Following the spinal cord injuries SCI , sexual function is affected and the goal for such individuals, as for all people, is to have a gratifying and productive life. During the initial phase following a spinal cord injury, it is expected for individuals to be focused on physical recovery and rehabilitation.
However, impending to stipulations with sexuality is a key step towards making a healthy adjustment. Sex is the module that identifies human being as male or female thus expressing sex is a fundamental part of human. It is often the choice after SCI people to become sexually active or not. Discussing about sex is such a topic that is often felt uncomfortable and avoided by patients as well as many health care professionals.
It is often an experience to discuss about such a sensible and private topic requires a familiar and knowledgeable person. From the time of injury till the gain of functional recovery, physiotherapists are the ones who spend a longer period providing rehabilitation. Therefore, the physiotherapists are the ones who are able to maintain the repo with the patients thus providing and sharing the health related solutions. The query allied with their sexual life is often a topic rose by them during rehabilitation and cannot be derelict.
Often to take first step in such a matter is the job of health care professionals as insisted by Davis and Taylor [ 2 ]. It is not the responsibility of a single professional to address sexuality of patients. Until now, the health care professionals are ambiguous about addressing such issue. Physiotherapists and other health care professionals on sexuality identified it as an uncomfortable issue to discuss with patients [ 4 , 5 ].
It was observed that the absence of awareness to sexuality in an undergraduate teaching in health care professionals could be key factor to explain why professionals are uncomfortable in addressing the patients need [ 6 - 8 ]. Following information may help briefly to get an idea on sexual function following SCI. Sexuality for Male TL2 and S are the two areas in spinal cord that are associated to sexual function. TL2 controls psychogenic erections the result of erotic stimuli that result in cortical modulation of the sacral reflex arc and release of fluids where as S controls reflexogenic erections achieved by manual stimulation.
If the injury level is above the T11— L2 center then erections are less likely to happen by looking at sexy pictures, videos etc. If the injury is below the T11—L2 area, it is possible that the nerves are working and erections can occur as they did before the injury. In general, erections are more likely with incomplete injuries both upper and lower motor neuron , than complete injuries.
Most of the time, men with a SCI are able to maintain an erection only when the penis is stimulated and the rigidity of the erection is insufficient for sexual intercourse. As such case, the erection can be augmented with devices Penile Vacuum Devices , medications Sildenafil or Viagra , through injection therapy Ntracavernosal Injection Therapy, Transurethral Therapy or a penile implant if the patient wish to engage in sexual intercourse.
Sexuality for Female The major effects of SCI on sexual functioning for women are the loss of sensation and the ability to lubricate, which can be mediated by reflexogenic or psychogenic factors. If lubrication is a problem then K—Y jelly over the counter product can help.
As Sildenafil was of limited value, the current studies seem to be focusing on the role of testosterone replacement. Following SCI, some women do miss cycles of menses. Menses usually return in the first few months to first year.
It is important to know that pregnancy is possible even without periods as ovulation may be occurring. Women with spinal cord injuries are able to become pregnant but depending on the injury, there may be additional tribulations such as increased difficulty in transferring; problems with bladder management and urinary tract infections; autonomic dysreflexia with injuries above T—6; leg edema; constipation; thromboembolism; pre mature birth and perceiving uterine contractions or fetal movements less possible with lesion above T All of these medical conditions can be manage with good care from health care professionals [ 9 - 11 ].
Even the research on such an area is not as robust as it is in other fields. It is relatively new area of inquiry for those dealing with SCI patients and for some people, is still associated with a certain level of discomfort.
In spite of the paucity of research, sexuality should be addressed in a planned, lenient manner while the patient is undergoing rehabilitation and during life-long follow-up. Therefore, by providing education and training on such issues to physiotherapist, they may aid a valuable contribution in sexual rehabilitation and in related research thus enhancing the quality of life in SCI patients. References World Health Organization Draft working definition. The Use of Theories and Models in Practice.