Sexual function

Question 1

barriers affecting sexual function

Answer 1

genital function
motor abilities
sensation
ROM
muscle tone
pre-existing attitudes (religion)

Question 2

Masters and Johnson framework

Answer 2

arousal
plateau
orgasm
resolution

Question 3

male sexual function

Answer 3

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

Question 4

reflexogenic erection

Answer 4

reflex arc intact

sensory stim from genital area, rectum or bladder travels to S2-S4 causing firing of parasympathetic efferents

Question 5

psychogenic erection

Answer 5

psychological stimulation
sympathetic efferents from Tll-L2 or impules from higher centers cause sacral efferents to fire
smell, visual, erotic talk

Question 6

level of injury guidelines for genital arousal

Answer 6

above T11= can only have reflexogenic
between T11 and L2= psychogenic and reflexogenic
low lesions= only psychogenic

Question 7

Summary of genital function

Answer 7

most men retain capacity to have erection

loss of input from either center alters quality and/or ability to sustain

Question 8

ejaculation

Answer 8

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

Question 9

retrograde ejaculation

Answer 9

semen goes back up in bladder; not harmful

Question 10

tx of ED

Answer 10

meds or injections- viagra
vacuum device- you have 30 min
penile implant

Question 11

women genital function

Answer 11

neural control comparable to male response
erection vs vaginal lubrication and vasocongestion of genitalia- response different
not as much info about female sexuality

Question 12

Orgasm

Answer 12

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

Question 13

fertility- men

Answer 13

men with SCI have low sperm count, impaired quality
slight chance of natural fertilization
sperm can be harvested through vibroejaculation, electroejaculation or surgery

Question 14

electroejaculation

Answer 14

most common way to get sperm from man

under anesthesia, successful, concern of autonomic dysreflexia

Question 15

fertility- women

Answer 15

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

Question 16

PLISSIT model

Answer 16

permission
limited info- end of PT scope of practice
specific suggestions
intensive therapy

Question 17

Psychosocial loss of

Answer 17

physical losses
autonomy
financial security
relationships
role in life

Question 18

additional factors besides psychosocial

Answer 18

sensory deprivation/ isolation
sleep deprivation
meds
effects of sx
boredom

Question 19

Adjustment

Answer 19

shock and disbelief
level of injury- no correlation on ability to adjust
some never adjust- suicide rate 3-5x higher

Question 20

factors influencing adjustment

Answer 20

personal characteristics
prior loss/trauma
social support
financial security
education

Question 21

early reaction

Answer 21

grief- life you had is gone, normal, lose appetite, poor sleep, decreased socialization
depression- can’t function in daily life; hopeless despair

Question 22

Impact of hospital LOS

Answer 22

pt not psychologically prepared for adjustment in rehab, now have 2nd chance- pt can return to rehab after 1 year

Question 23

Medical model

Answer 23

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

Question 24

educational model

Answer 24

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

Question 25

positive atmosphere

Answer 25

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

Question 26

psychosocial eval

Answer 26

personality, problem solving ability, cognitive abilities, coping, suport, financial status, hx anxiety/ depression, psychiatric, illness, substance abuse

Question 27

recommendations for success

Answer 27

pt focuses rehab
positive environment
maintain professional boundaries- be tough to get progression
education to pt and family
counseling- refer if needed

Question 28

post- discharge

Answer 28

have to handle situations
peer support
self help groups
independent living centers
vocational rehab