Sexual function Flashcards
barriers affecting sexual function
genital function motor abilities sensation ROM muscle tone pre-existing attitudes (religion)
Masters and Johnson framework
arousal
plateau
orgasm
resolution
male sexual function
based on questionnaires
neural control of erections involves 2 regions of SC and higher centers in brain (T11-L2 and S2-S4)
can be generated in 2 ways- psychological arousal and sensory stimulation
reflexogenic erection
reflex arc intact
sensory stim from genital area, rectum or bladder travels to S2-S4 causing firing of parasympathetic efferents
psychogenic erection
psychological stimulation
sympathetic efferents from Tll-L2 or impules from higher centers cause sacral efferents to fire
smell, visual, erotic talk
level of injury guidelines for genital arousal
above T11= can only have reflexogenic
between T11 and L2= psychogenic and reflexogenic
low lesions= only psychogenic
Summary of genital function
most men retain capacity to have erection
loss of input from either center alters quality and/or ability to sustain
ejaculation
normally involves both thoracolumbar and sacral regions, plus supraspinal centers; damage to any center makes chance remote
32% incomplete UMN, 70% incomplete LMN
may have retrograde ejaculation
retrograde ejaculation
semen goes back up in bladder; not harmful
tx of ED
meds or injections- viagra
vacuum device- you have 30 min
penile implant
women genital function
neural control comparable to male response
erection vs vaginal lubrication and vasocongestion of genitalia- response different
not as much info about female sexuality
Orgasm
not totally dependent on genital sensation- 52% incomplete reach orgasm through fantasy, erotic imagery or stim of areas above LOL
some with complete injuries experience orgasm
reported as satisfying with resolution of sexual tension
fertility- men
men with SCI have low sperm count, impaired quality
slight chance of natural fertilization
sperm can be harvested through vibroejaculation, electroejaculation or surgery
electroejaculation
most common way to get sperm from man
under anesthesia, successful, concern of autonomic dysreflexia
fertility- women
menstrual cycle may be absent up to a year
can become pregnant and carry baby to full term
premature labor and low birth weight common
consult rehab specialist needed
contraceptive problems- vascular complications- DVT
PLISSIT model
permission
limited info- end of PT scope of practice
specific suggestions
intensive therapy
Psychosocial loss of
physical losses autonomy financial security relationships role in life
additional factors besides psychosocial
sensory deprivation/ isolation sleep deprivation meds effects of sx boredom
Adjustment
shock and disbelief
level of injury- no correlation on ability to adjust
some never adjust- suicide rate 3-5x higher
factors influencing adjustment
personal characteristics prior loss/trauma social support financial security education
early reaction
grief- life you had is gone, normal, lose appetite, poor sleep, decreased socialization
depression- can’t function in daily life; hopeless despair
Impact of hospital LOS
pt not psychologically prepared for adjustment in rehab, now have 2nd chance- pt can return to rehab after 1 year
Medical model
rigid hierarchy of power
“fix” pt
pt passive role
professional knows best
educational model
respect and equality for pt
collaborate with pt
pt has active role
mutually agreed upon goals
positive atmosphere
physical environment- upbeat, age appropriate
pt schedule- pt needs to know and held accountable
emphasize what pt CAN do
encourage pt to take risks- get confidence
psychosocial eval
personality, problem solving ability, cognitive abilities, coping, suport, financial status, hx anxiety/ depression, psychiatric, illness, substance abuse
recommendations for success
pt focuses rehab positive environment maintain professional boundaries- be tough to get progression education to pt and family counseling- refer if needed
post- discharge
have to handle situations peer support self help groups independent living centers vocational rehab
