the Arizona Sexual Experiences Scale (ASEX). In the study, the predictors of the sexual life of individuals with SCI were evaluated with the Stepwise Multiple Linear Regression analysis. In addition, predictors of sexual dysfunction in individuals with SCI were evaluated by the logistic regression analysis. The results were discussed within the framework of objectification theory.

RESULTS

According to the results of the study, .67.2% of the individuals with spinal cord injuries experienced sexual functionality problems; increased age, falling injuries, and being in ASIA grade A increased sexual self-awareness and sexual dysfunction; and being a male with SCI increased sexual focus. It was found that the adjustment between individuals with SCI and their spouses was a predictor that significantly reduced sexual embarrassment, sexual self-consciousness, and sexual dysfunction and that the strong adjustment between couples was an important factor for the prevention of sexual dysfunction development.

CONCLUSION

It was found that most individuals with spinal cord injuries experienced sexual dysfunction. The importance of dyadic adjustment and sexual self-consciousness has come to the fore in the sexual life of these individuals.

Breaking the taboo: qualitative analysis of the sexuality in people with acquired motor disability

BACKGROUND

Globally 1 in 7 people experience some type of disability. In Latin America, as in other regions, there are programs focused on the protection of sexual and reproductive rights of this population group. However, to date, in Peru there are no programs, protocols or guidelines that include a specialist (sexologist or trained health professional) in the health system to improve the quality of life and well-being of this population. Therefore, the objective of this article is to qualitatively analyze the experience of sexuality in people with acquired motor disabilities.

METHODS

We used the interpretative phenomenological approach and the semi-structured in-depth interview composed of 60 questions, which was applied to 7 people (4 women and 3 men) with acquired motor disabilities.

RESULTS

Diversity in the experience of sexuality was observed. While some experience it without fear, others have annulled their sexual encounters, because in addition to physical limitations, they experience psychosocial limitations such as pain, functional alterations, depression, low self-esteem, discrimination, exclusion, stigmas and socio-environmental barriers, among others. Likewise, the study reflected the double discrimination suffered by women (for being a woman and having a disability), as well as the lack of education, counseling or sex therapy by specialized professionals, and the influence of religion, society and culture as factors that condition and limit their sexuality. This reflects the current situation in Peru and other countries in the region, where the sexuality of people with disabilities continues to be a complex and ambiguous issue.

CONCLUSIONS

It is concluded that for some participants it is possible to experience sexuality without fear, while others hold back their experiences for reasons other than physical, self-esteem, social discrimination, among others. The review of the profile and level of specialization of the health services professionals involved in the integral medical care of people with disabilities and their couples is required because of their need for adequate and specialized attention for their better adaptation to the new condition.

Vibration or Transcutaneous Tibial Nerve Stimulation as a Treatment for Sexual Dysfunction in Women with Spinal Cord Injury: Study Protocol for a Randomized Clinical Trial

BACKGROUND

Women with spinal cord injuries usually suffer from sexual dysfunction, such as alterations during arousal and an increase in the time to reach orgasm. However, little evidence has been found on its physiotherapeutic approach, as well as poor adherence to the latter. The aim of this study is to determine the effectiveness of two interventions to improve sexual dysfunction: the application of genital vibration and transcutaneous tibial nerve stimulation.

METHODS

This is a randomized clinical trial that will recruit 54 women who, one year after a spinal cord injury, suffer from sexual dysfunction associated with the latter. The participants will be randomized to three groups: (a) intervention group 1 treated with transcutaneous tibial nerve electrostimulation (n = 18), (b) intervention group 2 treated with genital vibration (n = 18), and (c) a control group (n = 18). The treatment time will be 12 weeks. Adherence to the treatment will be evaluated, as well as the effectiveness of the treatment, through the Female Sexual Function Index, the Sexual Quality of Life-Female questionnaire, quantitative sensory tests, and the improvement reported by the patient in terms of arousal and orgasm. The evaluations will be carried out before the treatment, at the end of the treatment and 3, 6 and 12 months after the end of the treatment.

Sexual Quality of Life-Female (SQoL-F): Cultural Adaptation and Validation of European Portuguese Version

The Sexual Quality of Life-Female (SQoL-F) questionnaire was developed with qualitative data to assess the impact of sexual dysfunction in women. Objectives: the aim was to conduct a cross-cultural adaptation and psychometric analysis of a European Portuguese version of the Sexual Quality of Life-Female questionnaire. Methods: Methodological study of the processes of translation and cultural adaptation. This is a retrospective study in which nursing students participated. Data collection: Lime Survey platform in a convenience sample was carried out in two stages, the latter being re-testing data. The instrument analysed, presented as a latent variable, consisted of 18 items on a Likert scale. The study was approved by the Ethics Committee. Participants: the sample was 113 women, mean age 21.99 years (±3.76), attending classes in the first 4 years of the first cycle of nursing. Results: Reliability was analysed and stability was found in the test–retest (rs = 0.658) and in the intraclass coefficient (rs = 0.821). The internal consistency analysis showed an alpha value of 0.846. Discriminant validity analysis using the Mann–Whitney test revealed a higher score of the quality of sexual life of students living with parents/surrogates. Factor validity analysis was conducted using Oblimin rotation with four-, three- and two-factor tests. Parallel analysis of the empirical matrix compared to the random matrix showed that the instrument was unidimensional. Conclusions: the assessment of the properties of the SQoL-F is valuable, as the provision of a valid and reliable instrument contributes to the quality of subsequent studies, including for local and multicentre research.

Measuring Sexual Performance: Development and Psychometric Properties of the Sexual Performance Questionnaire in Iranian People with Spinal Cord Injury

Sexual performance refers to activities served by sexual capacity and motivation. As a culturally sensitive issue, to date the scalar invariance of sexual performance has not been examined for Iranians with spinal cord injuries (SCIs). Aim: To develop and assess properties of an instrument evaluating sexual performance of an Iranian population with SCIs., in Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Using multi-modal methods, we developed and assessed the Sexual Performance Questionnaire (SPQ). This included collecting expert opinions; engaging with patients with SCI referred to BASIR; pilot testing to assess the scale; and a formal investigation. Participants (men = 156, women = 58) completed the SPQ. Internal consistency and reliability were measured using Cronbach's α coefficient. Content and face validity were examined by academic experts. Construct validity was assessed by examining convergent and discriminant validity. Finally, exploratory factor analysis was used to extract the factor structure of the questionnaire. The Cronbach's α coefficient was 0.77. There was a significant (p = 0.04) correlation (r = - 0.23) between the SPQ score and age. Those with a partner scored higher (p = 0.001). We found three components: Spouse as initiator, self-initiation, and genital-oriented sex which accounted for 59% of the observed variance. The face and content validity was approved by an expert committee. The development and application of the 13-item SPQ provides a thorough understanding of sexual performance amongst persons with SCI. It facilitates the development of efficient sexual rehabilitation interventions and SCI-specific sexuality education programs.

Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study

STUDY DESIGN

Cross-sectional explorative observational study.

OBJECTIVES

To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI).

SETTING

Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI).

METHODS

Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older.

RESULTS

Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising.

CONCLUSION

this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a "learning health system". Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment.

An evaluation of the factors that affect the sexual satisfaction of people with spinal cord injuries

Objective: To evaluate the relationships between the variables that affect the sexual satisfaction of patients with spinal cord injuries.Design: Descriptive and cross-sectional survey.Setting: The physical medicine and rehabilitation outpatient clinic of a university hospital in Turkey.Participants: This study was performed from July to December2018. It included 103 patients with spinal cord injuries.Outcome Measures: The data were collected using an introductory information form, the American Spinal Injury Association Impairment Scale and the Golombok Rust Inventory of Sexual Satisfaction. Data were evaluated using the chi-square test, the Mann-Whitney U test, the Kruskal-Wallis test and linear regression.Results: The total mean scores on the Golombok Rust Inventory of Sexual Satisfaction were 40.2 ± 21.6 for males and 44.9 ± 18.1 for females. According to the linear regression analysis, model VII presented the best results of the relationship between physiological and psychological determinants that affect the sexual satisfaction of patients with spinal cord injuries. Model VII consisted of the variables of ASIA A and B scores, age, injury due to falling from height, being a housewife, and thinking of being unable to reach future goals. These explained 75.4% of the variation in sexual satisfaction scores.Conclusion: The participants' mean scores on the Golombok Rust Inventory of Sexual Satisfaction were found to be affected by various variables. A significant relationship between their mean scores on the American Spinal Injury Association (ASIA) Impairment Scale and the Golombok Rust Inventory of Sexual Satisfaction was determined.

Sexual dysfunction in women with spinal cord injury living in Greece

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To provide data on the rates of sexual dysfunction (SD) among the Greek spinal cord injury (SCI) women and to investigate any association with demographic and clinical variables.

SETTING

Greek territory.

METHODS

Our sample was enrolled from rehabilitation institutes throughout Greece and included 30 women with SCI living in the community for at least 1 year after the primary inpatient rehabilitation program. They were assessed for SD using the Female Sexual Function Index (FSFI). Pearson's test was performed to examine the correlation of SD with clinical-demographic parameters as defined by specific questionnaires: Satisfaction With Life Scale (SWLS), World Health Organization Quality of Life-BREF (WHOQOL-BREF), Spinal Cord Independence Measure (SCIM), Patient Health Questionnaire (PHQ-9), Craig Handicap Assessment and Reporting Technique (CHART).

RESULTS

SD was revealed in 63.3% of the study participants. The mean FSFI score was 14.4. Pearson's analysis showed that age was negatively correlated with FSFI scores (p = 0.006), while pain had a negative impact only on desire scores (p = 0.04). FSFI scores were negatively correlated with PHQ-9 (p = 0.04), while there was a positive correlation with SWLS (p = 0.003), SCIM (p = 0.013), and specific domains of WHOQOL-BREF (psychological, relations, environment), and CHART (mobility, social integration).

CONCLUSIONS

The rate of SD (63.3%) generally agrees with the findings of high rates in most of the literature, although it is rather lower, in comparison to other populations. Old age and depressive symptoms were the major identified determinants of SD.

Sexual Competence in Higher Education: Global Perspective in a Multicentric Project in the Nursing Degree

Sexuality is an important issue in the university careers of nursing students to ensure that they provide comprehensive care. It is necessary according to the recommendation of the World Health Organization. However, research reveals deficiencies and the need for further development. The aim of the study is to describe the perspective of teachers and students on the content of sexuality in nursing education. The project aims to analyze the attitudes and beliefs of the students about the sexuality of their patients. Furthermore, the experience and sexual lives of the future nurses, as well the teaching of sexuality content in the curriculum, will be analyzed. As for the educators, their level of knowledge about sexuality and vision of sexuality education in undergraduate nursing education will be analyzed. This study is an exploratory and descriptive study with a quantitative-qualitative approach in a multi-center context. The sample is composed of students and professors of nursing courses from five universities (Portugal, Spain, Italy and United States). Questionnaires and semistructured interviews will be used for data collection. The results of the study will allow the inclusion of sexual competence in the curriculum from the beginning in higher education. This article describes the research protocol.

Metabolic syndrome is the key determinant of impaired vaginal lubrication in women with chronic spinal cord injury

PURPOSE

Spinal cord injury (SCI) affects sexual health of both male and female, but little attention has been given to sexuality of SCI women. Similar to penile erection, vaginal lubrication represents a neurovascular event and then both denervation and vascular damage might contribute to its impairment. Nevertheless, the relative weight of lesion location/degree and vascular risk factors in determining hypolubrication in women with SCI has not yet been investigated. The aim of this study was to recognize among putative determinants of poor sexual arousal in women with SCI, neurogenic and vascular/metabolic independent predictors of vaginal hypolubrication.

METHODS

Twenty-eight consecutive female patients admitted to a rehabilitation program because of chronic SCI (≥ 1 year) underwent clinical and biochemical evaluations, including assessment of vaginal lubrication by the Female Sexual Function Index (FSFI). As, in people with SCI, waist circumference overestimates visceral fat mass due to abdominal muscle paralysis, metabolic syndrome (MetS) was defined according to specific criteria proposed for SCI population: BMI ≥ 22 kg/m² and two or more of the following: triglycerides ≥ 150 mg/dL (or actual treatment), HDL < 50 mg/dL, hypertension (or actual treatment), fasting glucose ≥ 100 mg/dL or diabetes mellitus type 2.

RESULTS

A FSFI lubrication sub-score < 3.6, suggestive for impaired vaginal lubrication, was exhibited by 53.7% of the study population. When compared to the group with normal lubrication, a significantly higher proportion of these women had paraplegia (93.3% vs 38.5%, p = 0.003) and met the SCI-specific criteria for MetS (73.4% vs 7.6%, p = 0.0006), whereas, no significant differences were found between the two groups in the proportion of women exhibiting the single components of MetS. At the multiple logistic regression analysis, only the presence of MetS exhibited a significant independent association with impaired vaginal lubrication (OR = 3.1, 95% CI 1.2, 5.8, p = 0.01).

CONCLUSIONS

In women with SCI, a clustering of modifiable vascular/metabolic risk factors, constituting the MetS, could contribute to sexual dysfunctions by affecting the vaginal lubrication, independently of the level of the spinal cord lesion.

Knowledge Gaps in Urologic Care of Female Spinal Cord Injury Patients

PURPOSE OF REVIEW

We highlight the substantial gaps in knowledge on urologic care of female spinal cord injury (SCI) patients.

RECENT FINDINGS

Males account for approximately 80% of people living with SCI in developed nations. Although there is a robust body of literature in some aspects of urologic care of individuals with SCI, such as treatments for neurogenic detrusor overactivity, there are relatively few studies focusing specifically on females. There are also few studies focusing on other aspects of urologic care of women with SCI such as sexual dysfunction, pelvic organ prolapse, and bladder cancer. Established guidelines for bladder management exist, generally recommending intermittent catheterization, but the fact remains that a substantial number of women with SCI utilize indwelling catheters for bladder management. There remains a paucity of literature using patient-reported measures regarding both outcomes and experiences of urologic management in the SCI population. Bladder management is challenging for many women with SCI. There are few studies on other urologic concerns in women with SCI.

Development of a Sexual Needs Rehabilitation Framework in Women Post-Spinal Cord Injury: A Study From Iran

OBJECTIVE

To develop a sexual needs rehabilitation framework in women after spinal cord injury (SCI).

DESIGN

Mixed-methods study. The study consisted of 3 steps: (1) a primary needs assessment with quantitative and qualitative methods; (2) prioritization of identified needs by expert panels; and (3) development of a framework.

SETTING

Multi-dimensional clinical referral center.

PARTICIPANTS

Married women (N=31) with an SCI that occurred at least 1 year ago.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Development of sexual needs rehabilitation framework.

RESULTS

The quantitative phase in the first phase showed that the total mean ± SD score of the Sexual Quality of Life-Female questionnaire was 60.47±1.53, and the total mean ± SD score of the Female Sexual Function Index was 50.54±11.35. Moreover, women's sexual understanding post-SCI in the qualitative assessment revealed the following 3 main themes: (1) "dilemma leading to limited sexual activity"; (2) "seeking positive sexual adjustment"; and (3) "lack of client-based sexual and reproductive education/counseling in the rehabilitation process." Results from prioritizing identified needs in the second step indicated that the most important needs related to sexual aspects of life. In the final step, the framework for Iranian woman with post-SCI sexual rehabilitative needs developed with focus on sexual behavior complication post-SCI as a main need.

CONCLUSIONS

It is important to assess probable unmet needs before designing, planning, and implementing an interventional rehabilitative health care program, especially when focusing on issues of sexuality. A developed framework can be applied by the rehabilitation team during initial caregiving and can be continued as long as needed.