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Objectives

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OBJECTIVES

After reading this chapter, the reader will be able to:

  • Appreciate that sexuality is a very high priority for persons with spinal cord injuries (SCI)

  • Understand the mind-body interaction in sexual function and expression

  • Understand the underlying neurophysiology of sexual response and genital physiology, including assessment measures

  • Apply the principles of sexual reflexes to predict the changes in sexual functioning depending on the level of lesion after SCI

  • Understand the comprehensive changes to sexuality outside of sexual functioning and fertility

  • Review therapies currently available to men and women with acquired sexual dysfunctions and their applicability to the SCI population

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Introduction

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If you had a spinal cord injury (SCI), what would be a higher priority for you, to be able to walk again or to have sex? Most able-bodied persons would imagine that being able to walk again would be the function most desired. Thirty years ago, a survey of veterans with SCI noted that sex was a lower priority than the use of lower or upper limbs for individuals with paraplegia and tetraplegia,1 and for many years a negative perception existed that persons with SCI were asexual. Fortunately, this myth is slowly being dissipated, since the conscious rehabilitative emphasis on ability versus disability, the advent of oral erection enhancement medication in the late 1990s, and research clarifying the priorities of the SCI population have changed the attitude of healthcare professionals and the public about sexuality after SCI. Now, when surveyed about what gain of function was most important to their quality of life,2 men and women with SCI said sexuality is a major priority, placing it above the return of sensation, walking, and bladder and bowel function. Of 681 participants (approximately 25% female), the majority of individuals with paraplegia felt regaining sexual function was their highest priority, and it was the second highest priority for individuals with quadriplegia (preceded only by regaining hand and arm function). In a more recent survey, the majority (86%) of male and female participants with SCI stated that their injury had altered their sexual sense of self and that improving their sexual function would improve their quality of life.3,4

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The purpose of this chapter is to illustrate how changes to sexuality following SCI can be assessed and therapeutically managed in a comprehensive way to promote long-term gain rather than short-term solutions. The physiology of sexual function will be reviewed, followed by a discussion of specific changes to sexual function in men and women after SCI. A comprehensive approach to dealing with sexuality, a complex interaction of mind and body, will be presented to illustrate how sexual rehabilitation has the unique ability to continue to undergo evolution and expression after SCI, even when motor or sensory recovery has reached its full potential.

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The Mind–Body Interaction

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Sexuality is much more than the performance of sexual acts. ...

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