Sexual Function

Question 1

What are the factors affecting sexual function in SCI?

Answer 1

genital function
motor abilities (position and mobility)
sensation
ROM
muscle tone (spasticity)
pre-existing attitudes

Question 2

What are the 4 components of sexual function via Masters and Johnson framework?

Answer 2

arousal
plateau
orgasm
resolution

Question 3

How does male sexual function occur?

Answer 3

neural control of erections involves 2 regions of the SPC and higher centers in the brain (T11-L2 and S2-S4)
can be generated in 2 ways
-psychological arousal
-sensory stimulation

Question 4

What is a reflexogenic erection?

Answer 4

reflex are is intact
sensory stimulation from the genital area, rectum or bladder travels to S2-S4 causing firing of the parasympathetic efferents

Question 5

What is a psychogenic erection?

Answer 5

psychological stimulation
sympathetic efferents from T11-L2 or impulses from higher centers cause sacral efferents to fire
(thoughts, smells, sounds, etc)

Question 6

How does the level of injury corresponds to different dysfunctional erections?

Answer 6

above T11: reflexogenic
between the 2 centers: both psychogenic and reflexogenic
lower lesions: psychogenic
(incompletes are difficult to know what kind of function they will have)
(loss of input from either center alters quality and/or ability to sustain)

Question 7

What is involved in a normal ejaculation?

Answer 7

both thoracolumbar and sacral regions plus supraspinal centers

Question 8

How does a SCI affect ejaculation?

Answer 8

% able to ejaculate: incomplete UMN 32, incomplete LMN 70

may have retrograde ejaculation (semen goes into bladder but is not harmful)

Question 9

What are the treatments for ejaculation?

Answer 9

medications
vacuum devices
penile implants

Question 10

How is women’s sexual function affected by a SCI?

Answer 10

neural control is comparable to male response
erection vs vaginal lubrication and vasocongestion of the genitalia (pathways are similar response is different)
not as much information on female sexuality

Question 11

How are orgasms affected by SCI?

Answer 11

not totally dependent on genital sensation (fantasy, erotic imagery, stimulation above LOL)
some with complete injuries experience orgasms (78% male and 52% female)
reported as satisfying with a resolution of sexual tension

Question 12

How is fertility in men affected by SCI?

Answer 12

low sperm count
impaired quality
sperm can be harvested through vibroejaculation (non-evasive), electroejaculation(electroprobe and current/ invasive and must be aware of autonomic dysreflexia), or surgery
slight chance of fathering a child without medical help

Question 13

How is fertility in women affected by SCI?

Answer 13

menstrual cycle may be absent up to a year
can become pregnant and carry a baby to full term
premature labor and low birth weight are common
consult with a rehab specialist
contraceptive problems (vascular issues and risk of DVT)

Question 14

What is the PLISSIT model?

Answer 14

permission to talk about their problems
limited information resources for patient
specific suggestions to enhance experience, assignment
intensive therapy psychologist etc

Question 15

What are the psychodocial issues with loss?

Answer 15

physical losses (motor, sensory, basic physiological fxn)
autonomy (being dependent)
financial security (work, finance for rehab)
relationships (friends, family)
role in life

Question 16

What are some additional factors besides psychosocial issues?

Answer 16

sensory deprivation/isolation: ICU can't tell day/night
sleep deprivation: fatigue
medications
effects of surgery: chronic pain
boredom: same thing day in and day out

Question 17

What is adjustment?

Answer 17

shock and disbelief to acceptance of injury
ongoing process
some never adjust
suicide rate 3-5x higher

Question 18

What are the factors influencing adjustment?

Answer 18

personal characteristics (optimistic/pessimistic)
prior loss/trauma (past experiences)
social support (family)
financial support
education

Question 19

How does level of lesion affect adjustment?

Answer 19

no correlation in LOL and psychological disability

Question 20

What is a normal early reaction for a SCI patient?

Answer 20

grief

grieving for the loss from SCI

Question 21

How do you distinguish between grief and depression?

Answer 21

grief can still live life
depression sense of despair
common in grief and depression is decreased appetite, sleep disturbances, and decrease socialization

Question 22

How does the decreased LOS affect grief?

Answer 22

patient is discharged from acute before they are able to address psychological issues of what has happened

Question 23

What is the medical model approach for treatment?

Answer 23

rigid hierarchy of power
“fix” patient
patient has passive role
professional knows best

Question 24

What is the education model approach for treatment?

Answer 24

respect and equality for patient
collaborate with patient
patient has active role
mutually agreed upon goals

Question 25

How can you create a positive atmosphere?

Answer 25

keep physical environment upbeat, age appropriate and use music
let patient know and be accountable for their schedule
emphasize what patient can do (compromise and challenge patient)
encourage patient to take risks because that is the only way for patient to gain confidence

Question 26

What is included in a psychosocial evaluation?

Answer 26

personality, problem-solving ability, cognitive abilities, coping abilities, support network, financial status, history of anxiety/depression, psychiatric illness, substance abuse

Question 27

What are some general recommendations for treatment?

Answer 27

patient focused rehab (keep them informed, encourage them)
positive environment
maintain professional boundaries (some point you will have to be tough)
educate patient and family
counsel individual or peer

Question 28

What can patients do post-discharge?

Answer 28

peer support
self-help groups
independent living centers
vocational rehab (need to support themselves)