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Lai R, McKerchar R, Western MJ, Flannigan R, Krassioukov AV, Elliott S, Nightingale TE. Lived Experiences of Sexuality and Sexual Functioning in Males with SCI: A Mixed-Methods Study. Top Spinal Cord Inj Rehabil 2024; 30:37-53. [PMID: 38799605 PMCID: PMC11123612 DOI: 10.46292/sci23-00082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Abstract
Background Sexual dysfunction is highly prevalent in males with spinal cord injury (SCI) and has been recognized to be a key recovery priority. Objectives This cross-sectional, mixed-methods study aimed to investigate the major themes linked to sexual functioning in males with chronic (>1 year) SCI. Methods Twenty male participants with SCI, aged 25 to 59 years, completed validated questionnaires exploring sexual function/satisfaction and health-related quality of life and a semi-structured interview with an experienced sexual medicine physician. Sex hormone concentrations and metabolic biomarkers, along with body composition and habitual physical activity levels, were assessed. Interview recordings were transcribed and thematic analysis performed using combined COM-B (Capability, Opportunity, Motivation, and Behavior) and biopsychosocial models to identify and organize major contributors and barriers to sexual functioning. Results Metabolic and hormonal biomarkers largely fell within normal physiological ranges despite reduced sexual functioning reported in our cohort (19/20 participants reported some degree of erectile dysfunction). Qualitative analysis of interview transcripts revealed 24 themes. Adaptability was important for improving sexual satisfaction. Attraction and attentiveness to sex and partners remained stable over time, while the desire for intimacy increased post injury. Sexual social norms, and comparisons to the able-bodied population, provided challenges for sexual activity and partnership. Environmental concerns regarding access to sexual health resources and accessible physical spaces during intimacy were relevant. Mood disorders and general life stressors negatively impacted sexual desire, while physical activity encouraged sexual activity. Conclusion By considering a holistic view of sexuality in males with SCI, we identified key contributors and barriers to sexual functioning for the cohort studied.
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Affiliation(s)
- Rachel Lai
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Rory McKerchar
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Max J. Western
- Centre for Motivation and Health Behaviour Change, Department for Health, University of Bath, Bath, United Kingdon
| | - Ryan Flannigan
- Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Prostate Centre, Vancouver General Hospital, Vancouver, British Columbia, Canada
- Department of Urology, Weill Cornell Medicine, New York, New York, USA
| | - Andrei V. Krassioukov
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Stacy Elliott
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health, B.C. Centre for Sexual Medicine, Vancouver, British Columbia, Canada
- Departments of Psychiatry and Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tom E. Nightingale
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, United Kingdom
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Taheri T, Hosseindoost S, Kazemi H, Kamali S, Kolivand P, Gharaylou Z. Comorbidity in spinal cord injury in Iran: A narrative review. Transl Neurosci 2024; 15:20220343. [PMID: 38979518 PMCID: PMC11229886 DOI: 10.1515/tnsci-2022-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/17/2024] [Accepted: 05/07/2024] [Indexed: 07/10/2024] Open
Abstract
Spinal cord injury (SCI) is a severe medical condition that affects millions of people worldwide each year. In Iran, an estimated 9 out of every 100,000 individuals experience traumatic SCI occurrences. Long-term disabilities and comorbidities stemming from SCI often necessitate multiple therapeutic interventions. The aim of this study is to evaluate the morbidity in Iranian SCI patients. In this study, a four-step process was used to select, extract, analyze, and synthesize relevant literature. The search covered 750 records from five databases, resulting in 25 articles included in the review. These articles, published between 2000 and 2023, utilized cross-sectional, qualitative, or cohort designs. The findings explored the prevalence, risk factors, and consequences of comorbidities associated with SCI, categorized into four themes: physical, sexual, psychological, and metabolic morbidity. Physical morbidity refers to medical conditions or complications affecting body functions or structures in SCI patients. The most frequently reported cases include pressure ulcers, pain, osteoporosis, fractures, impaired pulmonary function, renal failure, and obesity. Metabolic morbidity includes conditions such as vitamin D deficiency and cardiometabolic risk factors. Psychological morbidity encompasses depression, anxiety, and adjustment disorders. Sexual morbidity refers to conditions or complications affecting the sexual function or satisfaction of SCI patients. This narrative literature review offers a comprehensive examination of various aspects of SCI in Iranian patients. The review identifies numerous challenges and difficulties faced by SCI patients while also highlighting protective factors that can improve their well-being. Additionally, the review acknowledges gaps and limitations within the current literature and suggests possible avenues for future research.
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Affiliation(s)
- Taher Taheri
- Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran
| | - Saereh Hosseindoost
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Pain Research Center, Neuroscience Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Kazemi
- Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran
| | - Seyedehalia Kamali
- Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran
| | | | - Zeinab Gharaylou
- Shefa Neuroscience Research Center, Khatamolanbia Hospital, Tehran, Iran
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Merghati-Khoei E, Aghajani N, Sheikhan F, Salmani Z, Bayat A, Rahdari F, Yousefi H, Yazdanpanah A, Atoof F, Korte JE. Measuring Sexual Performance: Development and Psychometric Properties of the Sexual Performance Questionnaire in Iranian People with Spinal Cord Injury. SEXUALITY AND DISABILITY 2021; 39:55-65. [PMID: 34522054 DOI: 10.1007/s11195-020-09644-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Sexual performance refers to activities served by sexual capacity and motivation. As a culturally sensitive issue, to date the scalar invariance of sexual performance has not been examined for Iranians with spinal cord injuries (SCIs). Aim: To develop and assess properties of an instrument evaluating sexual performance of an Iranian population with SCIs., in Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran. Using multi-modal methods, we developed and assessed the Sexual Performance Questionnaire (SPQ). This included collecting expert opinions; engaging with patients with SCI referred to BASIR; pilot testing to assess the scale; and a formal investigation. Participants (men = 156, women = 58) completed the SPQ. Internal consistency and reliability were measured using Cronbach's α coefficient. Content and face validity were examined by academic experts. Construct validity was assessed by examining convergent and discriminant validity. Finally, exploratory factor analysis was used to extract the factor structure of the questionnaire. The Cronbach's α coefficient was 0.77. There was a significant (p = 0.04) correlation (r = - 0.23) between the SPQ score and age. Those with a partner scored higher (p = 0.001). We found three components: Spouse as initiator, self-initiation, and genital-oriented sex which accounted for 59% of the observed variance. The face and content validity was approved by an expert committee. The development and application of the 13-item SPQ provides a thorough understanding of sexual performance amongst persons with SCI. It facilitates the development of efficient sexual rehabilitation interventions and SCI-specific sexuality education programs.
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Affiliation(s)
- Effat Merghati-Khoei
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Noura Aghajani
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Sheikhan
- Department of Midwifery, Khalkhal Branch, Islamic Azad University, Khalkhal, Iran
| | - Zahra Salmani
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Bayat
- Iranian National Center for Addiction Studies (INCAS), Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Rahdari
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Habib Yousefi
- Iranian National Center for Addiction Studies (INCAS), Institution of Risk Behavior Reduction, Tehran University of Medical Sciences, Tehran, Iran
| | - Abazar Yazdanpanah
- Brain and Spinal Cord Injury Research Center (BASIR), Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Atoof
- Department of Biostatistics and Epidemiology, Kashan University of Medical Sciences, Kashan, Iran
| | - Jeffrey E Korte
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
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Abstract
AbstractSexuality and intimacy are important aspects of life that are frequently compromised after severe injury or illness, yet these aspects are often overlooked by medical and rehabilitation professionals. This case series describes the Occupational Therapy Sexuality and Intimacy program at a Military Treatment Facility (MTF). Three diverse clients with a range of physical, cognitive and emotional impairments were chosen to illustrate complexities of the Occupational Therapy Sexuality and Intimacy Program at this MTF, and unique skills employed by Occupational Therapists. Consistent themes discovered include: perceived value of the program; appreciation of safe spaces to discuss personal topics; and enhanced awareness of role identity, body image, and emotional regulation. These cases illustrate that sexuality and intimacy interventions may have profound effects on injured service members, improving social reintegration, and quality of life.
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Dong C, Xie Z, Wang P, Dong Z. Erectile Functional Restoration With Genital Branch of Genitofemoral Nerve to Pelvic Nerve Transfer After Spinal Root Transection in Rats. Urology 2020; 148:179-184. [PMID: 33010291 DOI: 10.1016/j.urology.2020.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/12/2020] [Accepted: 09/20/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the feasibility of erectile function restoration by the genitofemoral nerve to pelvic nerve transfer in rats. METHODS Thirty-six male rats were included in this study. Rats in the nerve transfer group (n = 12) were subjected to pelvic nerve, sacral roots, and L6 roots transection and then bilateral genitofemoral nerve to pelvic nerve transfer, rats in the nerve resection group (n = 12) were subjected to pelvic nerve, sacral roots, and L6 roots transection without nerve transfer, and rats in the control group (n = 12) served as controls. After reinnervation, intracavernous pressure (ICP) assessment was performed. Fluoro-Gold was injected into the corpus cavernosum. Immediately before euthanasia, transferred nerves were stimulated to test penile intracavernous pressure. The L6, S1, and L1-2 spinal cord segments were used for retrogradely labeled neurons. Regenerative nerve morphologic examination assessment was performed. RESULTS Genitofemoral nerve stimulation induced an increase in ICP in the nerve transfer group. The mean ICP in this group was (33.8 ± 9.4 mm Hg), which is higher than the mean value in the nerve resection group (3.9 ± 1.0 mm Hg) but lower than that in the control group (69.8 ± 12.2 mm Hg; P < .05). The formation of new neural pathways was confirmed by the appearance of Fluoro-Gold labeled neurons in the L-1 and L-2 spinal cord segments in the nerve transfer group. Regenerative nerve morphologic examination showed good axonal regeneration after genitofemoral nerve transfer. CONCLUSION Nerve regeneration can be obtained by genitofemoral nerve to pelvic nerve transfer, and erectile function can be restored.
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Affiliation(s)
- Chuanjiang Dong
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China.
| | - Zonglan Xie
- Department of Nephrology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
| | - Peng Wang
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
| | - Ziqiang Dong
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei, China
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Abstract
STUDY DESIGN Observational study (Ethics Committee Number 973.648). OBJECTIVE Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE 3.
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Silva RDAE, Ximenes LB, Cruz AG, Serra MAADO, Araújo MFMD, Andrade LDM, Studart RMB, Carvalho ZMDF. Atividade sexual na lesão medular: construção e validação de cartilha educativa. ACTA PAUL ENFERM 2018. [DOI: 10.1590/1982-0194201800037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Descrever o processo de construção e validação de uma cartilha educativa sobre atividade sexual de pessoas com lesão medular. Métodos Estudo metodológico em quatro etapas: pesquisa documental em blogs, revisão integrativa, construção da cartilha educativa, validação de conteúdo com 11 juízes, validação de aparência técnica com 3 juízes e validação de aparência com 37 pessoas do público-alvo. Considerou-se o Índice de Validade de Conteúdo (IVC) mínimo de 0,80. Resultados A cartilha apresentou IVC global de 0,91 pelos juízes profissionais de saúde; 0,87 pelos juízes designers gráficos; e 0,94 na validação de aparência pelo público-alvo. Entretanto, os juízes e público-alvo propuseram sugestões de melhorias da cartilha, que foram acatadas e modificadas para versão final do material. Conclusão A cartilha apresentou conteúdo e aparência adequados para promoção da atividade sexual saudável e satisfatória da pessoa com lesão medular.
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Silva JM, Chavarriaga Soto J, Orrego PA, Iregui Parra JD, Álvarez Villaraga D, Godoy MP. Función eréctil y salud sexual en hombres con trauma raquimedular: estudio transversal. Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dong C, Dong Z, Xie Z, Zhang L, Xiong F, Wen Q, Fan Z, Peng Q. Functional Restoration of Erectile Function Using End-to-side Autonomic-to-somatic Neurorrhaphy in Rats. Urology 2016; 95:108-14. [DOI: 10.1016/j.urology.2016.05.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/27/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
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