Sexuality and Spinal Cord Injury

Increased Urination Urgency Exacerbates Sexual Risk-Taking Through Heightened Sexual Arousal

Increased urination urgency has been shown to facilitate impulse control in cognitive domains, but its effects in other areas are unknown. We examined whether inhibitory spillover effects would replicate and extend to close relationships-specifically, influencing decision making related to sexual risk-taking. Across three studies, we either measured (Studies 1 and 3) or manipulated (Study 2) participants' bladder pressure and assessed sexual self-control using a questionnaire of sexual risk-taking intentions (Study 1) or a simulated semi-behavioral sexual risk-taking (Choose Your Own Sexual Adventure) task (Studies 2 and 3). Study 1 (N = 44 men, 59 women) showed greater urination urgency was associated with greater sexual risk-taking. Study 2 (N = 65 men, 91 women) showed that increasing urination urgency led to greater sexual risk-taking, but only among men. Study 3 (N = 86 men, 183 women) showed elevated urination urgency was associated with an increase in sexual arousal, which accounted for the greater sexual risk-taking.

Exploring Iranian individual's perception toward divorce after disability related to spinal cord injury

STUDY DESIGN

An exploratory qualitative research.

OBJECTIVES

To understand how Iranian individuals with spinal cord injury (SCI) perceive post-SCI divorce.

SETTING

Protection Center of Spinal Cord Disables.

PARTICIPANTS

Post-SCI divorcees who were 18 years and older.

METHODS

The participants were 20 individuals with SCI (9 men and 11 women) who were willing to share their experiences through interviews. They had been referred to the 'Protection Center of Spinal Cord Disables'. The data were collected through ten semi-structured individual in-depth interviews and two focus group discussions. Braun and Clarke's thematic analysis approach was applied to extract the meanings informants used to conceptualize the concept of marriage.

RESULTS

Post-SCI divorce was conceptualized in terms of 'contextual scenarios'. We explored the scenarios related to post-SCI divorce in terms of predisposing scenarios and identified them as ground-breaking stories for constructing a decision process for post-SCI divorce. We also determined efforts that had been made to maintain marital stability.

CONCLUSIONS

Based on our participants' perceptions, post-SCI divorce was affected by their understanding of scenarios resulting in post-SCI divorce and their struggles to stay married.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): validation of the Italian version for individuals with spinal cord injury

STUDY DESIGN

Psychometric study.

OBJECTIVE

The aim of the study was to translate and culturally adapt the MSISQ-15 into Italian and to administer it to individuals with a spinal cord injury (SCI).

SETTING

Rome's Wheelchair Rugby Team and three spinal units in Italy.

METHODS

Translation and validation of the MSISQ-15 were performed based on international guidelines. The questionnaire, which was in a paper and online format, was administered with the Short Form-12 Health Survey (SF-12) and the Spinal Cord Independence Measure Self-Report.

RESULTS

Sixty-five participants were recruited. Internal consistency coefficient of MSISQ-15 scale, assessed by Cronbach's alpha, was 0.75. Test-retest reliability interclass correlations was, for example, 0.86. The construct validity was calculated and showed statistically significant results in relation to the mental health status investigated with the SF-12.

CONCLUSIONS

The MSISQ-15 is a valid, reliable, and useful questionnaire for investigating how often the symptoms of an SCI interfere with a person's satisfaction or sexual activity.

Sexuality as part of rehabilitation? A qualitative study on the perceptions of rehabilitation nurses on discussing patient sexuality during clinical rehabilitation

INTRODUCTION

Spinal cord injury may seriously affect sexual health and sexuality, which can lead to lower self-esteem, social isolation, lower quality of life, and an increased risk of depression. Nurses play an extensive role in providing patient education. However, a gap between the patients' need for information and the lack of information provided by nurses still exists. Therefore, knowledge about barriers and facilitators regarding discussing patient sexuality is necessary.

METHODS

Semi-structured interviews were conducted with 25 nurses working in Spinal Cord Injury rehabilitation in one clinic in the Netherlands. The following themes were discussed during the interviews: (1) attitude, (2) social factors, (3) affect, (4) habits and (5) facilitating conditions.

RESULTS

Addressing patient sexuality was difficult due to the nurses' attitude and their environment. Sexuality was considered important but respondents were reserved to discuss the topic due to taboo, lack of knowledge, and common preconceptions. Participants expressed the need for education, a clear job description, time and privacy.

CONCLUSION

Nurses consider discussing patient sexuality as important but are hindered due to multiple factors. Organizational efforts targeted at knowledge expansion are needed to break the taboo and remove preconceptions. Nurses should provide opportunities to discuss the subject to intercept sexuality-related problems.IMPLICATIONS FOR REHABILITATIONThe specific tasks of each profession within the multidisciplinary team regarding patient sexuality should be discussed, agreed upon and protocolized.Adding a sexologist in the multidisciplinary team may be of benefit as well as structurally incorporating an appointment with the sexologist within the patients' schedule.If a sexologist is not available, opt for a nurse practitioner who is specialized - or wants to further specialize - in sexual health and sexuality.In order to create more awareness on patient sexuality within the nursing team, a working group can be arranged to give special attention to discussing the subject by organizing trainings and coaching fellow nurses to address sexuality.Create a safe and private environment for the patient when addressing sexuality.Educational interventions to enhance the nurses' knowledge in order to make nurses feel capable to provide basic sexuality-related patient education.

Development of a Sexual Needs Rehabilitation Framework in Women Post-Spinal Cord Injury: A Study From Iran

OBJECTIVE

To develop a sexual needs rehabilitation framework in women after spinal cord injury (SCI).

DESIGN

Mixed-methods study. The study consisted of 3 steps: (1) a primary needs assessment with quantitative and qualitative methods; (2) prioritization of identified needs by expert panels; and (3) development of a framework.

SETTING

Multi-dimensional clinical referral center.

PARTICIPANTS

Married women (N=31) with an SCI that occurred at least 1 year ago.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Development of sexual needs rehabilitation framework.

RESULTS

The quantitative phase in the first phase showed that the total mean ± SD score of the Sexual Quality of Life-Female questionnaire was 60.47±1.53, and the total mean ± SD score of the Female Sexual Function Index was 50.54±11.35. Moreover, women's sexual understanding post-SCI in the qualitative assessment revealed the following 3 main themes: (1) "dilemma leading to limited sexual activity"; (2) "seeking positive sexual adjustment"; and (3) "lack of client-based sexual and reproductive education/counseling in the rehabilitation process." Results from prioritizing identified needs in the second step indicated that the most important needs related to sexual aspects of life. In the final step, the framework for Iranian woman with post-SCI sexual rehabilitative needs developed with focus on sexual behavior complication post-SCI as a main need.

CONCLUSIONS

It is important to assess probable unmet needs before designing, planning, and implementing an interventional rehabilitative health care program, especially when focusing on issues of sexuality. A developed framework can be applied by the rehabilitation team during initial caregiving and can be continued as long as needed.

Spinal cord injury and women's sexual life: case-control study

Study design :This is a case-control study.

OBJECTIVE

The objective of this study was to estimate the magnitude of association between spinal cord injury (SCI) and women's quality of sexual life and sexual function.

SETTING

This study was conducted in the Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

METHODS

From the referral university-based clinics, we used simple random sampling to recruit 62 women: 31 women with SCI and 31 women without SCI. Socio-demographic and reproductive traits questionnaire, Sexual Quality of life-Female (SQOL-F), Female Sexual Function Index (FSFI) and Spinal Cord Independence Measure (SCIM) were completed using telephone and face-to-face interviews in the cases and controls. After univariate analyses, multivariate linear and proportional odds regression models were conducted to investigate the relation between SCI and women's quality of sexual life, as well as sexual function.

RESULTS

The mean age of cases and controls was 35.42±6.51 and 33.77±4.02 years. Most women were high school-educated and housewives. Adjusting for probable confounders, the proportional odds regression model showed a significant relationship between the spinal cord injury (AOR=4.2, 95% CI: 1.8-9.2), non-college-educated (AOR=3.1, 95% CI: 1.2-5.9) and employed (AOR=1.8, 95% CI: 1.1-1.8) variables and being in one of the moderate or poor quality of life classes. Scores of SQOL-F and FSFI domains, except satisfaction, were significantly worse in cases versus controls (P<0.001).

CONCLUSION

Although our participants showed low sexual dysfunction, they tended to report moderate to poor quality of sexual life. Our findings support the implication that sexual rehabilitation must be provided for women with SCI soon after injury.

Sexual Functioning in Men Living with a Spinal Cord Injury-A Narrative Literature Review

BACKGROUND

Sexual dysfunction is a major concern for Indian men living with a spinal cord injury.

OBJECTIVES

To examine the literature related to sexuality traumatic cord injury and its impact on sexual functioning.

MATERIALS AND METHODS

Databases using Cumulative Index to Nursing and Allied Health Literature (CINAHL) 2000-2012, Medline 1989-2012, Applied Social Sciences Index and Abstracts (ASSIA) 1989-2012 and Google Scholar were the search engines used used for literature review.

RESULTS

The search yielded a total of 457 articles and only 75 of them were found relevant. The minimum number of articles required to meet the inclusion criteria for this review was 25-30 articles. Out of the 75 articles, 33 were considered relevant or related to the topic of sexual functioning, spinal cord injury, and paraplegia. Six areas were identified: Sexual stigmatization, physiological barriers to sexual satisfaction, clinical aspects of sexual functioning, biomedical approaches to sexual dysfunction, partner satisfaction, and lack of accessibility to sexual education.

CONCLUSION

Spinal cord injury and sexual functioning affects a large segment of the male Indian population, yet most current research focuses on quantitative measurement with the emphasis on ejaculatory dysfunction, orgasm impairment, incontinence, and other physiological dysfunction. Further research is needed to address the subjective accounts of patients themselves with respect to the emotional and social impact of sexual disability. This would help to identify the best possible outcomes for both treatment and rehabilitation.

Psychometric properties of the Sexual Adjustment Questionnaire (SAQ) in the Iranian population with spinal cord injury

STUDY DESIGN

This is a cross-sectional study.

OBJECTIVES

The objective of this study was to examine the psychometric properties of the Sexual Adjustment Questionnaire (SAQ) for Iranian people with spinal cord injury.

SETTING

This study was conducted in the brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran.

METHODS

We assessed the psychometric properties of the SAQ, with 200 participants (men=146, women=54) completing the scale. An evaluation of its test-retest reliability was performed over a 2-weeks period, on a subsample of 30 patients recruited from the overall group. Cronbach's α-coefficient was computed for assessment of internal consistency reliability. In addition, content and face validity were examined by an expert committee. Construct validity was assessed by examining convergent and discriminant validity. Finally, exploratory factor analysis was used to extract the factor structure of the questionnaire.

RESULTS

The Cronbach's α and intraclass correlation coefficient were 0.77 and 0.72 retrospectively. With regard to construct validity, there was a significant (P=0.009) negative correlation (r=-0.28) between the SAQ score and age. Those with lower levels of educations scored significantly lower on the SAQ (P=0.04). The exploratory factor analysis indicated a four-factor structure for the questionnaire, accounting for 68.9% of the observed variance. The expert committee approved the face and content validity of the developed measure.

CONCLUSION

The SAQ is a valid measure for assessing sexual adjustment in people with spinal cord injury. The evaluation of sexual well-being may be useful in clinical trials and practical settings.

Sexual satisfaction in women with spinal cord injuries

STUDY DESIGN

Structured interview based on a predesigned survey.

OBJECTIVE

To examine the factors that affect the degree of sexual satisfaction in a sample of women with spinal cord injury (SCI).

SETTING

The study participants were women with SCIs, from the area of the SCI Unit of A Coruña, a reference unit for the Community of Galicia in the northwest of Spain. All study participants were selected consecutively in the outpatient clinic in 2013.

METHODS

The study included women with the American Spinal Injury Association (ASIA) A-D spinal injuries, between the ages of 18 and 65 years, who completed rehabilitation therapy and live in the community. A total of 32 women formed the final study group.

RESULTS

When comparing the group of women who were sexually active with those who were not, variables such as age, neurological level, time since the SCI, ASIA or Spinal Cord Independence Measure score, urinary incontinence, chronic pain and spasticity were not related to sexual activity. The only factors that we found to be related to sexual activity were not having a stable partner (P=0.017) and a lack of sensation in the genital area (P=0.039).

CONCLUSION

The only variables related to sexual activity were not having a partner and a lack of sensation in the genital area. Improving sexual satisfaction, information and specific programs during rehabilitation can help women with SCI explore and investigate new erotic possibilities, thereby improving their self-esteem and social relationships.

Assessing student nurses' learning needs for addressing patients' sexual health concerns in Taiwan

BACKGROUND

Patients' health status may involve sexual issues and nursing education must prepare nurses to address patients' sexual health concerns. In Taiwan, nursing school curricula rarely include programs related to patients' sexuality or sexual health issues, and reflect conservative Asian attitudes toward sexuality.

OBJECTIVES

Our aims were to determine Taiwanese student nurses' learning needs relative to addressing patients' sexual health concerns, and to gather information for curriculum development in sexual health education.

DESIGN

Descriptive, correlational study.

SETTING

Nursing school at a medical university in central Taiwan.

PARTICIPANTS

140 senior student nurses.

METHODS

A 24-item instrument entitled "Learning Needs for Addressing Patients' Sexual Health Concerns" (LNAPSHC) was developed through 15 semi-structured interviews of senior nursing students, expert review, and comparative analysis of text and field notes. Content validity and reliability were evaluated using exploratory factor analysis to measure construct validity and Cronbach's alpha to measure internal consistency. Univariate and multivariate linear models were developed.

RESULTS

Age, gender, and religion were not significant influences. Expressed learning needs included sexuality in health and illness, communication about patients' intimate relationships, and approaches to sexual health care. "Obtaining a comprehensive sexual health history" was the highest learning need. "Having sexual consultations with patients without embarrassment" was lower. Most participants recognized their role in sexuality-related health care, but their preparation and willingness to address it were limited.

CONCLUSIONS

Our results indicated a gap between student nurses' positive perspectives on the role of nursing in sexual health care and their limited intention to provide it. Reported learning needs indicated that student nurses needed an effective curriculum to increase their ability and willingness to address patients' sexual health. Our results may help nursing educators develop curricula and clinical training to increase student nurses' competence in addressing patients' sexual health concerns.

Spinal cord injury and male infertility: a review

Spinal cord injuries remain an important factor of morbimortality in current society, involving mainly males from adolescence to adulthood. Among the sequelae caused by spinal cord injuries, the impairment of the sexual system is highly relevant since it affects the quality of sexual life and paternity. Infertility is secondary to multiple events such as erectile dysfunction, anejaculation, seminal biochemical modification and morphology of spermatozoa. Current therapies for the infertile spinal cord injured patient focus on the ejaculation stimulus followed by intrauterine insemination, leaving seminal low quality as the major factor of infertility in these patients. In this scenario, therapy with hyperbaric oxygenation, which is still being studied, represents an alternative treatment since it focuses on the central nervous system injured by the trauma and the testicular tissue in order to decrease spinal damage and to preserve the physiological regulation of the urogenital system as a form of avoiding infertility.

Predictors of changes in sentimental and sexual life after traumatic spinal cord injury

OBJECTIVE

To investigate changes and identify predictors in interpersonal functioning and sexual life after traumatic spinal cord injury (SCI).

DESIGN

Prospective, multicenter, follow-up observational study.

SETTING

Subjects at home, interviewed by phone during a 6-month period, 3.8 mean years after discharge from 24 centers participating in a previous epidemiologic prospective survey.

PARTICIPANTS

Subjects (N=403) with traumatic SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

DEPENDENT VARIABLES

satisfaction with sentimental life and satisfaction with sexual life compared with before the injury.

INDEPENDENT VARIABLES

demographic (age, sex, marital status, vocational status), SCI related (severity, level, bowel/bladder continence), car-driving ability, perceived quality of life (QoL), and impact of sentimental life, social integration, and vocational status on QoL.

RESULTS

Satisfaction with sentimental life was reportedly increased or the same as before SCI in 69% of the sample, but satisfaction with sexual life in only 31%. Lesser satisfaction with sexual life was reported by men than women (P=.002) and by married people than singles (P<.001). Significant predictors of sentimental life were perceived QoL and preserved driving ability (R(2)=.195). Bladder continence was positively associated with a better satisfaction with sexual life (R(2)=.368). Bowel continence did not remain a significant predictor of satisfaction with sexual life in multivariate analysis.

CONCLUSIONS

The challenge of a comprehensive rehabilitation of SCI, addressing the recovery of well-being including a satisfying sentimental and sexual life, requires identifying new issues that should be considered in up-to-date rehabilitation programs. The results indicate associations between driving ability and a better satisfaction with sentimental life. Further investigations are needed to explore whether the relationship is causative.