Assessment of Sexual Potential and Treatment of Sexual Dysfunctions in Men and Women with Spinal Cord Injury, pp. 167-229
Authors: Frédérique Courtois, Kathleen Charvier4, Jean-Guy Vézina, Serge Carrier, Nicolas Morel Journel, Géraldine Jacquemin and Albert Leriche
Abstract: A spinal cord injury (SCI) with its sensory and motor deficits alters sexual function to varying degrees depending upon the level and extent of the lesion (Biering-Sorensen & Sonksen, 2001; Brackett et al., 1998; Brindley 1981; 1984; Bors & Comarr, 1960; Comarr 1970; Chapelle et al., 1982 Courtois et al., 1995a; 2009a; 2009b; Deforge et al. 2005; 2006, Alexander et al, 2009). Yet, with the advances in research and clinical practice, most individuals with SCI can now achieve satisfactory sexual function. In men, the mechanical aspect of erection can be assessed with reflexogenic and psychogenic stimulation and when the response is lost, treatment options can be offered to restore adequate function. Reproductive and orgasmic aspects of sexuality can also be explored through ejaculation as assessed with natural stimulation and when this fails, alternatives are available to trigger responses in more than 90% of the patients (Biering-Sorensen & Sonksen, 2001; Brackett, 1999; Brackett & Lynne, 2000; Brackett et al., 1998; Charvier et al., 2005; Courtois et al., 1997; 2008c; 2008d; 2008e; 2009; Deforge et al., 2005). In women, studies have shown encouraging results concerning arousal and orgasm despite the SCI (Bérard, 1989; Courtois et al., 2008a; 2008b; Sipski, 2001; Sipski et al, 1995a; 1995b; 1997; 2001 Whipple et al., 1996; 2002) and while assessment is feasible, treatment strategies remain unfortunately scarce. As will be shown below, treatment options for women can be borrowed from those used in men, but they need to be adapted, in particular with cognitive behavioral strategies, in order to maximize their effect. In general, more studies are required, especially in women and especially on orgasmic function, to improve results, but as treatment and assessment strategies are available, clinicians can provide satisfactory options to men and women with SCI to achieve optimal post-traumatic sexual function. This chapter describes the assessment strategies and treatment options that are currently available for men and women with SCI. Based on a review of the literature and our own clinical experience with SCI patients, the chapter provides an overview of their indication, benefits and limits, and provides suggestions to adapt various strategies to maximize post traumatic sexual function. The chapter further discusses a theoretical framework that helps understanding these strategies and resulting sexual function. It offers practical advices to increase potency, optimize fertility and maximize sexual satisfaction among men and women with SCI.