Sexuality

Question 1

is erection possible

Answer 1

psychogenic erection - sights, sounds, thoughts
T11-L2

reflexogenic erection - physical stimulation, S2-S4

Question 2

is ejaculation possible

Answer 2

Very few men with complete SCI have ejaculations (<10%).

• Complete UMN and LMN= unlikely to have ejaculation
• Incomplete LMN>UMN

Question 3

is it possible to father a child

Answer 3

Possible, but difficult.

Most problems with fertility for men after SCI are related to ejaculation.

Question 4

vacuum-induced erections

Answer 4

least invasive

1. Place a tube with a pump over the penis.
2. Activate to pull the air out of the tube and cause blood to inflate penis.
3. Place a band around the base of the penis to maintain erection.

Question 5

oral systemic medication

Answer 5

1. Sildenafil (Viagra), Cialis
2. Great benefit to those men with SCI who have reflex erections
3. Unknown what the physiological trigger is in men with SCI

Question 6

penile injection therapy

Answer 6

1. Intracavernosal injections, penile suppository
2. Reliable & rigid erections
3. Relatively safe
4. Dose titration important
5. Once/24hrs only 3/week

Question 7

surgical implantation

Answer 7

1. Two types of penile protheses
I. Inflatable prosthesis
ii. Malleable prosthesis
o Only done when reversible methods have failed 
o At risk for mechanical failure
o May need replacement
o Preempts future use of other methods

Question 8

menstrual period

Answer 8

Menstrual periods frequently stop for a period of time after trauma and begin again within 6 months or less. Either tampons or menstrual pads can be used.

Question 9

pregnancy

Answer 9

ABSOLUTELY! It is possible for women with spinal cord injury to become pregnant through intercourse and carry a baby to term.

can have vaginal delivery

Question 10

is orgasm possible

Answer 10

The specific ability to have an orgasm after SCI is unknown but many people report they are able to have some form of orgasm after their injury.

Question 11

complications

Answer 11

Autonomic dysreflexia is possible during sexual activity.
Here are some ways AD can be triggered:
- Rough stimulation of the genital area such as stroking, squeezing, or sucking.
- Using a vibrator for stimulation. Be sure to use plenty of lubrication and be gentle.
- Ejaculation, infection, or inflammation of the testicles.
- Menstruation, pregnancy, infection, or inflammation of the vagina or uterus.
- Taking oral contraceptives will increase risk of CVA and DVT in women with SCI

Question 12

Rehab goals should aim for the patient to:

Answer 12

1. Learn ease of communication regarding sexuality
   • Patient & family should receive the message that sex is a legitimate concern.
   • Goal is for patient to become comfortable as a sexual being, affirm sexuality.
2. Gain basic understanding of how he/she functions sexually
   • Physical sexual response, fertility, techniques for giving/receiving pleasure, strategies to deal with logistical problems

Question 13

Plissit model

Answer 13

• Model where YOU decide where your comfort level/knowledge base is
• Every member of the team knows the “go to” for any information the person may ask
• ALL members should be comfortable AT LEAST at the first level!!!

permission - limited information - specific suggestions - intensive therapy

Question 14

5 tips for the therapist

Answer 14

1. Explain that sexuality is a legitimate topic.
2. Educate from general to specific.
3. Be very nonjudgmental or neutral.
4. Don’t pretend to know something that you don’t.
5. Ask permission and give permission to talk about it.