Craig J. Alexander

Sexual activities, response and satisfaction in women pre- and post-spinal cord injury

Twenty-five spinal cord injured (SCI) women (median age = 34) completed an 80-item multiple choice questionnaire (median 50 months postinjury) that assessed sexual functioning pre-spinal cord injury and post-spinal cord injury in four areas: (1) sexual adjustment; (2) sexual activities and preferences; (3) sexual desire, arousal and satisfaction; and (4) sexual abilities. Frequency of sexual activity decreased following SCI. Intercourse was the favorite activity preinjury; whereas, kissing, hugging and touching were favored postinjury. Sexual desire and satisfaction decreased postinjury. Ability to achieve lubrication and orgasm with various types of spinal injuries is reported. Although most women did not receive sexual information or counseling, 76% of the sample believed they had been adjusting well sexually. Results are discussed accounting for the limitations of self-report methodology in sexuality research. The need for laboratory based, physiologic studies is underscored.

Effects of level and degree of spinal cord injury on male orgasm.

Design:Controlled, laboratory-based analysis.Objective:To determine the impact of spinal cord injuries (SCIs) on the ability to achieve male orgasm.Setting:US academic medical center.Methods:A laboratory-based analysis of the ability of 45 men with SCIs and 16 able-bodied control subjects to achieve orgasm coupled with a detailed neurologic examination, history and physical examination, and administration of the International Index of Erectile Function.Results:Men with SCIs were less likely than controls to achieve orgasm. Mean latency to orgasm, blood pressure and heart rates at orgasm were not significantly different between controls and SCI subjects. Men with incomplete SCIs were more likely to achieve orgasm than those with complete SCIs. A disconnect was noted between the presence of orgasm and the presence of ejaculation. Men with complete lower motor neuron dysfunction affecting their sacral segments were less likely to achieve orgasm than men with any other patterns of SCI.Conclusion:These results document the ability of men with complete SCIs to achieve orgasm. Characteristics of orgasm in men with SCIs as compared to able-bodied subjects are similar. Although orgasm and ejaculation are more likely to occur together, a number of men with SCIs achieve orgasm without ejaculation. Further research should explore the possibility of retraining ejaculatory and orgasmic responses in men with SCIs.

Recommendations for Discussing Sexuality After Spinal Cord Injury/Dysfunction in Children, Adolescents, and Adults

Abstract Background/Objective: To review the literature and provide a framework for sex education for the child, adolescent, or adult with a spinal cord injury (SCI) or disorder. Methods: Discussion and review of the literature. Results: There is a paucity of research available regarding the impact of SCis and disorders on sexuality in children and adolescents; however, there is a significant body of literature on this topic in adults. Recommendations based on these findings are presented. Guidelines regarding sexuality in children and adolescents with general disabilities may be adapted for the education of children and adolescents with SCis and disorders. Conclusions: Parents, partners, and persons with SCis and disorders should be provided with ageappropriate information about sexuality that includes specific information with respect to SCis and disorders. Although there has been a significant increase in information that is available about the impact of sexuality in adults after SCI, more information is needed about the effects of SCis and disorders on the healthy sexual development of children and adolescents.

Effects of vibratory stimulation on sexual response in women with spinal cord injury.

Women with spinal cord injuries (SCIs) have predictable alterations in sexual responses. They commonly have a decreased ability to achieve genital sexual arousal. This study determined whether the use of vibratory stimulation would result in increased genital arousal as measured by vaginal pulse amplitude in women with SCIs. Subjects included 46 women with SCIs and 11 nondisabled control subjects. Results revealed vibratory clitoral stimulation resulted in increased vaginal pulse amplitude as compared with manual clitoral stimulation in both SCI and nondisabled subjects; however, these differences were not statistically significant. Subjective levels of arousal were also compared between SCI and nondisabled control subjects. Both vibratory and manual clitoral stimulation resulted in significantly increased arousal levels in both groups of subjects; however, statistically significant differences between the two conditions were only noted in nondisabled subjects. Further studies of the effects of repetitive vibratory stimulation are underway.

Lack of justification for routine abdominal ultrasonography in patients with chronic spinal cord injury.

Little evidence-based research is available to indicate which procedures should routinely be performed for screening exams in patients with spinal cord injuries (SCIs). It had been the procedure to routinely perform abdominal ultrasonography on a yearly basis at our medical center. Therefore, we conducted a retrospective study to determine whether the repetition of these procedures resulted in detection of any pathology warranting treatment that otherwise would have gone undetected. The electronic records of 174 individuals were reviewed, along with a total of 359 abdominal ultrasounds and exams. High incidences of abnormal findings were found in the liver, pancreas, spleen, gallbladder, and kidney; however, no specific interventions were noted solely on the basis of the ultrasound findings. Moreover, no added benefits could be documented through the performance of repetitive exams. We recommend that further evidence-based studies be performed to ascertain the benefits of performance of routine procedures in patients with SCIs.

Mothers with Spinal Cord Injuries: Impact on Family Division of Labor, Family Decision Making, and Rearing of Children

Purpose: The purpose of this study was to increase our understanding regarding the division of family household tasks, family decision making, and the caring and rearing of children in families where mothers were disabled by a spinal cord injury (SCI). Method: A 2 (mother, partner) 2 2 (spinal cord injured, able-bodied) factorial design was used. Mothers were matched on key demographic variables. Participants were selected from seven regional model SCI systems nationwide. The volunteer sample consisted of 251 participants: 88 mothers with SCI and 46 of their partners, and the matched control group including 84 able-bodied mothers and 33 of their partners. The main outcome measure was the Through the Looking Glass Parenting With Disabilities Couples Survey, disabled and able-bodied versions. Results: In families of SCI mothers, the division of household and child-care tasks was more egalitarian than in families with able-bodied mothers. Conclusion: Partners of SCI mothers did not perceive the disability...

Documentation of the Impact of Spinal Cord Injury on Female Sexual Function: The Female Spinal Sexual Function Classification

Significant new research has examined the impact of specific levels and degrees of spinal cord injury (SCI) on female sexual response. Research has also recently examined two methods of improving sexual responsiveness in women with SCI. The use of false-positive feedback and sildenafil were both noted as potential treatment methods that deserve further study. Concomitant with these observations, there has been a significant increase in overall interest in female sexual dysfunction. This interest has resulted in a new classification system for female sexual dysfunction, which takes into account both physiological and psychological aspects of sexual dysfunction. We propose a new classification system to predict female sexual function and dysfunction after SCI. This nomenclature, the Female Spinal Sexual Function Classification, is recommended for use as an adjunct to the International Standards for Neurological Classification of Spinal Cord Injury.

Cardiovascular Effects of Sildenafil in Men with SCIs at and Above T6

Purpose: To determine the cardiovascular effects of sildenafil in men with spinal cord injuries (SCIs) at and above the level of T6, we conducted a double-masked, placebo-controlled laboratory-based study. Method: Participants received sildenafil 50 mg or lactose placebo on alternating days 1 hour prior to a 78-minute experimental protocol. Six-minute baseline periods alternated with two 12-minute audiovisual stimulation periods. Participants include 10 men with traumatic SCIs, mean age of 43. Results: Results revealed significant increases in penile circumference with sildenafil compared to placebo (p = .0035). Although there was a trend for patients to acknowledge higher levels of arousal while on sildenafil, results were not statistically significant. Moreover, although there was a trend toward decreased blood pressure and increased heart rate with the use of sildenafil, differences were not statistically significant. Conclusion: Based upon these findings, sildenafil appears to be a safe, effective dru...

Randomized Trial of Clitoral Vacuum Suction Versus Vibratory Stimulation in Neurogenic Female Orgasmic Dysfunction

OBJECTIVE To examine the safety and efficacy of using a clitoral vacuum suction device (CVSD) versus vibratory stimulation (V) to treat orgasmic dysfunction in women with multiple sclerosis (MS) or spinal cord injury (SCI). DESIGN Randomized clinical trial. SETTING Two academic medical centers. PARTICIPANTS Women (N=31) including 20 with MS and 11 with SCI. INTERVENTION A 12-week trial of the use of a CVSD versus V. MAIN OUTCOME MEASURES Female Sexual Function Inventory (FSFI) and Female Sexual Distress Scale (FSDS). RESULTS Twenty-three women (18 MS, 5 SCI) completed the study including 13 of 16 randomized to CVSD and 10 of 15 randomized to V. There was a statistically significant increase in total FSFI score (P=.011), desire (P=.009), arousal (P=.009), lubrication (P=.008), orgasm (P=.012), and satisfaction (P=.049), and a significant decrease in distress as measured by FSDS (P=.020) in subjects using the CVSD. In subjects who used V, there was a statistically significant increase in the orgasm subscale of the FSFI (P=.028). Subjects using the CVSD maintained improvements 4 weeks after treatment. CONCLUSIONS CVSD is safe and overall efficacious to treat female neurogenic sexual dysfunction related to MS and SCI. V is also safe and efficacious for female neurogenic orgasmic dysfunction; however, results were limited to the active treatment period. Because of ease of access and cost, clinicians can consider use of V for women with MS or SCI with orgasmic dysfunction. CVSD is recommended for women with multiple sexual dysfunctions or for whom V is ineffective.