Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

Looking Beyond the Chair: Psycho-Perceptual Predictors of Sexual Distress and Sexual Satisfaction in Individuals with Spinal Cord Injury

Despite a large body of biomedical research, little is known about the psychological and perceptual predictors of sexual satisfaction (SS) and sexual distress (SD) post spinal cord injury (SCI). Guided by a bio-psycho-perceptual framework, this cross-sectional research aimed at assessing SS and SD in a large SCI sample using validated patient-reported outcome measures (PROM). Significant correlates and predictors of SS and SD were also identified. Ninety-one men and women with SCI completed PROMs of SS and SD, as well as psychological (mood, sexual and body esteem) and perceptual (interoceptive awareness, trait mindfulness, sexual mindfulness) factors. Neurological profiles were also assessed, along with experience of orgasm. Correlates of SS and SD were first identified using Pearson's correlations, then multiple hierarchical regression models were computed to isolate predictors. Orgasm experience and psychological factors emerged as moderate correlates of both SS and SD, while neurological factors did not. Interoceptive awareness and trait mindfulness showed weak associations with SD and none with SS. Among the tested predictors, experience of orgasm emerged as the strongest for SS (β = -.29, p < .01), followed by mood, which predicted SS and SD. Sexual and body esteem was predictive of SD only. In sexually active participants, sexual mindfulness predicted both SS (β = 0.55, p < .001) and SD (β = -0.56, p < .001) above and beyond all other variables. This study reveals unique aspects of SS and SD postinjury and supports further consideration of psychological and perceptual dimensions of SCI sexuality in rehabilitation research.

Sexual activity and function of adult men with spina bifida

OBJECTIVE

Data on sexual function of men with spina bifida (SB) is limited. We aimed to assess sexual activity and erectile dysfunction (ED) in a large international sample of men with SB.

METHODS

Men with SB (≥18yo) were recruited in an international online survey via clinics and social media. We collected data on demographics, ambulation (Hoffer classification), penile rigidity (Erection Hardness Score), sexual activity and ED (International Index of Erectile Function). Non-parametric tests were used.

RESULTS

A total of 162 men (median age 35, 62% shunted, 38% community ambulators) reported sexual desire similar to the general population (p = 0.82), but 55% were dissatisfied with their sex life (Summary Table). Overall, 36% reported full penile rigidity with erections, more commonly with better ambulation (p = 0.01), 69% had ever experienced orgasm and 84% ejaculated. In 44 men (27%) attempting sexual intercourse in the last 4 weeks, 59% had ED (11% severe, 7% moderate, 14% mild-moderate, 27% mild). In this group, 91% of men reporting less than full penile rigidity had ED, compared to 30% with full penile rigidity (p = 0.001). Overall, partnered non-genital contact in the last 3 months was reported by 56%, solo masturbation: 62%, partnered intercourse: 48% (31% vaginal). Of 54 men who used phosphodiesterase type 5 inhibitors (PDE5I), 80% reported improved erections, 56% improved intercourse. Overall, 40% reported non-genital erogenous zones as most pleasurable, especially with poorer ambulation (p = 0.002, chest/nipples: 73%).

COMMENT

Strengths of this study include anonymous, voluntary, online participation maximizing participation of a heterogenous, international population. Whenever available, we compared findings to published values for the general population. Since romantic and sexual activity is a complex intersection of interest, opportunity and ability, a more comprehensive assessment was beyond the study's scope. Future work will focus on the interplay with issues like incontinence.

CONCLUSIONS

ED was frequent among men with SB, especially in men with poorer ambulation. PDE5 inhibitors may be beneficial. Partnered sexual activity was reported by half of the men, although it may not involve penetrative intercourse.

Experiences of patients and their partners with sexual problems after spinal cord injury: A phenomenological qualitative study

Objective: This study aimed to examine the experiences of patients and their partners about their sexual lives after Spinal Cord Injury (SCI).Design: This qualitative study was based on Heidegger's hermeneutic phenomenological approach.Setting: The Physical Medicine and Rehabilitation Outpatient Clinic of a city hospital in the Central Anatolia Region in Turkey.Participants: The study consisted of seven female and six male patients with spinal cord injury and their partners.Outcome measures: The textual analysis was carried out in three stages: (1) a naive reading, (2) a structural analysis, and (3) a comprehensive understanding of the text including a discussion. The sample size was calculated by using the criterion sampling technique.Results: As a result of the in-depth interviews with individuals with SCI about their sexual experiences, five themes were derived: (1) first confrontation with SCI, (2) experienced sexual problems, (3) coping, (4) partners' views on sexual problems, and (5) other people.Conclusion: It was found that the sex life of individuals with SCI was negatively affected, they were left helpless in dealing with their problems, and that some patients had difficulties in coping with this condition.

An evaluation of the factors that affect the sexual satisfaction of people with spinal cord injuries

Objective: To evaluate the relationships between the variables that affect the sexual satisfaction of patients with spinal cord injuries.Design: Descriptive and cross-sectional survey.Setting: The physical medicine and rehabilitation outpatient clinic of a university hospital in Turkey.Participants: This study was performed from July to December2018. It included 103 patients with spinal cord injuries.Outcome Measures: The data were collected using an introductory information form, the American Spinal Injury Association Impairment Scale and the Golombok Rust Inventory of Sexual Satisfaction. Data were evaluated using the chi-square test, the Mann-Whitney U test, the Kruskal-Wallis test and linear regression.Results: The total mean scores on the Golombok Rust Inventory of Sexual Satisfaction were 40.2 ± 21.6 for males and 44.9 ± 18.1 for females. According to the linear regression analysis, model VII presented the best results of the relationship between physiological and psychological determinants that affect the sexual satisfaction of patients with spinal cord injuries. Model VII consisted of the variables of ASIA A and B scores, age, injury due to falling from height, being a housewife, and thinking of being unable to reach future goals. These explained 75.4% of the variation in sexual satisfaction scores.Conclusion: The participants' mean scores on the Golombok Rust Inventory of Sexual Satisfaction were found to be affected by various variables. A significant relationship between their mean scores on the American Spinal Injury Association (ASIA) Impairment Scale and the Golombok Rust Inventory of Sexual Satisfaction was determined.

Sexual function and dysfunction in men with spina bifida

Spina bifida is the most common neural tube defect, which can lead to multiple urologic problems stemming from neurogenic bladder including need for lifelong renal monitoring and urinary continence. However, as males with SB age, it is clear that many also start to care about their sexuality, which may also be affected by the disease process. After reviewing the literature, the authors summarize the available information regarding sexual function and sexual dysfunction in adult males with spina bifida, specifically focusing on sexuality education, relationship status/sexual activity, continence, penile rigidity, penile sensation, ability to orgasm, ability to ejaculate, quality of ejaculation and non-genital sexual contact. Finally, the authors conclude that more research is needed in the fields of sexual function and sexual dysfunction in adults with spina bifida. This area of study is in need of objective, standardized research with large cohorts so that we can better study and educate men with SB about the impact of SB on their sexuality.

Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review

INTRODUCTION

As most adults with spina bifida are either sexually active or interested in becoming sexually active, providers should understand how spina bifida impacts sexual function and options for treatment.

OBJECTIVES

The objective of this study is to summarize the current literature describing how features of spina bifida impact sexual function in men and women, effective available treatment options for sexual dysfunction, and to identify research gaps.

METHODS

Searches were conducted in PubMed, CINAHL Complete, PsychInfo, Cochrane Central, Scopus, and Web of Science Core Collection databases using keywords related to spina bifida and sexual function. 34 primary research studies were included.

RESULTS

Most men (56-96%) can achieve an erection, although it may be insufficient for penetration. Although 50-88% ejaculate, it is often dripping, retrograde, or insensate. Twenty percent to 67% achieve orgasm. Generally, men with lower lesions and intact sacral reflexes have better outcomes, although some men with all levels of lesion report good function. Sildenafil is efficacious at treating erectile dysfunction for most men. The "TO-MAXimize sensation, sexuality, and quality of life" procedure may improve sexual function in selected men with low-level lesions. Female sexual function and treatment is less well understood. Women may experience decreased arousal, difficulties with orgasm, and pain. No treatment has been studied in women. Bowel and bladder incontinence during intercourse appears to be bothersome to men and women. Although both men and women have diminished sexual satisfaction, their sexual desire appears to be least impacted. Present studies are limited by studies' small, heterogeneous populations, the misuse of validated questionnaires in the sexually inactive population, and the lack of a validated questionnaire specific to people with spina bifida.

CONCLUSIONS

Spina bifida impacts the sexual function of both men and women. Future studies should seek a better understanding of female sexual function and treatment, use validated questionnaires appropriately, and ultimately create a validated sexual function questionnaire specific to this population. Streur CS, Corona L, Smith JE, et al. Sexual Function of Men and Women With Spina Bifida: A Scoping Literature Review. Sex Med Rev 2021;9:244-266.

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.

A mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury: a randomized controlled trial

STUDY DESIGN

A randomized controlled trial.

OBJECTIVE

To assess the effectiveness of a mobile-based educational intervention on sexo-marital life in Iranian men with spinal cord injury (SCI).

SETTING

Foundation of Martyrs and Veterans Affairs', "Spinal Cord Injury Association", and the "Protection Center of Spinal Cord Disables".

METHODS

Participants were men with SCI aged at least 18 years old. The effectiveness of a mobile App was evaluated on 70 married men with SCI. Sexual adjustment, sexual satisfaction, marital adjustment, and marital satisfaction were assessed by valid and reliable questionnaires at baseline, 4 and 8 weeks after the intervention.

RESULTS

The between-group mean difference (95% CI) of sexual adjustment (4.2, CI: 3.6-4.8) after 4 weeks as well as 8 weeks (8.6, CI: 7.6-9.5) after baseline was significant (P < 0.001). The between-group mean difference (95% CI) of sexual satisfaction (6.9, CI: 8-11.2) after 4 weeks as well as 8 weeks (16.4, CI: 14.1-18.7) after baseline was significant (P < 0.001). There were significant increases in all the domains of marital satisfaction's between-group mean differences after 4 weeks as well as 8 weeks after baseline (P < 0.001). Repeated measures ANOVA showed there was no statistically significant increase in marital adjustment's between-group mean difference (95% CI) after 4 weeks (-0.1, CI: -0.1- 0, P < 0.16) as well as 8 weeks (0.4, CI: -0.3-1.1, P < 0.25) after baseline.

CONCLUSION

The application-based educational intervention showed the positive effect of education on sexo-marital life in men with SCI. We recommend the rehabilitation team's healthcare providers embrace this educational strategy for individuals with SCI.

Positive sexuality in men with spinal cord injury

STUDY DESIGN

Prospective study.

OBJECTIVES

To analyze determinants of sexual pleasure in men with spinal cord injury (SCI).

SETTING

Centre Bouffard-Vercelli, Cerbere, France.

METHODS

Face to face interviews with men with chronic SCI who had an active sex life with a female partner, reliable erections permitting intercourse, and sought regular counselling with a sex therapist. Questionnaires: the International Index of Erectile Function (IIEF) and a modified Sexual History Form.

RESULTS

Thirty-three men were enroled. IIEF subscores were high for erectile function (mean 27.6/30), sexual desire (mean 8.8/10), intercourse satisfaction (mean 11.9/15) and overall satisfaction (mean 8.7/10). Overall satisfaction was significantly related to the level (p < 0.01) but not the severity of the lesion (p = 0.59), positively correlated with intercourse satisfaction (p < 0.001), negatively with age (p < 0.05) and age at injury (p < 0.01), but not with time since injury (p = 0.80). Orgasm was reported by 14 men (42%), and correlated strongly with antegrade ejaculation (p < 0.001), but not with overall satisfaction (p = 0.81). All men, except one, described enjoyable, long foreplay. Intercourse was associated with sensations of pleasure for 30 men (90%). After intercourse, 26 men (78%) experienced sensations of fulfilment, and 30 (90%) of relaxation. Most men expressed frustration, primarily in the case of absent or intermittent ejaculation or orgasm. Men described their female partners as taking more initiatives, and having a satisfactory sex life.

CONCLUSIONS

A positive and satisfying sex life is achievable by the men's willingness to adapt their sexual behaviour coupled with the reward of physical pleasure experienced during intercourse.

Spinal cord injury and male infertility-a review of current literature, knowledge gaps, and future research

Spinal cord injury (SCI) affects nearly half a million new patients worldwide, with 17,700 in the US each year, and disproportionately impacts young males of reproductive age. Almost every aspect of male reproduction is affected by SCI, resulting in: erectile, endocrine and sexual dysfunction, decreased sperm motility despite an often-normal count, and abnormal semen emission and ejaculation. The aim of this review is to focus on how SCI impacts testicular spermatogenesis, sperm function, semen quality, and overall fecundity while discussing what is not known, and future avenues for research.

Sexual function and qualify of life in women with spina bifida: Are the women with spina bifida satisfied with their sexual activity?

AIMS

As the life expectancy of persons with spina bifida increases, sexual life in adulthood presents a considerable challenge for this population. The purpose of this study was to evaluate the sexual function of young women with spina bifida and its impact on their quality of life (QOL).

METHODS

To assess sexual function and QOL by using self-administered questionnaires (Female Sexual Function Index [FSFI] and 36-Item Short Form Health Survey) in young women with spina bifida, we collected data from 44 young women with spina bifida between June 2013 and October 2013 at the spina bifida clinic of our hospital.

RESULTS

Sexual dysfunction was noted in 55.5% of women with spina bifida who had sexual activity in the previous month. In sexually active women, the diagnosis, ventriculoperitoneal shunt in situ, mobility, and clean intermittent catheterization did not show a significant difference between each subdomain (desire, arousal, lubrication, orgasm, satisfaction, and pain) and the total FSFI score. However, women who did not have urinary incontinence experienced better sexual function in terms of lubrication and pain scores (P = 0.033 and P = 0.026, respectively). Both the physical and mental composites of QOL were positively weakly correlated with the arousal score of FSFI (r = 0.455, P = 0.044 and r = 0.507, P = 0.023, respectively).

CONCLUSIONS

More than half of sexually active women with spina bifida experience sexual dysfunction. Therefore, health-care providers should pay attention to the symptoms and their management.

Impact on quality of life and sexual satisfaction of continent cystostomy with enterocystoplasty in an adult neurologic population

AIMS

To evaluate long-term general and urinary quality of life (QOL) and sexual satisfaction in adult neurologic patients undergoing continent cystostomy surgery associated with a bladder enlargement to treat neurogenic lower urinary tract dysfunction.

METHODS

Monocentre, retrospective series of adult neurologic patients who underwent continent cystostomy with bladder enlargement and followed-up in the long-term. We assessed during follow-up, urinary and renal function and patients filled QOL questionnaires on general QOL, sexuality and urinary (short form Qualiveen) disability.

RESULTS

Fifty-three patients were included and followed-up 77 months on average. Rates of patients' satisfaction, stomal and urethral continences were respectively of 98.7% (n = 51), 94.1% (n = 48), and 80.4% (n = 41). Impact of surgery on general QOL and autonomy were strong and positive (respective mean scores of 4.8 and 4.7 on a scale ranging from 1 to 5). Mean overall urinary Qualiveen QOL score was 0.8 (0.09-2.67) indicating a low negative impact of urinary disability on QOL. In patients <45 years, 52.6% (n = 10) reported a moderate to important improvement of their sexuality after surgery. Renal function remained stable during follow-up.

CONCLUSION

In the long-term, continent cystostomy with bladder enlargement provides great satisfaction to almost most patients. It has a strong positive impact on general and specific urinary QOL, patients' autonomy and urinary continence. In young patients a positive impact on sexuality was also noticed. These encouraging data, that need to be confirmed, constitute interesting information to provide to neurologic patients to help them deciding whether they are willing to undergo continent cystostomy surgery.

Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury

INTRODUCTION

Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function.

AIM

To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life.

METHODS

We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score.

MAIN OUTCOME MEASURES

The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses.

RESULTS

We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0-16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14-432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2-1.4).

CONCLUSIONS

Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148-e155.

Research Needs for Effective Transition in Lifelong Care of Congenital Genitourinary Conditions: A Workshop Sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases

Over the last 5 decades, health-care advances have yielded quantum improvements in the life expectancy of individuals with congenital genitourinary conditions (CGCs), leading to a crisis of care. Many individuals with CGC enter adulthood unprepared to manage their condition. Pediatric CGC specialists lack training to manage adulthood-related health-care issues, whereas adult genitourinary specialists lack training within the context of CGCs. To address these challenges, the National Institutes of Diabetes and Digestive and Kidney Diseases convened individuals with CGCs and experts from a variety of fields to identify research needs to improve transitional urology care. This paper outlines identified research needs.

Factors Which Facilitate or Impede Interpersonal Interactions and Relationships after Spinal Cord Injury: A Scoping Review with Suggestions for Rehabilitation

Interpersonal interactions and relationships can influence an individual's perceptions of health and quality of life in the presence of disability. In the case of people with spinal cord injury (SCI), positive interpersonal interactions and relationships have been shown to contribute to resilience and adaptability. Understanding factors which facilitate or impede the development and maintenance of relationships after SCI may form the basis for proactive relationship support for people with SCI. To gain a broad insight into these factors, a scoping review was undertaken. Databases were searched for English language studies published between 2000 and 2015 that informed the review question. Sixty-two (62) studies were identified. Thematic analysis was conducted on data extracted from the studies and 51 factors which may facilitate relationships and 38 factors which may impede relationships after SCI were noted. The majority of factors could be categorized as environmental or personal according to the domains of the International Classification of Functioning, Disability, and Health (ICF). The facilitating factors included partner and social support, reciprocity in relationships, and presenting oneself positively. Impeding factors included physical environmental barriers, real and perceived social biases, and poor self-image. Factors identified may inform the provision of supportive, holistic rehabilitation for people with SCI.

Evaluation of Sexual Dysfunction in Men With Spinal Cord Injury Using the Male Sexual Quotient

OBJECTIVE

To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction.

DESIGN

Cross-sectional study.

SETTING

Tertiary rehabilitation center.

PARTICIPANTS

Patients (N=295) older than 18 years (mean age ± SD, 40.7±14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6-7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires.

RESULTS

Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8-66), and the median SHIM score was 5 (range, 0-16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923-.979) for the MSQ and .942 (95% CI, .915-.968) for the SHIM. There was a strong correlation between the 2 instruments (r=.826; 95% CI, .802-.878).

CONCLUSIONS

Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI.

Sexual and Reproductive Function in Spinal Cord Injury and Spinal Surgery Patients

Sexual and reproductive health is important quality of life outcomes, which can have a major impact on patient satisfaction. Spinal pathology arising from trauma, deformity, and degenerative disease processes may be detrimental to sexual and reproductive function. Furthermore, spine surgery may impact sexual and reproductive function due to post-surgical mechanical, neurologic, and psychological factors. The aim of this paper is to provide a concise evidence-based review on the impact that spine surgery and pathology can have on sexual and reproductive function. A review of published literature regarding sexual and reproductive function in spinal injury and spinal surgery patients was performed. We have found that sexual and reproductive dysfunction can occur due to numerous etiological factors associated with spinal pathology. Numerous treatment options are available for those patients, depending on the degree of dysfunction. Spine surgeons and non-operative healthcare providers should be aware of the issues surrounding sexual and reproductive function as related to spine pathology and spine surgery. It is important for spine surgeons to educate their patients on the operative risks that spine surgery encompasses with regard to sexual dysfunction, although current data examining these topics largely consists of level IV data.

Special needs dentistry: perception, attitudes and educational experience of Malaysian dental students

A compromised oral health condition amongst patients with special health care needs (SHCN) has been associated with the reluctance and shortage of skills of dental professionals in managing such patients. Lack of training and experience at the undergraduate level are reported barriers to the provision of care for this patient cohort. Undergraduate education therefore, plays an important role in producing professionals with the knowledge, skills and positive attitude in treating patients with SHCN. This study aims to determine the level of knowledge, comfort and attitudes of Malaysian undergraduate dental students towards caring for patients with SHCN, as well as their perception on education in this field. A self-administered questionnaire was administered in the classroom style to final year undergraduate dental students in Malaysian public dental schools. Most students were aware of Special Needs Dentistry (SND) as a specialty after being informed by academic staff. The majority of the students demonstrated poor knowledge in defining SND and felt uncomfortable providing care for such patients. They perceived their undergraduate training in SND as inadequate with most students agreeing that they should receive didactic and clinical training at undergraduate level. A high percentage of students also expressed interest in pursuing postgraduate education in this area of dentistry despite the lack of educational exposure during undergraduate years. The study supports a need for educational reform to formulate a curriculum that is more patient-centred, with earlier clinical exposure in various clinical settings for students to treat patients with special health care needs, applying the concept of holistic care in a variable clinical condition.

Sexuality for women with spinal cord injury

The authors conducted a review of the literature on women's sexuality after spinal cord injury, including studies from 1990 to 2011 retrieved from PubMed. Several facets of a woman's sexuality are negatively affected by after spinal cord injury, and consequently, sexual satisfaction has been shown to decrease, which also negatively affects quality of life. Neurogenic bladder is common after spinal cord injury, and the resulting urinary incontinence is a top therapeutic priority of this population. To improve sexual satisfaction and quality of life for women with spinal cord injury, future research needs to explore the effects of urinary incontinence on various aspects of sexuality.

Adults with myelomeningocele: an interview study about life situation and bladder and bowel management

AIM

To assess life situation, and bladder and bowel management in individuals with myelomeningocele (MMC) after transferal to adult medical care.

MATERIALS AND METHODS

All individuals (134) with myelomeningocele from western Sweden, born before 1981, and assessed on at least two occasions by a pediatric urologist, were invited to participate in a telephone interview according to a structured protocol. Sixty-nine individuals (32 males, 37 females) with a median age of 34 years (range 27-50) agreed to participate.

RESULTS

Sixty-two individuals (90%) passed high school or had university education and 46 (67%) were employed. Fifty-three (77%) had their own apartment and 27 (39%) lived with a partner. Clean intermittent catheterization was used by 49 (71%), more commonly in females (p < 0.05). Pads were used by 60 (87%) individuals. Ten (14%) had urotherapy support. Of those operated on, 16 (53%) had a consultation with a urologist every 3 years; the corresponding number for the non-operated was 12 (31%). Eight individuals were treated with anticholinergic drugs. None had support for improvement of the fecal emptying regimen.

CONCLUSIONS

Of the participants in the study, one third had no or rare contact with a urologist, few had urotherapy support and none had support for bowel regimen.

Health-related quality of life and economic impact of urinary incontinence due to detrusor overactivity associated with a neurologic condition: a systematic review

BACKGROUND

Patients with neurologic diseases often have neurogenic detrusor overactivity (NDO), which can result in a loss of voluntary bladder control and uncontrollable urinary incontinence (UI).The impact of UI due to NDO on patients' lives has not been well studied. The objective of this review was to assess the health-related quality of life (HRQoL) and economic burden in patients with urgency UI due to NDO in select countries in North America, the European Union, Asia, and Australia.

METHODS

Systematic literature searches and reviews of articles published in English (January 2000 to February 2011) were conducted using MEDLINE®, EMBASE®, and the Cochrane Library. Studies assessing the impact of UI on HRQoL of patients with an underlying neurologic condition of interest (i.e., multiple sclerosis, spinal cord injury, Parkinson's disease, stroke, or spina bifida) were included. Economic studies in urgency UI also were included.

RESULTS

Of 876 citations generated in the initial search, a total of 27 articles were deemed relevant: 16 articles presented HRQoL data and 11 articles presented information on the economic burden of UI. Humanistic studies used a range of HRQoL instruments to measure HRQoL burden, and the economic studies included different cost components to quantify the economic burden, making meaningful comparisons challenging. Despite this heterogeneity, the literature suggests that HRQoL in patients with UI due to NDO is worse than patients with UI in general or those with the same underlying neurologic condition without UI. In addition, urgency UI also results in substantial economic costs.

CONCLUSIONS

Incontinent patients with underlying neurologic conditions have impaired HRQoL as well as substantial economic burden attributable to UI due to NDO. There is a need for urgency UI treatments that improve HRQoL of these patients and alleviate the economic burden of this condition.

Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology

Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.

Intermittent catheterization with hydrophilic catheters as a treatment of chronic neurogenic urinary retention

AIMS

Neurogenic bladder can be effectively managed with intermittent catheterization (IC) to improve or restore continence, but there is no consensus on which type of catheter is preferred. Hydrophilic catheters were developed to reduce urethral friction, thereby minimizing trauma and sticking, and making them more acceptable to the patient, and easier and safer to use. The objective of this article was to review the literature on the benefits of hydrophilic catheters in patients with neurogenic bladder.

METHODS

A large body of experimental and observational evidence, including randomized controlled trials, was identified using PubMed.

RESULTS

Compared with plastic catheters that have been manually lubricated with gel, hydrophilic catheters reduce urinary tract infection and microhematuria. Hydrophilic catheters are also associated with high levels of patient satisfaction because they are comfortable to use.

CONCLUSIONS

There is a wealth of evidence, including randomized controlled trials, to support the benefits of hydrophilic catheters in terms of safety and quality of life, especially in men with spinal cord injury. More data are required for spina bifida, multiple sclerosis, and in women. Further research is warranted, especially large-scale and long-term robust comparisons of different types of catheter, and in well-defined and stratified populations.

Sexual health outcome measures for individuals with a spinal cord injury: a systematic review

STUDY DESIGN

A systematic review of all sexual health outcome measures reporting psychometric properties for a spinal cord injury (SCI) population.

OBJECTIVES

To evaluate the psychometric evidence for sexual health outcome measures used in a SCI population in order to (1) determine the clinical relevance of current tools and (2) suggest recommendations for future tool development.

SETTING

Vancouver, British Columbia, Canada.

METHODS

Electronic databases were searched for articles reporting psychometric properties of sexual health outcome measures used in a SCI population. The search was limited to papers published between January 1986 and January 2006. Hand-searching the references of papers obtained from the electronic search identified additional articles.

RESULTS

Four outcome measures met the search criteria: Emotional Quality of the Relationship Scale (EQR), Sexual Activity and Satisfaction Scale (SAS), Sexual Attitude and Information Questionnaire (SAIQ) and Sexual Interest and Satisfaction Scale (SIS). While the clinical utility of these tools may be compromised by their limited scope and advancing age, they may still prove useful for guiding SCI research and clinical practice.

CONCLUSION

There is no clinically agreed upon SCI measurement tool for sexual health outcomes. To adequately assess the complex issue of sexual health, it is recommended that future sexual health outcome measures include both quantitative and qualitative data as well as address several key issues.