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Sex, support and society: a journey to reclaiming sexuality for individuals living with paraplegia in Cape Town, South Africa. Spinal Cord 2020; 59:225-233. [PMID: 33051560 DOI: 10.1038/s41393-020-00558-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 09/16/2020] [Accepted: 09/17/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Qualitative descriptive study with inductive thematic content analysis. OBJECTIVES To explore how individuals living with paraplegia in South Africa experience sex and intimacy and how they perceive the related health services and support they received whilst adapting to life post injury. SETTING Community based in Cape Town, South Africa. METHODS Purposive and snowball sampling were combined to enrol ten individuals with paraplegia who were all users of the public health system and had been injured for more than 1 year. Semi-structured interviews were conducted, and data analysed using inductive thematic content analysis. RESULTS Four categories were derived and captured by the overarching theme of 'a journey to reclaiming sexuality', as depicted by each participant. Psychological consequences of the injury led to challenges with sex and intimacy including a strong emphasis on partner satisfaction. A perceived lack of support mechanisms particularly in relation to poor timing of health services and insufficient peer support led to a lack of understanding and difficulties adjusting to changes in sexual function. Meaningful relationships including elements of sex and/or intimacy were rediscovered following a re-adjustment period although participants often felt disabled by society as socio-cultural norms, such as gender concepts, influenced each individual journey. CONCLUSIONS Complex interactions between intrinsic psychological factors, such as low sexual self-esteem and external factors such as socio-cultural norms, affect sex and intimacy in individuals with paraplegia in this novel context. South Africa's health system should be strengthened to support optimal sexual outcomes of persons with a spinal cord injury.
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Philippon M, Karsenty G, Bernuz B, Courbiere B, Brue T, Saïas-Magnan J, Perrin J. Successful pregnancies and healthy live births using frozen-thawed sperm retrieved by a new modified Hotchkiss procedure in males with retrograde ejaculation: first case series. Basic Clin Androl 2015; 25:5. [PMID: 26034605 PMCID: PMC4450833 DOI: 10.1186/s12610-015-0021-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 05/04/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In couples presenting with retrograde ejaculation refractory to medical treatment, the first choice of fertility treatment should be Assisted Reproductive Techniques using rapidly purified spermatozoa retrieved from post-ejaculatory urine. The Hotchkiss technique and modified variants are simple and efficient for retrieving sperm from the bladder. We developed a new protocol, including a novel modified Hotchkiss technique involving sperm cryopreservation. The aim was to study the pregnancy rate and birth rate achieved by intra cytoplasmic sperm injection (ICSI) using frozen-thawed sperm retrieved from the bladder with this novel modified Hotchkiss technique in patients with refractory retrograde ejaculation. RESULTS In this descriptive retrospective, single-center study, we analyzed the local database of all patients who banked sperm at the CECOS Laboratory Biology of Reproduction of La Conception University Hospital, Marseille, France, between 2004 and 2014. A total of 2171 patients banked sperm during this time, including 63 patients with retrograde ejaculation, of whom ten patients banked sperm that had been retrieved by the modified Hotchkiss technique. These ten couples underwent 26 ICSI cycles: nine clinical pregnancies were achieved in six couples, including eight after fresh embryo transfer and one after thawed embryo transfer, resulting in seven live births. The average live birth rate per transfer was 28 %. CONCLUSIONS We report the largest series of births using frozen-thawed spermatozoa retrieved from post-ejaculatory urine by a modified Hotchkiss technique. This series of births demonstrates that this new modified Hotchkiss technique allows for successful association with sperm cryopreservation, leading to an efficient and easy management of couples with refractory retrograde ejaculation.
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Affiliation(s)
- Melanie Philippon
- AP-HM, La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 cedex 15 Marseille, France
| | - Gilles Karsenty
- Department of Urology, AP-HM La Conception, 147 bd Baille, 13385 Cedex 5 Marseille, France
| | - Benjamin Bernuz
- Neuro rehabilitation Unit, Leon Berard Hospital, bd du Dr Armanet, Hyères, France
| | - Blandine Courbiere
- Pôle Femmes-Parents-Enfants, Centre clinico-biologique d'Assistance Médicale à la Procréation, AP-HM La Conception, 147 Bd Baille, 13 005 Marseille, France ; Institut Méditerranéen de Biodiversité et d'Ecologie Marine et Continentale (IMBE), CNRS - IRD, Aix Marseille Université, Univ-Avignon, Biogénotoxicologie, Santé Humaine et Environnement, 27, Boulevard Jean-Moulin, F-13385 Cedex 05 Marseille, France
| | - Thierry Brue
- AP-HM, La Conception, Service d'Endocrinologie, Diabète et Maladies Métaboliques, Centre de Référence des Maladies Rares d'Origine Hypophysaire DEFHY, 13385 cedex 15 Marseille, France ; Aix Marseille Université, CNRS, CRN2M UMR 7286, 13344 cedex 15 Marseille, France
| | - Jacqueline Saïas-Magnan
- CECOS Laboratory Biology of Reproduction, Pôle Femmes-Parents-Enfants, 147 bd Baille, 13385 Cedex 5 Marseille, France
| | - Jeanne Perrin
- Institut Méditerranéen de Biodiversité et d'Ecologie Marine et Continentale (IMBE), CNRS - IRD, Aix Marseille Université, Univ-Avignon, Biogénotoxicologie, Santé Humaine et Environnement, 27, Boulevard Jean-Moulin, F-13385 Cedex 05 Marseille, France ; CECOS Laboratory Biology of Reproduction, Pôle Femmes-Parents-Enfants, 147 bd Baille, 13385 Cedex 5 Marseille, France
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Krebs J, Göcking K, Kissling-Niggli M, Pannek J. Cross-sectional study of the sperm quality in semen samples from spinal cord injured men after long-term cryopreservation. Andrology 2015; 3:213-9. [DOI: 10.1111/andr.12017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/27/2022]
Affiliation(s)
- J. Krebs
- Clinical Trial Unit; Swiss Paraplegic Centre; Nottwil Switzerland
| | - K. Göcking
- Neurourology; Swiss Paraplegic Centre; Nottwil Switzerland
| | | | - J. Pannek
- Neurourology; Swiss Paraplegic Centre; Nottwil Switzerland
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Bechoua S, Berki-Morin Y, Michel F, Girod S, Sagot P, Fauque P. Outcomes with intracytoplasmic sperm injection of cryopreserved sperm from men with spinal cord injury. Basic Clin Androl 2013; 23:14. [PMID: 25780576 PMCID: PMC4349465 DOI: 10.1186/2051-4190-23-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Erectile dysfunction, ejaculatory dysfunction and poor semen quality are the main causes of infertility in men with spinal cord injury (SCI). Different sperm retrieval techniques such as penile vibratory stimulation (PVS), electro-ejaculation (EEJ) or surgical sperm retrieval (SSR) associated or not with sperm cryopreservation can be offered to these patients to preserve their fertility. If fatherhood cannot be achieved naturally, assisted reproductive techniques can be offered to these patients using either fresh or frozen/thawed sperm. The aim of the study was to report in SCI patients from Dijon (Burgundy) and in the literature, intracytoplasmic sperm injection (ICSI) outcomes using frozen sperm obtained either by antegrade ejaculation (PVS or sexual intercourse) or by SSR. METHODS A retrospective analysis was performed in Dijon, Burgundy over a 17 year period (1995-2011) on a cohort of 19 SCI men (6 quadriplegics and 13 paraplegics, mean age: 25.2 ± 5.6 years) who underwent a sperm cryopreservation followed or not by intracytoplasmic sperm injection (ICSI). Patients were divided into two groups according to the sperm retrieval method used (antegrade ejaculation group (n=10): penile vibratory stimulation (PVS) for 9 patients and sexual intercourse for 1 patient and surgical sperm retrieval (SSR) group: n=9). The sperm parameters in both groups were analyzed. Pregnancy outcomes in the 8 couples who underwent ICSI were evaluated. RESULTS The fertilization rates were 57 and 55%, the embryo's cleavage rates were 90 and 93% in the antegrade ejaculation and SSR groups respectively. Among the 8 couples who underwent ICSI, 5 couples achieved pregnancy. The pregnancy rates per couple were 50% and 75% in the antegrade and SSR groups respectively. CONCLUSIONS Although some studies don't recommend freezing sperm in SCI patients, the pregnancy rates presented in this study are encouraging and warrant the use of frozen/thawed sperm in very specific situations.
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Affiliation(s)
- Shaliha Bechoua
- Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France
| | - Yasmine Berki-Morin
- Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France
| | - Frédéric Michel
- Hôpital de Dijon, Service de Chirurgie Urologique-Andrologie, Université de Bourgogne, 21079 Dijon, France
| | - Sophie Girod
- Hôpital de Dijon, Université de Bourgogne, Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, 21079 Dijon, France
| | - Paul Sagot
- Hôpital de Dijon, Université de Bourgogne, Service de Gynécologie-Obstétrique, Médecine Fœtale et Stérilité Conjugale, 21079 Dijon, France
| | - Patricia Fauque
- Hôpital de Dijon, Laboratoire de Biologie de la Reproduction, Université de Bourgogne, 21079 Dijon, France
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