Added: Terria Plouffe - Date: 01.12.2021 00:44 - Views: 44361 - Clicks: 543
Try out PMC Labs and tell us what you think. Learn More. Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries SCIwho must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess Women want sex Bruneau genital function and psychosocial factors.
Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity touch, pressure, vibrationand sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina G spotcervix, and nipples conveyed by different innervation sources.
Treatments may consider PDE5 inhibitors and flibanserin Women want sex Bruneau an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications.
Psychosocial issues must be addressed as possible contributors to sexual dysfunctions eg, lower self-esteem, past sexual history, depression, dating habits. Pregnancy is possible for women with SCI; younger age at the time of injury and at the time of pregnancy being ificant predictors of successful pregnancy, along with marital status, motor score, mobility, and occupational scores.
Pregnancy may decrease the level of functioning eg, self-care, ambulation, upper-extremity tasksmay involve complications eg, decubitus ulcers, weight gain, urological complicationsand must Women want sex Bruneau monitored for postural hypotension and autonomic dysreflexia. Taking into consideration the physical and psychosocial determinants of sexuality and childbearing allows women with SCI to achieve positive sexual and reproductive health.
Sexual function and to a lesser extent reproduction are often disrupted following a lesion to the spinal cord. Fertility is usually maintained, but pregnancy requires close monitoring and follow-up. It is thus beneficial to educate women about these issues to help them adapt to their new lives and to maintain a positive attitude toward sexual health and motherhood.
The literature on women with spinal cord injuries SCIs repeatedly shows that sexual function is possible despite the level or degree of injury. These women remain sexually active and consider sexuality as essential part of their quality of life. Studies of women with SCIs indicate that their sexual responses can be differentially preserved with psychogenic or reflexogenic genital stimulation depending on the lesion level and extent. Vaginal lubrication was possible for women with lower spinal cord lesions using psychogenic stimulation, whereas vaginal lubrication was reported in women with higher spinal cord lesions using reflexogenic genital stimulation.
Sipski et al 12 performed a laboratory-based controlled analysis of components of sexual arousal in women after SCI using vaginal pulse amplitude to measure genital vasocongestion. Analysis of the vaginal responses of 67 women with varying degrees and levels of SCI revealed that the occurrence of psychogenic genital responsiveness was ificantly associated with the degree of combined pinprick plus light touch American Spinal Injury Association Impairment Scale AIS sensory score in the TL2 dermatomes.
In later laboratory-based controlled studies, these were confirmed by documenting a greater impact of anxiety-provoking stimulation 23 and false feedback, 24 both treatments that rely on psychogenic stimulation to promote increased genital blood flow, in women with SCI and varying degrees of combined pinprick and light touch scores from TL2. The same group of subjects 1114 participated in a separate controlled study where they were provided a vibrator and asked to stimulate themselves any way they desired to achieve orgasm.
Heart rate and blood pressure readings were compared between able-bodied and SCI subjects every 3 minutes and at orgasm, and readings in both groups were statistically increased at orgasm versus baseline but were similar in both groups. In a controlled laboratory-based analysis, Whipple et al 25 studied 16 women with complete SCI above the level of T10 and 5 able-bodied subjects and found that women with spinal cord lesions could reach orgasm with cervix stimulation.
The orgasmic response was also accompanied by ificant changes in blood pressure and heart rate; these were statistically similar in control and SCI subjects. In another study of 5 women with SCI at arousal and orgasm while undergoing fMRI of the brain, 3 women, including 2 with complete injuries, achieved orgasm. Findings in this pilot study were interpreted to reveal activity in the brainstem solitary nucleus, 26 a region of the medulla oblongata to which the vagus nerves project. As recommended by Salonia et al, 27 this finding would need to be repeated in a larger group of subjects; 10 to 20 subjects are usually needed in a study using this type of cerebral imaging.
Altogether these findings indicate that even women with complete SCI can self-stimulate to orgasm through genital, clitoral, or cervical stimulation. Although women with SCI have not been directly studied for anterior vaginal wall or nipple stimulation, findings from women with and without SCI suggest that anterior vaginal wall and nipple stimulation contribute to sexual arousal and orgasm; these structures are mediated by different peripheral or spinal nerves.
Neurological pathways can therefore convey sexual responses in women with spinal cord lesions through at least 3 routes involving 1 the dorsal clitoral pudendal nerve somatosensory innervating the clitoris and external labia, 2 the pelvic nerve and inferior hypogastric nerve feeding into the uterovaginal plexus parasympathetic and innervating the vagina and cervix, and 3 the hypogastric nerves sympathetic innervating the cervix and uterus. A climactic-like response of firing of the pudendal motor nerve also occurs in response to stimulation of the pudendal sensory nerve but does not require intact pelvic or hypogastric nerves.
As these afferent fibers and their corresponding efferent pathways convey genital responses through sacral reflexes S2-S4psychogenic responses can also be mediated through the TL pathway running through the sympathetic chain and feeding into the uterovaginal plexus or the hypogastric nerves to innervate the cervix and uterus.
Evidence has documented the presence of a spinal pattern generator for ejaculation in males.
Additionally a spinal fMRI study of 9 healthy women that assessed spinal responses to varying types of sexual stimulation 34 revealed evidence of increased spinal activity in the region of the lumbar spinothalamic cells prior to orgasm, thus this area of the spinal cord may receive both cervical and supraspinal input and begin to integrate these inputs with autonomic outflow from the intermediolateral columns and the sacral parasympathetic nucleus, possibly as a trigger for orgasm.
Based on the above studies, further research is necessary to determine the neurologic pathways involved in sexual responses in spinal cord—injured and able-bodied women. Advance imaging techniques need to be utilized to determine the spinal and cortical circuitry involved in orgasm. Controlled studies such as that of Georgiadis et al 35 with adequate sample sizes are Women want sex Bruneau to perform in this study population, so translational methods merging basic science and clinical findings must also be emphasized.
Although the findings are optimistic about the ability for women to maintain genital responses with relatively independent sources of stimulation, they must not be taken to suggest that genital responses are the only goal of sexual rehabilitation in women with SCI. Sexual rehabilitation must use a holistic approach 3 consistent with Basson's 3637 theory emphasizing the emotional, cognitive, couple, and past history of women in their sexual perceptions. Genital function in women with SCI must therefore be assessed along with other aspects of sexuality, including physical concerns associated with SCI eg, incontinence, spasticity and psychosocial adaptations.
The primary impact of SCI on sexual function concerns the direct neurological consequences of the spinal lesion. Women with SCI may differentially Women want sex Bruneau a potential for psychogenic or reflexogenic responses through the TL pathway for psychogenic responses and through the sacral pathway for reflexogenic responses. Reflexogenic potential should be explored not only with clitoral stimulation but also with vaginal, G spot, and cervix stimulation. As a first step of sexual rehabilitation, women with SCI should be assessed for TL dermatomes, as suggested by Sipski et al's work 11—14 on psychogenic potential, and vulvar sensitivity and perineal reflexes for reflexogenic potential.
Vulvar sensitivity may be assessed with different sensory modalities, including light touch as involved in sexual caresses and pressure and vibration as involved in vaginal penetration and sex toys. Documentation of women's sexual potential is recommended using the international standards to document remaining autonomic function after spinal cord injury 41 Women want sex Bruneau addition to the international spinal cord injury female sexual function basic data set.
In contrast, the data set is deed to be used clinically and as a research tool to document the specific sexual dysfunctions that are present. Assessment should be followed by exercises, ideally performed in the rehabilitation setting where coaching can be offered, or at home where self-explorations should been couraged with stimulation of the clitoris manual or vibrator stimulationthe vaginal entry G spotand deeper vaginal tissue including the cervix. Nipple exploration should also be encouraged as an additional source of stimulation to feed into sexual arousal and to help in reaching orgasm.
When these rehabilitation options are not sufficient for women's sexual satisfaction, other options can be offered, including phosphodiesterase type 5 PDE5 inhibitors. Although they were beneficial in a laboratory-based study of women with SCI, 43 positive were not observedin an international clinical trial. Thus, these medications can be offered on an individual basis to improve genital congestion. Women may also be encouraged to explore devices such as the Eros Clitoral Therapy Device CTD or its equivalent to improve sexual congestion and orgasm.
The secondary impact of SCI involves the consequences of the neurological lesion on other body functions that are important for sexuality. Reduced mobility, which limits sexual positions, spasticity, contractures, pain, concerns with incontinence, and side effects of medications are recurrent concerns that can limit the willingness of women with SCI to engage in sexual activities.
Rehabilitation strategies may focus on providing practical advice, for example, instructing the woman to compensate for reduced mobility by using pillows eg, under the hipswedges, or cushions to relieve pressure and to provide support during intercourse. Longer foreplay and perception of other body sensations breast, ear lobes, inner thighs may provide additional pleasure; behaviors such as kissing, hugging, fantasies, or sexual memories can provide alternatives to intercourse. Yet severe AD should always be avoided and reported whenever it occurs. Women receiving perineal training for urinary incontinence may find it beneficial to sexual function, as it involves similar strategies to Kegel exercises ie, voluntary pelvic contractions.
No formal studies have been conducted on this issue in women with SCI. The use of sex toys, assistive devices eg, straps for vibrators, dildosand substitution systems 76 may be suggested to facilitate stimulation, overcome positioning issues, and increase sexual adjustment. A regular revision of medications, including antispasmodics, pain killers especially opioidsand antidepressives, that are known to be associated with increased risks of sexual dysfunction is advisable.
The tertiary impact of SCI concerns the psychosocial effects on sexuality. Readiness for sexuality is an important aspect in determining a client's motivation to reengage in sexual activities. Rehabilitation professionals should be aware of the importance of providing sexual information during rehabilitation, whether the patient has asked for specific information or not.
Patients expect professionals to provide information regardless of whether they have demonstrated a readiness for sexuality during rehabilitation. Psychological effects of SCI such as major depression, anxiety, and alcohol and drug abuse 7 are usually managed during rehabilitation, but they may reappear after hospital discharge. The relationship between partners may change at home, and regular habits may have to be reinvented.
Facilitating dating, leisure, and social activities prevents social isolation and can help prevent depression.
Social activity improves self-esteem, self-confidence, and psychological well being. The neurological changes in women following an SCI may affect their reproductive and obstetrical health. Responses of the reproductive system to SCI-related conditions determine how women with SCI experience issues related to menstruation, fecundity, pregnancy, labor, delivery, and postpartum state.
Following an SCI, a woman's menstrual cycle is usually disrupted and gynecologic dysfunction may occur. Secondary amenorrhea, menorrhagia, metrorrhagia, and neurogenic prolactinemia with and without galactorrhea 80—82 have been described in the initial postinjury months. Neurogenic prolactinemia-galactorrhea syndrome mimics lactation, whereby the thoracic nerves are stimulated and initiate disinhibition of dopamine control, thereby producing breast milk.
If, after 6 months, a woman's menstruation has not returned to preinjury Women want sex Bruneau, the clinician should check her FSH, LH, estradiol, testosterone, thyroid stimulating hormone, Vitamin D, and prolactin levels to detect underlying imbalances and target a correction. Some data suggest 83 that women with SCI become pregnant for the first time at an older age than able-bodied women, but social issues rather than physiological issues may play a major role. In a cross-sectional study, 66 The relatively lower pregnancy rate makes prospective studies about obstetrical complications difficult.
Although some studies have addressed incidence of pregnancy, no studies have examined the physiological factors involved with fertility following SCI. Unique medical problems, however, appear to occur in these women during pregnancy, labor, and delivery.
In a recent publication, Iezzoni et al 84 examined Women want sex Bruneau prevalence of pregnancy in a large cohort of 1, women with SCI. Only 2. This annual prevalence differed ificantly by years elapsed since injury with the highest rate occurring 15 years after injury 3. Compared with nonpregnant women, those reporting current pregnancy were ificantly more likely to be married or partnered, have sport-related SCI, have higher motor scores, and have more positive psychosocial status scores.
Multivariable analyses found ificant associations between current pregnancy and age, marital status, motor score, mobility, and occupation scale scores. Although it has often been reported that the ability of a woman to conceive is not affected by SCI, the evidence for this has not been shown conclusively. Examining these aspects of health following SCI will further elucidate the changes that occur during pregnancy. Little has been written on the major pregnancy determinants for women with SCI, but Iezzoni's study 84 gives insight into 2 important conditions: 1 disability-specific issues and 2 age-induced concerns.
Age-related factors are commonly implicated as determinants for fertility and pregnancy rates; these are also considerations in the able-body population. Of course the degree and level of SCI dictates the amount of assistance that the woman may require and the level of functioning for self-care, ambulation, and upper extremity tasks. Furthermore, the higher functioning neurological impairment rating AIS D and Para ABC statistically corroborates the importance of independence with becoming pregnant.
Conversely, women with higher neurological lesions may show important complications including AD, urinary infections, respiratory problems, and thrombophlebitis. Many other factors can impact functional abilities after SCI. Physical restrictions may occur when spasticity develops in those women with UMN levels of injury. Contractures can fuse ts and prevent movement in the lower extremities. Heterotopic ossification may occur following a central nervous system insult, with the most common site being the hips followed by the knees, shoulders, and elbows.
This condition would prevent mobility, transfers, and ambulation.
Another type of skeletal deformity that may affect pregnancy after SCI is spinal misalignment. ificant kyphosis or scoliosis anatomically interferes with posture and mobility and can also alter circulation and the capacity to carry a fetus. Mobility may be affected physiologically by the secondary medical conditions that are exacerbated by the growing fetus. Depending on level of injury, varying degrees of pulmonary dysfunction occur following SCI.Women want sex Bruneau
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Women's Sexual Health and Reproductive Function After SCI