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Spinal Cord Injury, Sexuality & Reproductive Health

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Full Title: Sexuality and Reproductive Health Following Spinal Cord Injury

December 2004

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Structured Abstract

Objectives: This report focuses on two questions:

  • Issues related to fertility, pregnancy rates, and live births in persons with spinal cord injury (SCI).
  • Issues related to male impotence post-SCI.

Data Sources: MEDLINE® (1966-2003), PreMEDLINE® (till June 13 2003), CINAHL (1975-2003), the Cochrane Central Register of Controlled Trials, (1st Quarter, 2003), SocioFile (1974-2003) and PsycInfo (1887-2003). The annual proceedings (1997-2002, inclusive) of several groups were searched. Several manufacturers were also approached for potential data.

Review Methods: Two reviewers independently screened the bibliographic records for relevance by liberally applying the eligibility criteria. Data abstracted included the details of publication, study design, population, intervention/exposure, and participant dropouts. A qualitative synthesis for all studies was performed which included a narrative summary of the key features of the study report, such as, population, intervention/exposure, outcomes, study quality, applicability, and individual study results. Meta-analytical techniques for single proportions were used, when appropriate.

Results: A total of 2,128 reports were evaluated and 122 reports were included in the systematic review; 66 of the reports examined fertility and 56 reports examined sexual dysfunction in individuals with SCI. The 122 studies included 6,668 individuals, ranging in age from 16 years to 81 years and 78% of the studies reported 100% male participation, with 6% reporting all female participation. No studies were found that investigated fertility in females after SCI. For male fertility, ejaculation interventions in the last decade resulted in an overall ejaculation response rate of 95%. Data from 13 studies over the past 10 years documented pregnancy rates of 51%. Data from the 11 studies over the past 10 years documented live birth rates of 41%. Eight reports examined the phenomena of sexual arousal in response to physical and cognitive stimulation in SCI women and described the separate roles of physical reflex and cognitive pathways in sexual response, but did not test treatment methods for dysfunction. Several interventions (i.e., behavioral, topical agents, intraurethral Alprosatadil, intracavernous injections, vacuum tumescence devices, penile implants, sacral stimulators, and pharmacological) have been used to evaluate male sexual dysfunction.

Conclusions: There is a paucity of literature regarding fertility and pregnancy in SCI females but a relatively large body of evidence regarding males with SCI. Several interventions studies positively affect sexual activity at least in the short-term. Long-term sexual adjustment has not been examined.

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Sexuality and Reproductive Health Following Spinal Cord Injury

Evidence-based Practice Center: University of Ottawa
Topic Nominator: Consortium for Spinal Cord Medicine

Current as of December 2004


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