Spinal cord injury (SCI) causes disruption to motor, sensory and autonomic pathways, which depending on the level and extent of impairment impacts significantly on many areas of a person’s life, including sexual functioning. Sexuality is an integral part of being human. While changes to sexual function usually refer to changes in arousal (erection in men and vaginal lubrication in women), ejaculation in men, and orgasm in men and women, sexuality is also inclusive of the psychological and physiological effects of loss of motor and sensory function, bladder and bowel control and alterations to body image and sexual self esteem. Furthermore, in men with SCI, fertility is affected not only by altered erection and ejaculatory function, but also by changes to semen quality. Sexual adjustment, function and performance are key issues to address after SCI with marital relationships often being strained and increased risk of separation. Additionally, although rehabilitation professionals may feel uncomfortable discussing sexual issues and inadequately trained (Herson et al. 1999; Booth et al. 2003; Post et al. 2008).
In 2004, Anderson surveyed 681 participants (approximately 25% were female) asking what “gain of function” was most important to their quality of life. For the majority of individuals with paraplegia, regaining sexual function was rated the highest priority. For those with tetraplegia, sexual function was rated as the second highest priority after restoration of hand and arm function.
In contrast to the priority given to sexuality by people with SCI, insufficient medical research has been performed in this area to provide a great deal of evidence-based information to guide clinical sexual health practice (Biering-Sorensen & Sonksen 2001; Deforge et al. 2005). Several authors have highlighted the lack of attention given to this area and the resulting dissatisfaction within the SCI community (Tepper 1992; Tepper et al. 2001; Anderson 2004; Kennedy 2006). Current sexual health clinical practice has limitations since it is primarily based on results from case reports and observational studies, with some areas (such as erectile dysfunction in men with SCI) having a larger body of evidence.
This review attempts to summarize the quality of the literature and main research findings to provide some recommendations for sexual and reproductive clinical practice based on evidence existing currently. In areas where evidence is lacking, recommendations based on case reports, expert opinion and observational studies are also indicated. The clinician can therefore weigh the recommendations separately.