Marca L. Sipski

Sexual arousal and orgasm in women: Effects of spinal cord injury

Sexual disorders are common in women; however, the neurological basis of female sexual response has not been adequately investigated. This information is necessary to characterize the impact of various neurological disorders on sexual arousal in women and to develop appropriate management strategies for sexual dysfunction. To assess the spinal mediation of sexually stimulated genital vasocongestion in women, we conducted two laboratory‐based, controlled analyses: (1) of womens genital, subjective, and autonomic responses to audiovisual erotic and audiovisual erotic combined with manual genital stimulation; and (2) of womens ability to achieve orgasm. Subjects included 68 premenopausal women with spinal cord injuries (SCIs) and 21 able‐bodied, age‐matched controls. Results indicated that preservation of sensory function in the T11‐L2 dermatomes is associated with psychogenically mediated genital vasocongestion. Less than 50% of women with SCIs were able to achieve orgasm, compared with 100% of able‐bodied women (p = 0.001). Only 17% of women with complete lower motor neuron dysfunction affecting the S2‐S5 spinal segments were able to achieve orgasm, compared with 59% of women with other levels and degrees of SCIs (p = 0.048). Time to orgasm was significantly increased in women with SCIs compared with able‐bodied controls (p = 0.049). Independent raters were unable to differentiate between subjective descriptions of orgasm from SCI women compared with controls. This information should be used when counseling women with spinal dysfunction about their sexual potential. Ann Neurol 2001;49:35–44

Women's Orgasm

Abstract An orgasm in the human female is a variable, transient peak sensation of intense pleasure, creating an altered state of consciousness, usually with an initiation accompanied by involuntary, rhythmic contractions of the pelvic striated circumvaginal musculature, often with concomitant uterine and anal contractions, and myotonia that resolves the sexually induced vasocongestion and myotonia, generally with an induction of well-being and contentment. Womens orgasms can be induced by erotic stimulation of a variety of genital and nongenital sites. As of yet, no definitive explanations for what triggers orgasm have emerged. Studies of brain imaging indicate increased activation at orgasm, compared to pre-orgasm, in the paraventricular nucleus of the hypothalamus, periaqueductal gray of the midbrain, hippocampus, and the cerebellum. Psychosocial factors commonly discussed in relation to female orgasmic ability include age, education, social class, religion, personality, and relationship issues. Findings from surveys and clinical reports suggest that orgasm problems are the second most frequently reported sexual problems in women. Cognitive-behavioral therapy for anorgasmia focuses on promoting changes in attitudes and sexually relevant thoughts, decreasing anxiety, and increasing orgasmic ability and satisfaction. To date there are no pharmacological agents proven to be beneficial beyond placebo in enhancing orgasmic function in women.

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.

Efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and spinal cord injury: a review.

Spinal cord injury (SCI) affects a substantial number of men who are young, active, and otherwise healthy. Erectile dysfunction (ED) is a common consequence of SCI. Since its approval, sildenafil citrate (Viagra) has been shown to effectively treat ED of various etiologies. We review the evidence for the efficacy and safety of sildenafil treatment of ED in men with SCI. A literature search identified 2 randomized controlled trials and 4 prospective case series that evaluated sildenafil treatment for ED from SCI. Efficacy was evaluated using an assessment of global efficacy and a more specific assessment of erectile function. For general efficacy, the proportion of patients who reported improved erections and ability to have intercourse was as high as 94%. Up to 72% of intercourse attempts were successful. For measures of erectile function, 5 of the 6 studies showed statistically significant improvements among sildenafil-treated versus placebo-treated patients. Erectile response rates were generally higher in patients with incomplete versus complete SCI and in patients with upper versus lower motor neuron lesions. Nevertheless, a substantial proportion of patients with complete lesions, regardless of level or lower motor neuron lesions, also benefited from sildenafil. Sildenafil was well tolerated. Incidence rates and types of adverse events that occurred in these studies were similar to those published previously. Symptoms of autonomic dysreflexia were not reported in any study. Existing evidence suggests that oral sildenafil is a highly effective and well-tolerated treatment for ED associated with SCI.

Sexual Response In Women With Spinal Cord Injury: Neurologic Pathways And Recommendations For The Use Of Electrical Stimulation

Abstract Background: Determination of the exact level and degree of a woman’s spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI. Design: Literature review Findings: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11 -T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc. Conclusions: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with ablebodied controls, provide valuable information regarding female sexual neurophysiology. Electrical stimulation can be used to improve sexual response, as well as bladder and bowel function. Interventions that interfere with the sacral reflex arc, such as sacral rhizotomy, can impair the ability to achieve orgasm. To develop alternative treatment protocols, further investigation of sexual response and orgasm is recommended. f Spinal Cord Med. 2001 ;24:155–158

Invited Review Shoulder Pain In Chronic Spinal Cord Injury, Part 1: Epidemiology, Etiology, And Pathomechanics

Abstract Background/Objectives: Few studies have adequately examined the unique issues of womenwith spina bifida as they enter their reproductive years. Most studies are anecdotal, retrospective case studies that contribute little to our understanding of the physiologicaleffects of the disability on the reproductive system and, conversely, the effects of thereproductive endocrine changes on the womans disability. The purpose of this article wastoreview previously published reports on the reproductive issues facing female adolescentsand women and to ascertain the current knowledge so that future research needs can be established. Methods: Multiple MEDLINE searches were performed for publications from 1957 through the present pertaining to females/women with spina bifida and/or disabilities. Papers werethen chosen if information was provided on menarche, menstruation and sexual maturation,gynecologic issues, sexual function, birth control, pregnancy outcomes, and menopause. These were then reviewed and classified according to the level of evidence (as defined by Ball et al). Results: More than 150 titles and abstracts were reviewed for inclusion. Of these, 75 papers met the guidelines for the subject content. Studies were stratified by level of evidence and included 1 study at level 3,71 studies at level 4,and 3 studies at level 5. Conclusion: Little research has examined the reproductive issues of women with spina bifida and women with other neurologic disabilities. Future controlled prospective research studies are needed to examine issues related to puberty and sexual and gynecologic issues throughout the life span and pregnancy in these populations.

From the bench to the body: key issues associated with research aimed at a cure for SCI.

Significant advances have been made in the study of neuroprotection and neural regeneration following spinal cord injury (SCI). However, there is wide variability in the animal models used for these studies. Moreover, there is no consensus on which outcome measures are best used to document recovery in animals. On top of these issues, the transfer of research from the laboratory into clinical trials is also hampered by a lack of sensitive outcome measures to document the recovery of function in humans with SCIs. This paper identifies specific issues related to the transfer of research findings from animals into humans. In the laboratory, these issues include the choice of animal model and outcome measures selected; and in humans, the standardization of medical treatment and other therapies, patient selection, and the outcome measures chosen. In the transfer of research from animals into humans, safety and feasibility issues must also be considered.

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.

Central nervous system based neurogenic female sexual dysfunction: Current status and future trends

The amount of information available regarding the impact of various central nervous system disorders on female sexual function has greatly increased. In this article, the most recent information regarding brain and spinal cord disorders in human females is reviewed. Evidence from women with spinal cord injuries (SCIs) supports findings in able-bodied females that the sympathetic nervous system provides regulation of psychogenic sexual arousal. In women with SCIs, the ability to achieve orgasm persists in approximately 50%; however, there is a relative inability to achieve orgasm with complete disruption of the sacral reflex arc. These natural effects of injury should be considered when educating patients about neurogenic sexual dysfunction and when developing treatment protocols. Published research protocols aimed at improving sexual responsiveness and future possibilities for treatment of neurogenic sexual dysfunction are also discussed.

Women's Issues After SCI

Women with spinal cord injury (SCI) have unique medical and psychosocial needs that have not been specifically addressed in spinal cord medicine research. The purpose of this article is to summarize the gender-specific problems, effective interventions, and gaps in knowledge noted in the current literature on women with SCI. This article indicates that most of the evidence to support current medical practices is based on nonrandomized trials or is based on evidence from controlled studies done either in the non-SCI population or in a mixed sample of men and women with SCI. As more attention is now being given to different womens issues after SCI, expansion of these investigations is recommended.