Although spinal cord injury (SCI) often causes sexual dysfunction, many people with SCI may have a satisfying sex life. The physical limitations obtained from SCI affect sexual function and sexuality in a larger area, which in turn has an important effect on quality of life. Damage to the spinal cord undermines its ability to transmit messages between the brain and body parts below the level of the lesion. This results in loss or decrease in sensation and muscle movement, and affects orgasm, erection, ejaculation, and vaginal lubrication. Other indirect causes of sexual dysfunction include pain, weakness, and side effects from drugs. Psycho-social causes include depression and altering self-image. Many people with SCI have a satisfying sex life, and many experience sexual arousal and orgasm. People with SCI use various adaptations to help run their sex lives healthily, focusing on different areas of the body and types of sexual acts. Nerve plasticity can cause increased sensitivity in parts of the body that do not lose sensation, so people often discover new erotic areas of the skin in sexually sensitive zones or near the border between preserved areas and loss of sensation.
Drugs, devices, surgery, and other interventions exist to help men achieve erection and ejaculation. Although male fertility is reduced, many men with SCI can still be the fathers of children, especially with medical intervention. Female fertility is usually unaffected, although precautions should be taken for safe pregnancy and childbirth. People with SCI need to take steps during sexual activity to deal with SCI effects such as weakness and limitation of motion, and to avoid injuries such as skin damage in the reduced sensation area. Education and counseling on sexuality is an important part of SCI rehabilitation but is often lost or inadequate. Rehabilitation for children and adolescents aims to promote the development of healthy sexuality and includes education for them and their families. Cultural heritage biases and negative stereotypes affect people with SCI, especially when held by professional caregivers. Body image and other discomforts affect sexual functioning, and have a profound impact on self-esteem and self-concept. SCI causes difficulties in romantic partnerships, due to problems with sexual functioning and other pressures caused by injuries and disabilities, but many of them with SCI have met the relationship and marriage. Relationships, self-esteem, and reproductive ability are all aspects of sexuality, which include not only sexual practice but also a number of complex factors: cultural, social, psychological, and emotional influences.
Video Sexuality after spinal cord injury
Sexuality and identity
Sexuality is an important part of everyone's identity, although some people may not be interested in sex. Sexuality has biological, psychological, emotional, spiritual, social, and cultural aspects. It involves not only sexual behavior but relationships, self-image, sexual drive, reproduction, sexual orientation, and gender expression. Everyone's sexuality is influenced by lifelong socialization, where factors such as religious and cultural backgrounds play a role, and are expressed in the self-esteem and beliefs one holds about oneself (identifying as a woman, or as an attractive person).
SCI is very disturbing to sexuality, and it is most common in young people, who are at the peak of their sexual and reproductive lives. But the importance of sexuality as part of life is not reduced because of a crippling injury. Although for many years people with SCI are believed to be asexual, research has shown sexuality to be a high priority for people with SCI and an important aspect of quality of life. In fact, of all the abilities they want to restore, most paraplegics assess sexual functioning as their top priority, and most tetraplegics assign it a second rank, after hand and arm function. Sexual functioning has a tremendous impact on self-esteem and adjustment to post-injury life. People who are able to adapt to their changed bodies and have a satisfying sex life have a better quality of life overall.
Maps Sexuality after spinal cord injury
Sexual function
SCI usually causes sexual dysfunction, due to problems with sensation and passionate response of the body. The ability to experience sexual pleasure and orgasm is one of the top priorities for sexual rehabilitation among injured people.
Much research has been done for erection. With two years post-injury, 80% of men restore at least some erectile function, although many experience problems with their reliability and duration of erections if they do not use interventions to improve it. Studies have found that half or up to 65% of men with SCI have an orgasm, although the experience may feel different than before the injury. Most men say it feels weaker, and takes longer and more stimulation to achieve.
Common problems experienced by post-SCI women are pain during intercourse and difficulty reaching orgasm. About half of women with SCI can achieve orgasm, usually when their genitals are stimulated. Some women report the same orgasmic sensation before the injury, and others say the sensation is reduced.
Complete and incomplete injuries
The severity of the injury is an important aspect in determining how much sexual function returns when a person recovers. According to the scale of the assessment of the American Bone Injury Association, an incomplete SCI is one in which a number of sensations or motor functions are maintained in the rectum. This shows that the brain can still send and receive some messages to the lowest part of the spinal cord, outside the damaged area. In people with incomplete injuries, some or all of the spinal cancers involved in a sexual response remain intact, allowing, for example, an orgasm like an unharmed person. In men, having an imperfect injury increases the likelihood of achieving an erection and orgasm in those with total injury.
Even people with complete SCI, in which the spinal cord can not send any message through the level of the lesion, can reach orgasm. In 1960, in one of the earliest studies to see orgasm and SCI, the term phantom orgasm was created to describe women's perception of orgasmic sensations despite SCI - but subsequent research suggests that experience is not just psychological. Men with full SCI report sexual sensation during ejaculation, accompanied by physical signs usually found during orgasm, such as elevated blood pressure. Women may experience orgasm with vibration to the cervix regardless of level or completeness of injury; the sensation is the same as the experience of an uninjured woman. The peripheral nerves of the parasympathetic nervous system that carry messages to the brain (afferent nerve fibers) can explain why people with full SCI experience sexual sensation and climax. One of the explanations proposed for orgasm in women despite a complete SCI is that the vagus nerve passes through the spinal cord and carries sensory information from the genitals directly to the brain. Women with complete injuries can achieve sexual arousal and orgasm through clitoral, cervical, or vaginal stimulation, each of which is innervated by different neural pathways, indicating that even if SCI interferes with one area, the function can be maintained on the other. In both the wounded and unharmed, the brain is responsible for how the perceived climax is felt: the qualitative experience associated with the climax is modulated by the brain, not the specific area of ​​the body.
Injury rate
In addition to the completeness of the injury, the location of damage to the spinal cord affects how much sexual function is maintained or returned after an injury. Injury may occur in the cervix (throat), thorax (back), lumbar (lower back), or sacral level (pelvis). Between each spinal pair, the spinal cord branched off from the spinal cord and carried information to and from certain parts of the body. The location of an injury to the spinal cord mapped to the body, and the skin area is innervated by a specific spinal cord, called a dermatome. All dermatomes below the level of injury to the spinal cord can lose sensation.
Injury at the lower point of the spine does not necessarily mean better sexual function; for example, people with injuries in the sacral area tend to be unable to orgasm than those who have a higher injury to the spine. Women with injuries above the sacral level had a greater likelihood for orgasm in response to clitoral stimulation than with a sacral injury (59% vs. 17%). In men, injuries above the sacral level are associated with better function in terms of erection and ejaculation, and fewer and less severe dysfunction reports. This may be caused by reflexes that do not require input from the brain, which may cause a sacral injury.
Psychogenic and reflexogenic responses
The physical stimulation response of the body (vaginal lubrication and clitoral enlargement in women and erection in men) occurs due to two separate pathways that usually work together: psychogenic and reflexes. The passion due to fantasy, visual input, or other mental stimuli is a psychogenic sexual experience, and the passion resulting from physical contact to the genital area is reflexogenic. In psychogenic arousal, the message travels from the brain through the spinal cord to the nerves in the genital area. Psychogenic pathways are served by the spinal cord at T11-L2 level. So people who are injured above the T11 vertebral level usually do not experience psychogenic erections or vaginal lubrication, but those with injuries under T12 can. Even without this physical response, people with SCI often feel aroused, just like an unharmed person. The ability to feel the sensation of needle puncture and light touch in the dermatomes for T11-L2 predicts how well the ability to have psychogenic arousal is maintained in both sexes. The input of the psychogenic pathway is sympathetic, and most of the time it sends an inhibitory signal that prevents the physical arousal response; in response to sexual stimulation, increased excitatory signals and reduced inhibition. Eliminating the usual inhibition allows a spinal reflex that triggers a passionate response to take effect.
The reflexogenic pathway activates the parasympathetic nervous system in response to the touch sensation. It is mediated by an arc reflex that enters the spinal cord (not to the brain) and is served by a sacral segment of the spinal cord in S2-S4. A woman with a spinal cord lesion above T11 may not experience psychogenic vaginal lubrication, but may still have reflex lubrication if her sacral segment is unharmed. Likewise, although a man's ability to get psychogenic erections when mentally aroused may be disrupted after a higher-grade SCI, he may still be able to get a spontaneous reflex or erection. These erections can lead to a lack of psychological arousal when the penis is touched or brushed, for example by clothing, but they do not last long and are generally lost when the stimulus is removed. Erectile reflection can increase the frequency after SCI, due to loss of inhibitory input from the brain that will suppress the response of uninjured men. In contrast, injuries below the level of S1 impair a reflex erection but not psychogenic erections. People who have some sensation preservation in the dermatomes at S4 and S5 levels and display bulbocavernosus reflexes (contractions of the pelvic floor in response to pressure on the clitoris or glans penis) can usually experience a reflex or lubrication erection. Like other reflexes, reflexive sexual responses can disappear shortly after the injury but return over time as the individual recovers from spinal shock.
Factors in reduced functionality
Most people with SCI have problems with the body's sexual arousal response. The problem directly generated from nerve transmission interference is called primary sexual dysfunction . The function of the genitals is almost always affected by SCI, by changes, reduction, or complete loss of sensation. Neuropathic pain, in which the damaged nerve pathways indicate pain in the absence of a dangerous stimulus, is common after SCI and interferes with sex.
Secondary dysfunction results from factors that follow from injury, such as loss of bladder control and bowel movements or movement disorders. The main obstacles to sexual activity that people with SCI citations are physical limitations; for example, the problem of balance and muscle weakness causes difficulties with position. Spasticity, muscle tightening due to increased muscle tone, is another complication that interferes with sex. Some medications have side effects that hinder sexual pleasure or interfere with sexual function: antidepressants, muscle relaxants, sleeping pills and medications that treat flexibility. Hormonal changes that alter sexual functioning may occur after SCI; prolactin levels increase, women stop menstruation while (amenorrhea), and men decrease testosterone levels. Lack of testosterone causes reduced libido, increased weakness, fatigue, and failure to respond erection-enhancing drugs.
The result of tertiary sexual dysfunction comes from psychological and social factors. Reducing libido, desire, or passion experiences can be caused by psychological or situational factors such as depression, anxiety, and changes in relationships. Both sexes decreased sexual desire after SCI, and nearly half of men and nearly three quarters of women had difficulty becoming psychologically stimulated. Depression is the most common cause of problems with passion in people with SCI. People often experience sadness and despair at first after the injury. Anxiety and drug and alcohol abuse may increase after discharge from a hospital because of a new challenge, which can exacerbate sexual difficulties. Drug and alcohol abuse promotes unhealthy behavior, stressful relationships and social functions. SCI can cause significant insecurity, resulting in sexuality and self-image. SCI often affects body image, either because host changes in the body that affect appearance (eg unused muscles in the legs become stopped developing), or because of changes in self-perception are not directly from physical changes. People often find themselves less attractive and expect others not to be attracted to them after SCI. This insecurity causes fear of rejection and prevents people from initiating contact or sexual activity or engaging in sex. Feelings of being unsaved or worthless even point some to suggest to their partner that they find a healthy person.
Fertility
Men
Men with SCI rated the ability to father children among their highest concerns regarding sexuality. Male fertility decreases after SCI, due to a combination of problems with erection, ejaculation, and semen quality. Like other types of sexual response, ejaculation can be psychogenic or reflexogenic, and the degree of injury affects a man's ability to experience each type. As many as 95% of men with SCI have problems with ejaculation (anejaculation), probably due to impaired input coordination from different parts of the nervous system. Erection, orgasm, and ejaculation can occur independently, although ejaculation appears to be related to erectile quality, and orgasmic abilities associated with ejaculation. Even men with complete injuries may be able to ejaculate, since other nerves involved in ejaculation may affect responses without input from the spinal cord. In general, the higher the level of injury, the more physical stimulation a man needs to experience ejaculation. In contrast, premature or spontaneous ejaculation may be a problem for men with injury at the T12-L1 level. It is quite severe that ejaculation is triggered by sexual thinking, or for no reason at all, and is not accompanied by orgasm.
Most men have normal sperm counts, but a high proportion of sperm is not normal; they are less motile and do not survive too. The cause of this disorder is unknown, but studies show the dysfunction of the seminal vesicles and the prostate, which concentrates substances that are toxic to sperm. Cytokines, immune proteins that increase the inflammatory response, are present at higher concentrations in male semen with SCI, such as acetylhydrolase factor that activates platelets; both are harmful to sperm. Another response related to immune to SCI is the presence of more white blood cells in semen.
Female
The number of women with SCI who gave birth and had a healthy baby increased. About half to two thirds of women with their SCI report may wish to have children, and 14-20% become pregnant at least once. Although female fertility is usually not permanently reduced by SCI, there is a stress response that can occur immediately after an injury that alters hormone levels associated with fertility in the body. In about half of women, menstruation stops after injury but then returns within an average of five months - he returns within a year for a large majority. After returning menstruation, women with SCI become pregnant at levels approaching other populations.
Pregnancy is associated with a greater than normal risk in women with SCI, including increased risk of deep venous thrombosis, respiratory infections, and urinary tract infections. Considerations exist such as maintaining the right position in a wheelchair, preventing pressure sores, and increasing the difficulty of moving due to weight gain and changes in the center of balance. Tools may need to be changed and medicines changed. For women with injuries above T6, the risks during labor and delivery that threaten the mother and fetus are autonomic dysreflexia, in which blood pressure rises to dangerous levels high enough to cause potentially lethal strokes. Drugs such as nifedipine and captopril can be used to manage an episode if it occurs, and epidural anesthesia is helpful although not particularly reliable in women with SCI. Anesthesia is used for labor and delivery even for women without sensation, which may only experience contractions as abdominal discomfort, increased flexibility, and episodes of autonomic dysreflexia. The reduced sensation in the pelvic area means that women with SCI usually have less painful delivery; in fact, they may fail to realize when they give birth. If there is a deformity in the pelvis or the caesar section of the back may be necessary. Baby girls with SCI are more likely to be premature, and, prematurely or not, they are more likely to be small for their pregnancy time.
Management
Erection problems
Although an erection is not necessary to satisfy sexual intercourse, many men consider it important, and treating erectile dysfunction improves their relationship and quality of life. Whichever treatment is used, it works best in combination with speech-oriented therapy to help integrate it into the sex life. Oral medicines and mechanical devices are the first choice in treatment because they are less invasive, often effective, and well tolerated. Oral medications include sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra). Penile pumps induce an erection without the need for medication or invasive treatment. To use the pump, the man inserts his penis into the cylinder, then pumps it to create a vacuum that draws blood to the penis, making it erect. He then shifts the ring from the outside of the cylinder to the base of the penis to hold the blood and maintain an erection. A man who is capable of an erection but has difficulty maintaining it for long enough can use the ring by itself. The ring can not be left for more than 30 minutes and can not be used at the same time as an anticoagulant drug.
If oral medications and mechanical treatments fail, the second option is localized injections: drugs such as papaverine and prostaglandins that alter blood flow and trigger an erection injected into the penis. This method is preferred because of its effectiveness, but it can cause pain and scarring. Another option is to insert a small amount of drug pellets into the urethra, but this requires a higher dose than the injections and may be ineffective. Topical drugs for dilating blood vessels have been used, but are not very effective or well-tolerated. Electrical nerve stimulation at the level of S2 can be used to trigger an erection that lasts for as long as no stimulation. Surgical implants, either from flexible stems or inflatable tubes, are reserved when other methods fail because of the potential for serious complications, occurring in as many as 10% of cases. They carry the risk of eroding the penile tissue (penetrating the skin). Although satisfaction among men who use it high, if they do need to be thrown away the implants make other methods such as injections and vacuum devices can not be used because of tissue damage. Erectile dysfunction may also exist not as a direct result of SCI but due to factors such as severe depression, diabetes, or drugs such as those taken for flexibility. Finding and treating root causes can alleviate the problem. For example, men with erectile problems due to a lack of testosterone may receive androgen replacement therapy.
Ejaculation and male fertility
Without medical intervention, the male fertility rate after SCI is 5-14%, but the rate increases with treatment. Even with all available medical interventions, less than half of men with SCI can be the fathers of children. Aided insemination is usually required. As with erections, therapies used to treat infertility in non-injured men are used for those with SCI. For anejaculation in SCI, the first-line method for sperm retrieval is the stimulation of the penis vibration (PVS). A high-speed vibrator is applied to the glans penis to trigger a reflex that causes ejaculation, usually within minutes. Efficacy reports with PVS ranges from 15-88%, probably due to differences in vibrator settings and physician experience, as well as the extent and completeness of the injury. Completely tight lesions above the Onuf nucleus (S2-S4) were responsive to PVS in 98%, but complete lesion of S2-S4 segment was not. In the case of failure with PVS, spermatozoa is sometimes collected by electroejaculation: an electrical probe is inserted into the rectum, where it triggers ejaculation. The success rate is 80-100%, but this technique requires anesthesia and does not have the potential to be done at home owned by PVS. Both PVS and electroquaculation carry the risk of autonomic dysreflexia, so drugs to prevent the condition can be given in advance and blood pressure is monitored throughout the procedure for those who are vulnerable. Massage of the prostate gland and seminal vesicles is another method of taking stored sperm. If this method fails to cause ejaculation or does not produce sufficiently useful sperm, sperm can be removed through surgical sperm testis or percutaneous epididymal sperm aspiration. This procedure produces sperm in 86-100% of cases, but non-surgical treatment is preferred. Premature or spontaneous ejaculation treated with antidepressants includes selective serotonin reuptake inhibitors, which are known to delay ejaculation as a side effect.
Female
Compared to the options available to treat sexual dysfunction in men (for concrete results can be observed), which is available for limited women. For example, a PDE5 inhibitor, an oral drug to treat erectile dysfunction in men, has been tested for its ability to improve sexual response such as arousal and orgasm in women - but no controlled trials have been performed in women with SCI, and trials in other women only result inconclusive results. In theory, the female sexual response can be enhanced by using a vacuum device designed to draw blood into the clitoris, but several studies of care for sexual function in women with SCI have been performed. There is a lack of certain information outside the area of ​​reproduction.
Education and counseling
Counseling about sex and sexuality by medical professionals, psychologists, social workers, and nurses is part of most of the SCI rehabilitation programs. Education is part of follow-up care for people with SCI, such as psychotherapy, peer mentors, and social activities; it is useful to improve the skills needed for socializing and relationships. Rather than overcome sexual dysfunction strictly as a physical problem, appropriate sexual rehabilitation treatments take into account the individual as a whole, for example addressing problems with relationships and self-esteem. Sexual counseling includes teaching techniques to manage depression and stress, and to raise awareness of the sensation that is preserved during sexual activity. Education includes information on birth control or assistive devices such as sex positioning, or suggestions and ideas for coping with issues such as incontinence and autonomic disreflexia.
Many SCI patients have received misinformation about the effects of their injuries on their sexual function and benefited from education about it. Although sexual education shortly after the injury is found to be beneficial and desirable, it is often absent in rehabilitation settings; a common complaint of those undergoing rehabilitation programs is that they offer inadequate information about sexuality. Long-term education and sex counseling after leaving the hospital is very important, but sexuality is one of the most frequently overlooked areas of long-term SCI rehabilitation, especially for women. The providers may refrain from discussing the topic because they feel intimidated or unprepared to handle it. Doctors should be careful in raising sexual issues because people may feel uncomfortable with or unprepared for the subject. Many patients wait for providers to discuss topics even if they want information.
A person's experience in managing sexuality after an injury depends not only on physical factors such as severity and level of injury, but on aspects of life and personality such as sexual experiences and attitudes about sex. As well as evaluating physical problems, clinicians should take into account the factors that affect each patient's situation: gender, age, culture, and social factors. Aspects of the patient's cultural and religious background, even if unconsciously before the injury causes sexual dysfunction, affect care and care - especially when cultural attitudes and patient assumptions and conflict care providers. Health professionals should be sensitive to issues of sexual orientation and gender identity, showing respect and acceptance when communicating, listening, and supporting emotionally. Providers treating SCI have been found to regard their patients as heterosexual or exclude LGBTQ patients from their consciousness, potentially resulting in sub-standard care. Academic research on sexuality and disability is also less representative of LGBTQ perspectives.
As well as patients, couples from injured people often need support and counseling. This can help with adjustments to new dynamic relationships and self-image (such as being placed in the role of the caretaker) or with the pressure that arises in sexual intercourse. Often, the partner of the wounded person must face feelings of guilt, anger, anxiety, and fatigue when faced with the additional financial burden of wage loss and medical expenses. Counseling aims to strengthen relationships by improving communication and trust.
Children and adolescents
SCI not only presents children and adolescents with many of the same difficulties facing adults, it affects the development of their sexuality. Although substantial research is on SCI and sexuality in adults, very little exists in ways that affect the development of sexuality in young people. Injured children and adolescents need age-appropriate sex education to answer SCI questions related to sexuality and sexual function. Very young children become aware of their inadequacies before their sexuality, but as they get older, they become curious as well as able-bodied children, and it's right to give them an increasing amount of information. Caregivers help children and families prepare for a transition into adulthood, including in sexuality and social interaction, starting early and intensifying during adolescence. Parents need education about the effects of SCI on sexual function so they can answer their children's questions. As soon as the patient reaches adolescence, they need more specific information about pregnancy, birth control, self-esteem, and dating. Teenagers with loss or diminished genital sensations benefit from education on alternative ways to experience pleasure and satisfaction from sexual acts. The teenage years are often very difficult for those with SCI, in terms of body image and relationships. Given the importance they place on sexuality and privacy, adolescents can experience humiliation when parents or caregivers bathe them or take care of intestinal and bladder needs. They can benefit from counseling on sexuality, support groups, and mentoring by adults with SCI who can share experiences and lead discussions with peers. With proper care and education of families and professionals, wounded children and adolescents can develop into sexually healthy adults.
Changes in sexual practices
People make sexual adaptations to help adjust to SCI. They often alter their sexual practices, move away from genital stimulation and sexual intercourse and toward greater emphasis on touch above the level of injury and other aspects of intimacy such as kissing and stroking. Needed to find new sexual positions if previously used have become too difficult. Other factors that enhance sexual pleasure are positive memories, fantasies, relaxation, meditation, breathing techniques, and most importantly, trusting with a partner. People with SCI can use visual, auditory, olfactory, and touch stimuli. It is possible to train yourself to pay more attention to the aspects of sex and sexy feelings in sensory areas of the body; this increases the likelihood of orgasm. The importance of desire and comfort is the reason behind the pain "the most important sexual organ is the brain."
Adjusting post-injury changes to body sensations is quite difficult to cause some people to give up on the idea of ​​sexually satisfying at first. But the change in sensitivity above and at the level of injury occurs over time; people may find sensitive zones such as nipples or ears becoming more sensitive, sexually satisfying enough. They may find new erogenous zones that are not erotic before the injury; care providers can help guide the invention. These sensitive areas can even cause orgasm when stimulated. Such changes can occur as a result of "remapping" sensory areas in the brain due to neuroplasticity, especially when the sensations in the genitalia are completely lost. Generally there is an area in the body between the area where the sensation disappears and those preserved are called "transition zones" which have increased sensitivity and are often sexually excited when stimulated. Also known as the "border zone", this area may feel like a penis or clitoris before an injury, and may even give you an orgasmic sensation. Due to such a sensational change, people are encouraged to explore their bodies to discover what areas of fun are. Masturbation is a useful way to learn about the body's new response.
The test exists to measure how much sensation a person has in the genitalia after an injury, used to adjust the treatment or rehabilitation. Sensory tests help people learn to recognize sensations associated with arousal and orgasm. The injured person who is able to reach orgasm from stimulation to the genitalia may require stimulation for longer periods or at greater intensity. Sex toys like vibrators are available, eg. to increase sensation in areas with reduced sensitivity, and this can be modified to accommodate defects. For example, a hand strap can be added to a vibrator or dildo to help someone with poor hand function.
Considerations for sexual activity
SCI provides additional needs to consider for sexual activity; eg muscle weakness and limitations of movement limit the choice for positioning. Pillows or devices such as slices can be placed to help achieve and maintain the desired position for people affected by weakness or limited mobility. Aids are there to help the movement, like a sliding seat to give a pelvic impulse. Spasticity and pain also create barriers to sexual activity; this change may require the couple to use a new position, such as sitting in a wheelchair. Warm baths can be taken before sex, and massage and stretching can be incorporated into foreplay to reduce spasticity.
Another consideration is the loss of sensation, which puts people at risk for injuries such as pressure sores and injuries that can get worse before being noticed. Friction from sexual activity can damage the skin, so it is necessary after sex to examine areas that may have been injured, especially in the buttocks and genital. People who have already suffered injuries must be careful so that the wound does not get worse. Irritation of the genitals increases the risk of vaginal infection, which becomes worse if they escape the attention. Women who do not get enough vaginal lubrication alone can use commercially available commercially available lubricants to reduce friction.
Another risk is autonomic dysreflexia (AD), a medical emergency involving dangerous high blood pressure. People at risk of AD can take medication to help prevent it before sex, but if it happens they should stop and seek treatment. Mild signs of AD such as a rather high blood pressure often accompany sexual arousal and cause no concern. In fact, some interpret AD symptoms that occur during sexual activity as fun or evocative, or even climax.
Concern for non-harmful sexual activity but can disrupt both partners is a bladder or bowel leak due to urinary incontinence or feces. Couples can prepare for sex by emptying the bladder using intermittent catheterization or putting a towel in advance. People with persistent urine catheters should be careful with them, remove them or record them out of the way.
Birth control is another consideration: women with SCI are usually not prescribed oral contraceptives because the hormones in it increase the risk of blood clots, where people with SCI are at high risk. Intrauterine devices can have dangerous complications that can go undetected if the sensation is reduced. Diaphragms that require something to be inserted into the vagina can not be used by people with poor hand function. The choice of choice for women is for couples to use condoms.
Long-term adjustments
In the first months after the injury, people usually prioritize other aspects of rehabilitation on sexual issues, but in the long run, the adjustment of life with SCI requires that sexuality be dealt with. Although physical, psychological and emotional factors refuse to reduce the frequency of sex after injury, it increases over time. As the years pass by, it is likely that someone will be involved in sexual enhancement. Difficulty adjusting to changing appearance and physical limitations contribute to the reduced frequency of sexual acts, and enhancement of body image is associated with improvement. Like frequency, sexual desire and sexual satisfaction often decline after SCI. The reduction in female sexual desire and frequency may be partly because they believe they can no longer enjoy sex, or because their independence or social opportunities are reduced. Over time people usually adjust sexually, adapting to their changing bodies. Approximately 80% of women return sexually active, and the number that reports sexual satisfaction ranges from 40-88%. Although women's satisfaction is usually lower than before the injury, it improves over time. Women report higher levels of sexual satisfaction than post-SCI men over 10-45 years. More than a quarter of men have substantial problems with adjustments to their post-injury sexual function. Sexual satisfaction depends on a number of factors, some more important than the physical functioning of the genitals: intimacy, relationship quality, partner satisfaction, willingness to be sexually experimental, and good communication. The function of the genitals is not as important as male sexual satisfaction as the satisfaction and intimacy of their partner in their relationship. For women, the quality of the relationship, the proximity of the partner, the sexual desire, and the positive body image, as well as the physical functioning of the genitals, contribute to sexual satisfaction. For both sexes, long-term relationships are associated with higher sexual satisfaction.
Relationships
Severe injuries such as SCI put the strain on marriage and other romantic relationships, which in turn have important implications for quality of life. Partners of the wounded often feel out of control, overwhelmed, angry, and guilty when adding work related to injury, lack of assistance with responsibilities such as parenting, and wage loss. Excessive stress and reliance in relationships increases the risk of depression for people with SCI; supportive relationships are protective. Relationships change when partners take on new roles, such as caregivers, who can run counter to partner roles and require huge sacrifices of time and self-care. This change of responsibility can mean the opposite of gender roles defined by society in relationships; the inability to fulfill this role affects sexuality in general. Sexual dysfunction is a stressor in the relationship. People often worry about failing to keep a satisfied partner as they are about fulfilling their own sexual needs. In fact, the two main reasons people with SCI exemplify the desire to have sex is for intimacy and for keeping a partner. Frequency of sex with the desire of an unharmed partner.
Although problems with sexual function resulting from SCI play a role in some divorce, they are not as important as emotional maturity in determining the success of marriage. People with SCI divorced more often than the rest of the population, and marriages that occurred before the injury failed more often than those after (33% vs 21%). People who married before the injury reported an unhappy marriage and worse sexual adjustment than those who married thereafter, may indicate that couples have difficulty adjusting to new circumstances. For those who choose to engage with someone after an injury, a defect is a part of the relationship received from the beginning. Understanding and accepting the limitations caused by injury to unharmed spouses is an important factor in successful marriage. Many divorces have been found initiated by partners who are injured, sometimes due to depression and rejection that often occurs early after an injury. So counseling is important, not just to manage change in self-perception but in perception of relationships.
Regardless of the pressure that SCI puts on people and relationships, research has shown that people with SCI can have a happy and satisfying romantic and marital relationship, and to raise well-adjusted children. People with SCI who want to be parents may question their ability to raise a child and choose not to have it, but research shows no difference in care outcomes between injured and unhurt groups. Girls with SCI have no self-esteem, adjustments, or worse attitudes toward their parents. Women with post-SCI children have a higher quality of life, though parenting increases the demands and challenges of their lives.
For those single when injured or single, SCI causes difficulties and inconvenience with respect to one's ability to meet new partners and start relationships. In some settings, beauty standards cause people to see a defective body as less attractive, limiting choices for sexual and romantic partners with disabilities such as SCI. In addition, physical defects of stigmatization, causing people to avoid contact with people with disabilities, especially those who have very visible conditions such as SCI. The stigma can cause people with SCI to experience self-awareness and public embarrassment. They can improve their social success by using impression management techniques to change the way they are perceived and create a more positive image of themselves in the eyes of others. Physical limitations create difficulties; with lower independence comes less social interaction and fewer opportunities to find partners. Difficulties with mobility and lack of accessibility to persons with social disabilities (eg lack of wheelchair trails) create further barriers to social activities and limit the ability to meet with partners. The isolation and associated depression risks can be limited by participating in physical activity, social gatherings, clubs, and online chats and dating.
Society and culture
Negative social attitudes and stereotypes about people with disabilities such as SCI affect interpersonal interaction and self-image, with important implications for quality of life. In fact, for women, psychological factors have a more important impact on sexual adjustment and activity than are physical. Negative attitudes about disability (along with relationships and social support) are more predicting results than the extent or completeness of the injury. Stereotypes exist that people with SCI (especially women) are not interested, unsuitable for, or unable to sexual relationships or encounters. "People think we can only date people in wheelchairs, that we're lucky to get men, that we can not be picky," says Mia Schaikewitz, who is profiled in Push Girls, 2012 reality series about four women with SCI. Not only does it affect the self-image of the wounded, this stereotype is very dangerous when held by counselors and professionals involved in rehabilitation. Caregivers are influenced by culturally transmitted beliefs that can treat their patients as asexually, especially if the injury occurs at a young age and the patient has never had any sexual experience. Failure to recognize sexual and reproductive abilities of wounded people limits their access to birth control, information on sexuality, and medical care related to sexual health such as annual gynecological exams. Another common belief that affects sexual rehabilitation is that sex is just about genital function; This can cause caregivers to reduce the importance of other body parts and individuals.
Cultural attitudes toward gender roles have a profound effect on people with SCI. This injury can cause discomfort around the sexual identity, especially if disability hinders the fulfillment of gender norms that are socially taught. The female beauty standards propagated by mass media and culture portray ideal and able-bodied women: as one fashion model with SCI commented, "when you have severe injuries or disabilities, you are not often regarded as sensual or beautiful because you do not look like women in magazines. "The inability to meet these standards can lower self-esteem, even if these ideals are also not reachable by most able-bodied women. Lower self-esteem is associated with poorer sexual adjustment and quality of life, and higher levels of loneliness, stress, and depression. Men are also influenced by the expectations of society, such as the notion of masculinity and sexual prowess. Men from some traditional backgrounds may feel performance pressure that emphasizes the ability to have erections and sexual relationships. Men who have strong sexual desire but are unable to engage in sexual intercourse may be at risk of depression, especially when they strongly believe in traditional, male-masculine gender norms as the core of male identity. Men who strongly believe in this traditional role may feel inadequately sexually, not manly, not confident, and less satisfied with life. Because sexual dysfunction has a negative impact on self-esteem, the treatment of erectile dysfunction can have psychological benefits although it does not help with physical sensations. SCI may require reassessment and rejection of assumptions about gender norms and sexual function to fit healthily with disabilities: those who are able to change the way they think about gender roles may have better life satisfaction and outcomes with rehabilitation. Counseling helps in this review process.
References
Bibliography
External links
- PleasureABLE: A Manual of Sexual Devices for Persons with Disabilities.
- SCI Forum Report: Dating and Relationships after SCI. University of Washington
- Sexuality & amp; The Sexual Function follows SCI. University of Alabama at Birmingham Spinal Cord Injury Model System video series
- Sexuality and spinal injury: Where we are and where we are going. Free Library
- Sexuality in Spinal Injuries. University of Miami School of Medicine
Source of the article : Wikipedia
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