The-Clitoris.com - Medical Article Abstracts: Spinal Cord Injuries and Female Sexuality, Part 2

Source: J Sex Marital Ther. 1999 Jan-Mar;25(1):11-22.

Title: Sexual response in women with spinal cord injuries: implications for our understanding of the able bodied.

Authors: Sipski ML, Alexander CJ, Rosen RC.

This study assesses the impact of psychogenic and reflex sexual arousal on women with complete and incomplete spinal cord injuries (SCIs) and explores the effects of SCI on orgasm in women. Thirty women with SCIs and 10 able-bodied women participated in the study. Three individual experiments were conducted over a 3-day period, assessing (a) the impact of SCI on psychogenic sexual arousal, (b) the impact of SCI on orgasm; and (c) the impact of SCI on reflex sexual arousal. Results support the hypothesis that women with complete SCIs and upper motor neuron injuries affecting the sacral spinal segments and women with incomplete upper motor neuron SCIs had the capacity for reflex lubrication. Women with SCIs were significantly less likely than able-bodied women to achieve orgasm. However, there was not a significant difference among women with different SCIs to achieve orgasm.

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Source: Arch Phys Med Rehabil. 1997 Dec;78(12 Suppl 5):S34-8

Title: Prevalence of abuse of women with physical disabilities.

Authors: Young ME, Nosek MA, Howland C, Chanpong G, Rintala DH.

OBJECTIVE: Emotional, physical, and sexual abuse of women with physical disabilities is a problem largely unrecognized by rehabilitation service providers. This article documents the prevalence of abuse of women with physical disabilities compared to women without physical disabilities.

DESIGN: Case-comparison study using written survey. Data were analyzed using chi 2 analyses and the Mann-Whitney U Wilcoxon rank sum W tests.

SETTING: General community.

PARTICIPANTS: A sample of 860 women, 439 with physical disabilities and 421 without physical disabilities, was compiled from women responding to a national sexuality survey.

MAIN OUTCOME MEASURES: The women were asked if they had ever experienced emotional, physical, or sexual abuse. If they answered yes, they were asked to identify the perpetrator(s) of the abuse and when the abuse began and ended.

RESULTS: Sixty-two percent of both groups of women had experienced some type of abuse at some point in their lives. Of women who had experienced abuse, half of each group had experienced physical or sexual abuse. Husbands or live-in partners were the most common perpetrators of emotional or physical abuse for both groups. Male strangers were the most common perpetrators of sexual abuse for both groups. Women with physical disabilities also were more likely to be abused by their attendants and by health care providers. Thirteen percent of women with physical disabilities described experiencing physical or sexual abuse in the past year.

CONCLUSIONS: Women with physical disabilities appear to be at risk for emotional, physical, and sexual abuse to the same extent as women without physical disabilities. Prevalence of abuse by husbands or live-in partners in this study is similar to estimates of lifetime occurrence of domestic violence for women living in the United States. Women with physical disabilities are more at risk for abuse by attendants or health care providers. They are also more likely to experience a longer duration of abuse than women without physical disabilities.

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Source: Acta Obstet Gynecol Scand. 1997 Nov;76(10):977-83

Title: Sexuality in women with traumatic spinal cord injury.

Authors: Westgren N, Hultling C, Levi R, Seiger A, Westgren M.

BACKGROUND: Sexuality in spinal cord injured women has largely been neglected. One reason may be the male dominance amongst traumatically spinal cord injured individuals. The purpose of this study is to elucidate sexual issues in women with spinal cord injuries.

METHODS: Survey of near-total prevalence population in the greater Stockholm area. Structured interview, based on a standardized questionnaire. Self-rating scales for evaluation of the importance of sexual activity before and after injury and for defining and rating the medical problem most significantly interfering with sexual activity. Marital status and/or partnership pre- and post-injury and information on sexual matters provided after injury were evaluated in detail. Out of a total 65 women, 62 participated in the study.

RESULT: Women with complete and incomplete cervical lesions rated the importance of sexual activity significantly lower after, as compared to before, spinal cord injury. No significant differences were found in women with lower-level lesions. Urinary leakage, spasticity and positioning problems were the medical problems most significantly interfering with partner-related sexual activity. Only six women had received information on sexual matters before discharge from hospital. None of the partners had received such information.

CONCLUSION: The women's neurological status affect their ability to adapt sexually after injury. Medical problems commonly interfere with sexuality and should be identified and treated. No adverse impact of spinal cord injury on marital status could be confirmed. Sexual counseling has yet to become an integral part of rehabilitation.

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Source: Arch Phys Med Rehabil. 1997 Mar;78(3):305-13.

Title: Physiologic parameters associated with sexual arousal in women with incomplete spinal cord injuries.

Authors: Sipski ML, Alexander CJ, Rosen RC.

OBJECTIVE: To compare the physiologic sexual responses of women with incomplete spinal cord injuries (SCIs) with and without preservation of the ability to perceive T11-L2 pinprick sensation.

DESIGN: Controlled laboratory-based analysis of responses to varying combinations of audiovisual erotic stimulation, manual genital stimulation, and performance of a distracting task coupled with manual genital stimulation.

SETTING: The sexual physiology laboratory at our freestanding rehabilitation hospital.

PARTICIPANTS: A volunteer sample of 17 women with incomplete SCIs.

INTERVENTIONS: Two 78-minute protocols using 6-minute baselines alternating with 12-minute testing conditions. One protocol was designed to study the effects of psychogenic and psychogenic combined with manual sexual stimulation, while the other was designed to examine the effects of genital sexual stimulation performed in conjunction with a distracting task.

DEPENDENT VARIABLES: Vaginal pulse amplitude, subjective arousal, heart rate, respiratory rate, and blood pressure.

RESULTS: Subjective arousal increased in both groups of subjects with isolated audiovisual erotic stimulation; however, only those subjects with the ability to perceive T11-L2 pinprick sensation had concomitant increases in vaginal pulse amplitude. In contrast, when manual genital stimulation was added to the audiovisual erotic stimulation, both groups of subjects developed increases in vaginal pulse amplitude, whereas only those subjects with the ability to perceive T11-L2 demonstrated a further increase in their level of subjective arousal. Performance of manual genital stimulation in conjunction with a distracting task resulted in significantly increased vaginal pulse amplitude and arousal level only in those subjects with preservation of the ability to perceive T11-L2 pinprick sensation. With the changeover to masturbation, neither group of subjects developed significant increases in vaginal pulse amplitude. During masturbation, both groups of subjects had increases in their level of sexual arousal; however, only those subjects with T11-L2 pinprick preservation had a significant increase.

CONCLUSIONS: Women with preservation of the ability to perceive T11-L2 pinprick sensation tended to maintain the ability for psychogenic genital vasocongestion. Psychogenic protocol results showed that all subjects appeared to develop reflex genital vasocongestion when manual stimulation was added to audiovisual erotic stimulation. Manual genital stimulation in conjunction with the performance of a distracting task only resulted in increased vaginal pulse amplitudes in those subjects with preservation of T11-L2 pinprick sensation. We believe that this was due to increased subjective sexual arousal and that the reason all subjects did not develop increased genital vasocongestion under these conditions was due to poor hand function. Further research examining women with lower levels of SCI is necessary to understand the neurophysiology of female sexual response after SCI.

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Source: Arch Phys Med Rehabil. 1996 Feb;77(2):107-15

Title: Sexual functioning among women with physical disabilities.

Authors: Nosek MA, Rintala DH, Young ME, Howland CA, Foley CC, Rossi D, Chanpong G.

OBJECTIVE: Three a priori hypotheses were tested: (1) There are significant differences in sociosexual behaviors of women with physical disabilities compared with women without disabilities; (2) the sexual functioning of women with disabilities is significantly related to age at onset of disability; (3) psychological factors explain more of the variance in the sexual functioning of women with physical disabilities than do disability, social and environmental factors.

DESIGN: Case-comparison study using written survey.

SETTING: General community.

PARTICIPANTS: The questionnaire was mailed to 1,150 women with physical disabilities who were recruited as volunteers or through independent living centers. Each woman gave a second copy of the questionnaire to an able-bodied female friend, which comprised the comparison group. The response rate was 45%, with 475 cases and 425 comparisons eligible to participate. The most common disability type was spinal cord injury (24%), followed by polio (18%), muscular dystrophy (11%), cerebral palsy (11%), multiple sclerosis (10%), joint disorders (7%), and skeletal abnormalities (5%).

INTERVENTIONS: None.

MAIN OUTCOME MEASURES: Sexual-functioning, consisting of four factors: (1) sexual desire, (2) sexual activity, (3) sexual response, (4) sexual satisfaction.

RESULTS: Highly significant differences were found in level of sexual activity (p = .000001), response (p = .000009), and satisfaction (p=.000001) between women with and without disabilities. No significant differences were found between groups on sexual desire. Severity of disability was not significantly related to level of sexual activity.

CONCLUSIONS: Psychological and social factors exert a strong impact on the sexual functioning of women with physical disabilities. Further investigations is needed of the effect of social environment on development of self-esteem and sexual self-image, and how these influences affect levels of sexual functioning in women with physical disabilities.

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Source: Arch Phys Med Rehabil. 1995 Dec;76(12):1097-102.

Title: Orgasm in women with spinal cord injuries: a laboratory-based assessment.

Authors: Sipski ML, Alexander CJ, Rosen RC.

OBJECTIVE: To understand the characteristics and physiological sexual responses of women with spinal cord injuries (SCI) during orgasm.

DESIGN: Controlled laboratory-based analysis of women's physiological and subjective responses during a single session in which they attempted to perform stimulation to orgasm.

SETTING: The sexual physiology laboratory at our free-standing rehabilitation hospital.

PARTICIPANTS: A volunteer sample of 25 women with SCI and 10 able-bodied control subjects, matched for age.

INTERVENTION: A 75-minute protocol designed to obtain information on the physiological events accompanying orgasm.

DEPENDENT VARIABLES: Included vaginal pulse amplitude, heart rate, respiration rate, blood pressure, subjective arousal and subscores on the Derogatis Sexual Functioning Inventory (DSFI).

RESULTS: Data were analyzed both within and across neurological groups: complete SCI, incomplete SCI, and able-bodied controls. All able-bodied subjects achieved orgasm whereas 52% of SCI subjects achieved orgasm. Degree and type of SCI did not significantly relate to subjects' ability to achieve orgasm. Subjects with no lower extremity function took significantly longer than able-bodied subjects to achieve orgasm. Differences between baseline and orgasm readings are described for each of the major physiological measures. Results of DSFI revealed that able-bodied subjects acknowledged greater sexual satisfaction than SCI subjects. Subjects who achieved orgasm scored higher on sexual information and sex drive.

CONCLUSION: Results support previous self-report studies, in that a large percentage of SCI women achieved orgasm regardless of pattern or degree of neurological injury. No consistent characteristics were identified that would allow prediction of which women with SCI would be able to experience orgasm. However, subjects who achieved orgasms had a higher sex drive and greater sexual knowledge. Implications for sex therapy treatment programs with spinal cord injured women are discussed.

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Source: Paraplegia. 1995 Dec;33(12):687-92.

Title: Factors associated with sexual functioning in women following spinal cord injury.

Authors: Harrison J, Glass CA, Owens RG, Soni BM.

Research into sexuality following spinal cord injury (SCI) has tended to concentrate on male experiences and the physical capabilities for sexual intercourse. The sexuality of women following SCI has only recently been addressed and studies are limited to small numbers and the use of non-standardised measures. The present investigation utilised standard measures of affective state and body satisfaction together with pre and post-injury questionnaire information of sexual dysfunction, feelings about sex and importance of sexual activity in a group of 85 women with SCI. Sexual dysfunction increased significantly post-injury, whilst feelings about sex and it's importance were unaffected. Sexual dysfunction and the importance of sex were inversely correlated. General and Head satisfaction estimates were not significantly different to control samples, whilst Body Satisfaction was increased for women with disabilities. None of the body satisfaction measures were related to the sexual functioning measure. General dissatisfaction was associated depression. Both anxiety and depression were experienced by the same individuals, and anxiety related to current sexual dysfunction. Qualitative data supported previous findings concerning the effects of social and attitudinal barriers on sexual functioning.

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Source: Arch Phys Med Rehabil. 1993 Oct;74(10):1025-9

Title: Sexual activities, response and satisfaction in women pre- and post-spinal cord injury.

Authors: Sipski ML, Alexander CJ.

Twenty-five spinal cord injured (SCI) women (median age = 34) completed an 80-item multiple choice questionnaire (median 50 months postinjury) that assessed sexual functioning pre-spinal cord injury and post-spinal cord injury in four areas: (1) sexual adjustment; (2) sexual activities and preferences; (3) sexual desire, arousal and satisfaction; and (4) sexual abilities. Frequency of sexual activity decreased following SCI. Intercourse was the favorite activity preinjury; whereas, kissing, hugging and touching were favored postinjury. Sexual desire and satisfaction decreased postinjury. Ability to achieve lubrication and orgasm with various types of spinal injuries is reported. Although most women did not receive sexual information or counseling, 76% of the sample believed they had been adjusting well sexually. Results are discussed accounting for the limitations of self-report methodology in sexuality research. The need for laboratory based, physiologic studies is underscored.

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Source: Paraplegia. 1992 Dec;30(12):890-902

Title: Pregnancy, labor and delivery post spinal cord injury.

Authors: Cross LL, Meythaler JM, Tuel SM, Cross AL.

There are approximately 3,000 women of childbearing age who become spinal cord injured each year in the United States. There are few reports in the literature that address pregnancy, labor and delivery in this patient population. We are reporting on 22 women post spinal cord injury who had 33 pregnancies. There were equal numbers of paraplegic and quadriplegic women. Three pregnancies aborted, one spontaneously. The babies were near normal or normal weight with one exception. The mothers waited 5 years on average to become pregnant. Cesarean section was performed on 43% of pregnancies. Abnormal presentations occurred in over 10% of pregnancies. Indications for cesarean section included 5 that were repeats; the remainder were necessary due to bleeding (1), breech presentation (1), transverse presentation (2), lack of progress (2), onset of labor 1 day post spinal fusion, and a mother's request to have tubal ligation. Epidural anesthesia was selected for 9 deliveries; 6 of these patients had controlled autonomic hyperreflexia. Five general and 4 local anesthetics were used, and 12 patients received no anesthesia. Diagnostic ultrasound and amniocentesis were used selectively. Complications included autonomic hyperreflexia (9), frequent urinary tract infections, infected pressure sores (3, 2 resulting in below-knee amputations), seizures during and after delivery, pneumonia, bladder stones (2), episiotomy dehiscence (1), and breakdown of spinal fusion. The newborns were healthy, although one double footing breech vaginal delivery had an APGAR of 1 at 1 min, 7 at 5 min and 9 at 10 min. One premature baby, who weighed only 1600 g, was a precipitate birth at home unattended. Implications for the care of pregnant SCI women are discussed.

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Source: Paraplegia. 1992 Mar;30(3):192-9.

Title: Sexual issues of women with spinal cord injuries.

Authors: Charlifue SW, Gerhart KA, Menter RR, Whiteneck GG, Manley MS.

The need for research addressing problems unique to women with spinal cord injuries is well documented. Consequently, 231 such women, ages 18 to 45, were surveyed. Demographic characteristics and data relating to physician usage, female hygiene, pregnancy, contraception and sexuality were collected. Analysis revealed that 60% of the respondents had post injury amenorrhea; the average time until menses resumption was 5 months. The group's post injury pregnancy rate was one-third its pre injury rate, but women with incomplete paraplegia had significantly more pregnancies than those with complete quadriplegia. Of 47 women who did carry babies to delivery, one-half had vaginal deliveries; 49% used no anesthesia. Problems during pregnancy included autonomic hyperreflexia, decubitus ulcers, urinary tract infections, water retention, bladder and bowel problems, anemia, spotting, fatigue, cardiac irregularity and toxemia. Many of these problems plagued the women during labor and delivery and in the post partum period as well. Sixty-nine percent of the women were satisfied with their post injury sexual experiences, although self confidence, spasticity, and lack of spontaneity were issues. Although satisfied with care received from physicians, many women were not content with the information provided during rehabilitation, and felt a need for more literature, counselling, and peer support.

PIP: In 1984, researchers analyzed data on 231 18-45 year old women with a spinal cord injury who underwent initial rehabilitation at Craig Hospital in Englewood, Colorado to examine sexual issues. More than 50% of the women reported that health workers did not provide them sufficient sexuality information during rehabilitation, but those who underwent rehabilitation after 1977 were more satisfied with it than those before 1977. They tended to be satisfied with the care they received from their physicians after the injury. Most women were comfortable talking about sexuality with family, friends, and/or other women with spinal cord injuries. Some women were concerned with increases in vaginal discharges (53%) and perspiration (27%) after the injury. Clinicians must realize that the needs of women with spinal cord injuries are different than those of men. Spasticity during sexual relations, pregnancy, childbirth, and the postpartum period troubled some women, e.g., it interfered with sexual intercourse in 21% of the women. Yet 2 newborns were addicted to valium which is used to control spasticity. Other issues were self-confidence and lack of spontaneity. Nevertheless 69% of all women were satisfied with sexual experiences. 60% of the women had amenorrhea after their injury and the mean time for menses resumption was 5 months. The preinjury pregnancy rate was 1.3/person compared with only .34 after the injury. Women with incomplete paraplegia had a higher postinjury pregnancy rate than those with complete quadriplegia (.63 vs. .15; p.001). 50% of the 47 women who had full-term infants delivered vaginally. 49% did not use any anesthesia. Pregnancy complications and complications during labor and delivery were bladder and bowel problems, autonomic hyperreflexia, decubitus ulcers, urinary tract infections, edema, anemia, spotting, fatigue, cardiac irregularity, and preeclampsia.

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Source: J Am Paraplegia Soc. 1991 Jul;14(3):122-6.

Title: The impact of spinal cord injury on female sexuality, menstruation and pregnancy: a review of the literature.

Authors: Sipski ML.

Spinal cord injury (SCI) results in alterations in sexual functioning. This area has been studied in depth in males; however, the literature pertaining to female sexual dysfunction after injury is sparse and focused primarily on menstruation and pregnancy. This report reviews the literature on female sexuality, menstruation and pregnancy after SCI and discusses the findings.

PIP: This is a review of the impact of spinal cord injury on female sexuality, which has received far less attention than male sexuality, and on menstruation, contraception and pregnancy, which have been reported more extensively. The few reports of sexuality in women after spinal cord injury suggests a wide range of adaptability, from 40% to 88% of the subjects achieving satisfactory sexual activity. Some women were able to adapt a positive body image and find new ways of stimulation to orgasm, despite altered body shape, bladder and bowel incontinence, spasticity, and lack of sensation often resulting from spinal injury. The pill, vaginal methods, and IUDs are not recommended, but condoms and possibly Norplant, are appropriate for these women. Menstruation, often ceasing for several months after injury, usually resumes. One study reported lack of menstrual pain, others did not. Many spinal injuries women have achieved 1 or more pregnancies. A few cases have been described of successful pregnancy when the injury occurred during gestation, as has 1 intrauterine death that was successfully delivered by induction. Premature cervical dilatation and labor and small-for-dates infants are more common than usual, but spontaneous abortion are not. Some of the typical problems in pregnancy are urinary tract infections, decubiti, anemia, pedal edema, weight transfer problems, thrombophlebitis, TIA episodes, and nausea. A more serious problem is management of labor, especially if the woman cannot perceive labor pains, or cannot bear down. Frequent check-ups and early hospitalization are recommended. A potentially fatal risk in those injured at T6 or above, is autonomic dysreflexia, stimulated by induction, labor, delivery, or even breast feeding. Autonomic dysreflexia can be treated with epidural anesthesia with lidocaine. Induction is contraindicated. Lactation may cease after 3 months or so because of lack of nipple stimulation.