Sexuality and Fertility - Impact on Women with SCI
by Suzy Kim, MD
Until recently, sexual function in women with SCI was relatively understudied. Statistics and demographic studies have consistently shown the incidence of SCI in men is significantly higher (78%) than in women (22%). The majority of newly injured women are of childbearing age (16 to 30 years old).The impact of SCI on the fertility of women who are in their “prime” childbearing age weighs heavily on their complete adjustment.
Genital Arousal Dysfunction
Fact #1: Women are sexual beings with a healthy libido. A woman’s expression of a man’s erection is vaginal lubrication. Similar to men, the neurologic level and severity of SCI may predict the ability for women to achieve psychogenic and/or reflexogenic vaginal lubrication. The degree of preservation of sensation at the T11-L2 dermatomes is associated with psychogenic vaginal lubrication. If you have an injury at the T11-L2 spinal cord levels, it is unlikely that you will achieve arousal from erotic thoughts from your brain. In other words, the SCI does not allow these messages to reach this “sexual function center.” Expert researchers recommend that women with SCI check for their ability to feel the groin area when they put their hands in their pants' pockets.
Try this. If you can feel this area, you will likely be able to achieve genital arousal via stimulating thoughts.Alternatively, manual genital stimulation will produce reflexogenic vaginal lubrication if the S2-S4 spinal nerves are intact. Therefore, if you have injury to the lumbar vertebrae or cauda equina, you will not likely achieve arousal through tactile or manual genital stimulation. Clinically, the presence of the bulbocaverosus or anal wink reflexes (mediated by S2-S4) correlates with the capacity of reflexogenic arousal.Caution is advised for women with SCI above T6 as genital stimulation has been reported to induce autonomic dysreflexia.
Treatment
Medications and assisted devices similar to those recommended for men with SCI have been shown to also improve a women’s ability to achieve adequate genital lubrication for sexual intercourse. One study showed that taking Viagra (sildenafil citrate) 60 minutes prior to a sexual encounter with manual stimulation improved genital lubrication by promoting vasocongestion of the women’s erectile tissue. Conceptually, clitoral vacuum pump devices act on local vasocongestion by creating negative pressure, similar to the penile vacuum device. Widely available commercial vibrator stimulators have also assisted women with reflexogenic vaginal lubrication.
Orgasm
The impact of SCI on women’s sexual function is not as well studied or defined when compared to that of men. However, in a controlled lab setting, investigators found that 50% of women with SCI (regardless of the level or severity of SCI) were able to achieve an orgasm but had a prolonged time to orgasm when compared to their able-bodied counterparts. Functional MRI studies further suggest that other non-spinal pathways may carry the information from genital stimulation to the brain for an orgasm to occur. But, reports from women with injury to the sacral spinal cord (conus medullaris or cauda equina) note great difficulty in achieving orgasm. Thus, conflicting theories are offered for the physiologic basis for orgasm in women with SCI, which has stimulated a growing body of ongoing research.
