Medical Article Abstracts: Spinal Cord Injuries and Female Sexuality, Part 1

The following is a collection of medical article abstracts, i.e. summaries, related to the subject of spinal cord injuries (SCI) and female sexuality.

You can do your own search for information on this subject at PubMed. Simply enter "spinal cord orgasm female" into the search box that appears at the top of your screen after you click the link.

The following online medical dictionaries may be of help when reading this medical information:

http://www.nlm.nih.gov/medlineplus/mplusdictionary.html

http://www.medterms.com/script/main/hp.asp

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Source: Spinal Cord. 2006 Oct 10.

Title: Spinal cord injury influences psychogenic as well as physical components of female sexual ability.

Authors: Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL.

Study design: Secure, web-based survey.

Objectives: Elicit specific information about sexual function from women with spinal cord injuries (SCI).

Setting: World-wide web.

Methods: Individuals 18 years or older living with SCI obtained a pass code to enter a secure website and then answered survey questions.

Results: Bladder and/or bowel incontinence during sexual activity and/or sexual intercourse were significant concerns and prevented some women from seeking sexual activity. Autonomic dysreflexia (AD) during sexual activity was interpreted negatively by many and was found to interfere with sexual activity. Most subjects reported difficulty becoming psychologically aroused as well as physically aroused, which were both correlated with feeling that their SCI had altered their sexual sense of self. An inverse relationship existed between developing new areas of arousal above the level of lesion and not having sensation or movement below the lesion. The most commonly reported sexual stimulation leading to the best arousal involved stimulation of the head/neck and torso areas. The majority of subjects reported having experienced intercourse post injury. Most participants reported difficulty with positioning during foreplay and intercourse, vaginal lubrication, and spasticity during intercourse. Almost half reported experiencing orgasm post injury and this was positively associated with the presence of genital sensation.

Conclusion: SCI significantly impairs psychological and physical aspects of female sexual arousal. In addition, bladder and bowel incontinence as well as AD negatively impact sexual activity and intercourse.

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Source: Prog Brain Res. 2006;152:401-14.

Title: Ascending spinal pathways from sexual organs: effects of chronic spinal lesions.

Authors: Hubscher CH

A recent survey of paraplegics indicates that regaining sexual function is of the highest priority for both males and females (Anderson, K.D. (2004) Targeting recovery: priorities of the spinal cord-injured population J. Newrotrauma, 21: 1371-1383). Our understanding of the neural pathways and mechanisms underlying sexual behavior and function is limited at the present time. More studies are obviously needed to direct experiments geared toward developing effective therapeutic interventions. In this chapter, a review of studies on the processing of sensory inputs from the male and female reproductive organs is presented with a review of what is known about the location of ascending spinal pathways conveying this information. The effect of spinal cord injury on sexual function and the problems that ensue are discussed.

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Source: Prog Brain Res. 2006;152:387-99

Title: Problems of sexual function after spinal cord injury.

Authors: Elliott SL.

Sex is a legitimate and fundamental need in humans. Substantial changes to both the autonomic and somatic nervous system occur after spinal cord injury, and result in altered sexual function and fertility potential. This chapter provides a clinical overview of the main sexual and reproductive concerns and priorities men and women face after spinal cord injury. Besides genital functioning, other autonomic functions affect sexuality, such as bladder and bowel function, cardiovascular control and temperature regulation. These interlinked autonomic functions are presented in their impact on sexuality. The mind-body interaction and spinal feedback loops are discussed. It is proposed that human sexuality after spinal cord injury can be a model for investigating integrated autonomic function. Recent research on the measurement of cardiovascular parameters during vibrostimulation and ejaculation demonstrates the discordance between objective and subjective signs of autonomic dysreflexia. It is hoped that health care professionals and researchers will become motivated to attend to the unmet sexual health care needs of this population.

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Source: Spinal Cord. 2006 Apr;44(4):234-41.

Title: Sexual rehabilitation of women with a spinal cord injury.

Authors: Forsythe E, Horsewell JE.

STUDY DESIGN: Literature review and a qualitative study.

OBJECTIVE: This article reviews literature examining the sexual rehabilitation of women following spinal cord injury (SCI). It includes recommendations for improvements in initial clinical rehabilitation efforts and counselling services.

SETTING: United Kingdom, Denmark and Sweden.

METHODS: Articles concerning sexual rehabilitation following SCI from the last two decades have been reviewed and critiqued. Qualitative results from discussions with women with SCI in Denmark and Sweden are presented.

RESULTS: The literature focuses on the effect of neurological change on women's ability to achieve sexual arousal and orgasm. Urinary and bowel incontinence, spasticity, vaginal lubrication and autonomic dysreflexia are the physical consequences of SCI that appear to have most impact on sexual activity. More recent studies have acknowledged that psychosocial factors such as age and partnership status may also affect the successful sexual rehabilitation. Discussions with women with SCI in Denmark and Sweden on their reactions to information and counselling offered during rehabilitation revealed an overwhelming need for the exchange of information and experience with other women with SCI, and a desire for opportunities for counselling after initial rehabilitation.

CONCLUSION: Successful sexual rehabilitation of women with SCI demands a holistic approach that considers individual neurological, physical and psychosocial circumstances. Peer-counselling could make a significant contribution to the sexual rehabilitation of women with SCI.

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Source: Prog Brain Res. 2006;152:441-7.

Title: Female sexual function after spinal cord injury.

Authors: Sipski ML, Arenas A.

Over the past 10 years, studies of the impact of spinal cord injuries on female sexuality have expanded from questionnaire studies in small populations with unknown levels and degrees of injury to laboratory-based analyses of women with known injury patterns. These studies have provided detailed information on how specific injury patterns affect specific aspects of the female sexual response. Research findings have supported the hypothesis that the sympathetic nervous system is regulatory for psychogenic genital vasocongestion and that orgasm is a reflex response of the autonomic nervous system. Based on these results, a new system for the classification of sexual function in women with spinal cord injury (SCI) is proposed. Moreover, studies related to the treatment of sexual dysfunction in women with cord injury are reviewed.

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Source: Arch Sex Behav. 2004 Jun;33(3):295-302

Title: Sexual responsiveness in women with spinal cord injuries: differential effects of anxiety-eliciting stimulation.

Authors: Sipski ML, Rosen RC, Alexander CJ, Gomez-Marin O.

Sexual dysfunction is a common problem in women after spinal cord injuries (SCIs). Recently, the use of anxiety-provoking stimulation has been explored as a means of improving sexual responses in able-bodied sexually functional and dysfunctional women. In this laboratory-based study, we assessed the sexual and autonomic responses of women with SCIs with varying degrees of preservation of sympathetic innervation to their genitals to respond to anxiety-provoking audiovisual (AV) stimulation. Subjects were 45 women with SCIs and 11 able-bodied women. For purposes of analysis, SCI subjects were grouped on the basis of the degree of preservation of sensation in the T11-L2 dermatomes. Results revealed that women with low sensory scores in these dermatomes achieved higher vaginal pulse amplitude (VPA) responses to audiovisual erotic stimulation after anxiety preexposure than after neutral preexposure; however, women with SCIs and the greatest degree of preservation of sensory function in the T11-L2 dermatomes, as well as able-bodied controls, did not. Moreover, these same 2 groups of subjects had a decrease in VPA responses during baseline periods in which an anxiety-provoking video sequence was shown, but not during the neutral sequence. It is concluded that these findings are due to the proximity of sensory and autonomic neurologic elements in the spinal cord. Moreover, they demonstrate the differential effects of sympathetic stimulation on genital sexual arousal.

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Source: Arch Sex Behav. 2003 Aug;32(4):359-69

Title: Sexual esteem, sexual satisfaction, and sexual behavior among people with physical disability.

Authors: McCabe MP, Taleporos G.

This study investigated the association between the severity and duration of physical disability and sexual esteem, sexual depression, sexual satisfaction, and the frequency of sexual behavior. A total of 1,196 participants completed the study. There were 748 participants (367 males, 381 females) who had a physical disability and 448 participants (171 males, 277 females) who were able-bodied. The age range of participants was 18-69 years, with a mean age of 36.39 years (SD = 10.41). The results demonstrated that people with more severe physical impairments experienced significantly lower levels of sexual esteem and sexual satisfaction and significantly higher levels of sexual depression than people who had mild impairments or who did not report having a physical impairment. The study also found that people with more severe physical disabilities engaged in mutual sexual activity significantly less frequently. Women with physical disabilities had significantly more positive feelings about their sexuality and significantly more frequent mutual sexual experiences than their male counterparts. For people with physical disabilities, the frequency of oral sex and nude cuddling were significant predictors of sexual satisfaction in men, while the frequency of deep kissing predicted sexual satisfaction in women. Furthermore, the viewing of erotica was significantly related to sexual dissatisfaction in men. Finally, it was found that people who had experienced their physical impairment for a longer period of time reported significantly more positive feelings about their sexuality. Implications of these findings are discussed and suggestions are made for future research.

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Source: Soc Sci Med. 2003 Apr;56(8):1737-47

Title: Self-esteem and women with disabilities.

Authors: Nosek MA, Hughes RB, Swedlund N, Taylor HB, Swank P.

This study examines the sense of self of women with physical disabilities in terms of self-esteem, self-cognition (perceptions of how others see them), and social isolation. It was hypothesized that these variables mediate the relation of precursor variables (age, education, severity of disability, and childhood experiences, including overprotection, familial affection, and school environment) and outcomes (intimacy, employment, and health promoting behaviors). Data were gathered from a sample of 881 community-dwelling women in the USA, 475 with a variety of mild to severe physical disabilities, and 406 without disabilities. Correlation analyses indicated that the women with disabilities had significantly lower self-cognition and self-esteem, and greater social isolation than the women without disabilities, as well as significantly less education, more overprotection during childhood, poorer quality of intimate relationships, and lower rates of salaried employment. Path analysis indicated that each of the sense of self mediators was significantly related to the outcome of intimacy, that both social isolation and self-esteem were significantly related to health promoting behaviors, and that only self-esteem was significantly related to employment. Respondents who were older, less disabled, less educated, less over-protected, and had more affection shown in the home tended to feel that others saw them more positively. Women with positive school environments, less over-protection, and more affection in the home experienced less social isolation; age, education, and disability severity were not significantly related to social isolation. Older respondents with less disability, a more positive school environment, less over-protection, and more affection in the home tended to have greater self-esteem; education was not significantly related to self-esteem. Older respondents tended to report less intimacy. Younger, more educated, and less disabled respondents were significantly more likely to be employed. More highly educated respondents reported engaging in more health promoting behaviors.

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Source: J Spinal Cord Med. 2001 Fall;24(3):148-54.

Title: Neural circuitry involved in sexual function..

Authors: McKenna KE.

BACKGROUND: Neurological injury results in devastating sexual deficits in both men and women. Effective treatment requires an understanding of the central nervous system (CNS) pathways and physiology. This article emphasizes the essential similarities in the pathways and physiology of sexual function in men and women.

METHODS: Literature review.

FINDINGS: Systems within the spinal cord are fully capable of generating a large number of sexual responses. Spinal sexual centers may be activated by genital afferents or by descending commands from higher CNS sites. Normal functioning probably involves activation of spinal centers by both descending pathways and afferent stimulation. Afferent stimulation also modulates the activity of supraspinal sites, creating a positive feedback system. Descending control consists of powerful inhibitory and excitatory pathways. An important serotonergic inhibitory pathway has been demonstrated. The medial preoptic region participates in the integration of hormonal and sensory cues necessary for sexual behavior. The medial amygdala and paraventricular nucleus of the hypothalamus also play essential excitatory roles. The paraventricular nucleus projects directly to relevant spinal sites, indicating another important pathway for excitatory control.

CONCLUSIONS: Recent advances have markedly enhanced our understanding of the physiology, pharmacology, molecular biology and pathology of sexual mechanisms. This knowledge base is essential in order to understand changes in sexual mechanisms that follow spinal cord injury, and for the development of effective interventions to maximize sexual function in men and women with spinal cord injury.

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Source: J Spinal Cord Med. 2001 Fall;24(3):155-8.

Title: Sexual response in women with spinal cord injury: neurologic pathways and recommendations for the use of electrical stimulation.

Authors: Sipski ML.

BACKGROUND: Determination of the exact level and degree of a woman's spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI.

DESIGN: Literature review.

FINDINGS: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11-T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc.

CONCLUSIONS: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with able-bodied controls, provide valuable information regarding female sexual neurophysiology. Electrical stimulation can be used to improve sexual response, as well as bladder and bowel function. Interventions that interfere with the sacral reflex arc, such as sacral rhizotomy, can impair the ability to achieve orgasm. To develop alternative treatment protocols, further investigation of sexual response and orgasm is recommended.

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Source: World J Urol. 2002 Jun;20(2):93-100. Epub 2002 May 24.

Title: The neurophysiology of female sexual function.

Authors: McKenna KE.

Recent research on the neural control of female sexual function is reviewed. The control of female genital responses has not been extensively studied and significant gaps in our knowledge remain. Sexual arousal is largely the product of spinal level reflexes. A network of interneurons processes the sensory information and generate complex patterns of activities that are then distributed to the autonomic and somatic efferents. The spinal reflexive systems are under inhibitory and excitatory control from the brainstem and hypothalamic sites. Further research is necessary to identify the mechanisms underlying female sexual function, the pathogenesis of sexual dysfunctions and their possible treatment.

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Source: J Sex Marital Ther. 2002;28 Suppl 1:101-21

Title: Neurophysiology and pharmacology of female genital sexual response.

Authors: Giuliano F, Rampin O, Allard J.

Vaginal sexual arousal is a vasocongestive and neuromuscular event controlled by facilitatory parasympathetic and inhibitory sympathetic inputs. Autonomic preganglionic parasympathetic and inhibitory sympathetic fibers to the vagina and clitoris originate in the spinal cord in the sacral parasympathetic nucleus at the sacral level and in the dorsal gray commissure and the intermediolateral cell column at the thoracolumbar [Thoracolumbar’ refers to a range of vertebrae (bones) in the back: those in the thoracic (‘thoraco-‘) and those in the lumbar region.] level, respectively. Parasympathetic fibers are conveyed by the pelvic nerve, and sympathetic fibers are conveyed by the hypogastric nerve and the paravertebral sympathetic chain. The activity of these spinal nuclei is controlled by descending projections from the brain and sensory afferens (conveyed in the pudendal, hypogastric, pelvic, and vagus nerves) from the genitalia. A key but unresolved issue concerns the neurotransmitters involved in the control of genital sexual arousal. At the peripheral level, acetylcholine plays a minor role in the regulation of vaginal blood flow, however, recent data suggests that it may be involved in the control of vaginal smooth muscle contractions. Vasoactive intestinal peptide and nitric oxide may be responsible for the increase in vaginal blood flow during sexual arousal, whereas noradrenaline is likely inhibitory. Within the central nervous system, serotoninergic projections from the brain to the spinal cord likely inhibit the induction of genital arousal by peripheral informations (spinal reflex). Although some neurotransmitters regulating the display of sexual behavior have been identified (for example, dopamine), their involvement in the control of genital sexual arousal has not been invested. Anatomical and electrophysiological data point to a contribution of the paraventricular nucleus of the hypothalamus and the median preoptic area, respectively, as key elements in the control of genital arousal. The recent development of models allowing the assessment of vaginal sexual arousal in anesthetized female rats should assist in deciphering the neurochemical pathways controlling vaginal sexual arousal and the development of suitable pharmacological treatment for female sexual dysfunctions.

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Source: Ann Neurol. 2001 Jan;49(1):35-44.

Title: Sexual arousal and orgasm in women: effects of spinal cord injury.

Authors: Sipski ML, Alexander CJ, Rosen R

Sexual disorders are common in women; however, the neurological basis of female sexual response has not been adequately investigated. This information is necessary to characterize the impact of various neurological disorders on sexual arousal in women and to develop appropriate management strategies for sexual dysfunction. To assess the spinal mediation of sexually stimulated genital vasocongestion in women, we conducted two laboratory-based, controlled analyses: (1) of women's genital, subjective, and autonomic responses to audiovisual erotic and audiovisual erotic combined with manual genital stimulation; and (2) of women's ability to achieve orgasm. Subjects included 68 premenopausal women with spinal cord injuries (SCIs) and 21 able-bodied, age-matched controls. Results indicated that preservation of sensory function in the T11-L2 dermatomes is associated with psychogenically mediated genital vasocongestion. Less than 50% of women with SCIs were able to achieve orgasm, compared with 100% of able-bodied women (p = 0.001). Only 17% of women with complete lower motor neuron dysfunction affecting the S2-S5 spinal segments were able to achieve orgasm, compared with 59% of women with other levels and degrees of SCIs (p = 0.048). Time to orgasm was significantly increased in women with SCIs compared with able-bodied controls (p = 0.049). Independent raters were unable to differentiate between subjective descriptions of orgasm from SCI women compared with controls. This information should be used when counseling women with spinal dysfunction about their sexual potential.

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Source: Urology. 2000 Jun;55(6):812-5

Title: Sildenafil [Viagra] effects on sexual and cardiovascular responses in women with spinal cord injury.

Authors: Sipski ML, Rosen RC, Alexander CJ, Hamer RM.

OBJECTIVES: Sexual dysfunction is common in women with spinal cord injuries (SCIs) and other neurologic conditions. Sildenafil has previously been shown to be safe and effective in the treatment of erectile dysfunction due to SCI. This study is the first to evaluate the sexual and cardiovascular effects of sildenafil in women with SCIs in a controlled, laboratory setting.

METHODS: Nineteen premenopausal women with SCIs were randomly assigned to receive either sildenafil (50 mg) or placebo in a double-blind, crossover design study. Physiologic and subjective measures of sexual response, heart rate, and blood pressure were recorded during baseline and sexual stimulation conditions. Adverse events were also recorded.

RESULTS: Significant increases in subjective arousal (SA) were observed with both drug (P <0.01) and sexual stimulation conditions (P <0.001), and a borderline significant (P <0.07) effect of drug administration on vaginal pulse amplitude (VPA) was noted. Maximal responses occurred when sildenafil was combined with visual and manual sexual stimulation. Cardiovascular data showed modest increases in heart rate (+/-5 bpm) and mild decreases in blood pressure (+/-4 mm Hg) across all stimulation conditions, consistent with the peripheral vasodilatory mechanism of the drug. Sildenafil was well tolerated with no evidence of significant adverse events.

CONCLUSIONS: Findings suggest that sildenafil may partially reverse the sexual dysfunction commonly associated with SCI in women. Consistent with previous findings in men, the sexual effects of the drug were most evident under conditions of optimal stimulation. Mild, clinically insignificant cardiovascular effects were also noted. Further large-scale studies of sildenafil's effects in women with neurogenic sexual dysfunction are strongly indicated.

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Source: Arch Phys Med Rehabil. 1999 Nov;80(11):1420-8

Title: A multicenter study of women's self-reported reproductive health after spinal cord injury.

Authors: Jackson AB, Wadley V.

OBJECTIVE: Little attention has been given to women's reproductive health issues in the disabled population. This study documents the unique reproductive health conditions, complications, and behaviors in women with spinal cord injury (SCI).

SUBJECTS: A total of 472 women at least 18 years of age who were at least 1 year post-SCI. Their average age at injury was 32 years.

DESIGN: An extensive questionnaire regarding gynecologic, sexual, obstetric, and menopausal health issues was developed and piloted. The questionnaire was then administered by a trained woman health care clinician to women who agreed to participate in the study.

SETTING: Private outpatient clinics at 10 regional model SCI systems of care.

RESULTS: Women reported similar gynecologic problems in both preinjury and postinjury time periods. Exceptions were urinary tract infections and vaginal yeast infections. Sexually transmitted infections appear to be less common after injury, but the difference was not statistically significant. The number of hysterectomies was similar both before and after injury, but reasons differed greatly. Women with SCI were less likely to have routine mammograms. They reported similar preventive practices such as performing self-breast examinations and obtaining Papanicolaou smears. Almost 14% of women with SCI became pregnant after injury (101 pregnancies). Complications from pregnancy, labor, and delivery were reported to be more frequent in their postinjury than in their preinjury obstetric experiences. They tended to have babies of lower birth weight and with more complications at time of delivery. Of the sample, 87% reported having sexual intercourse before injury, with only 67% having intercourse after injury. Years postinjury and level of injury were predictive of intercourse; extent of injury was not. Experience of orgasms and methods of contraception varied among the two groups. There were significant complaints of dysreflexia and bladder incontinence with sexual function. Menopause after injury was reported by 14.6% of the women. Postinjury menopausal symptoms were of low frequency, but more than those reported by women who had undergone menopause before injury. Only 19% of women who had menopause after SCI were placed on hormone replacement therapy. Almost one third of the women who had menopause after injury reported new bone fractures.

CONCLUSION: This study illustrates the unique reproductive health concerns of women with SCI. Many pregnancy, labor, and delivery experiences in these women are different. Sexual activity and function have several disability-related consequences and the effects of menopause are still unknown, but may be more problematic than for able-bodied women.

Continued in Part 2