Sexual Health Assessment
Sexual and reproductive health must be addressed in a biopsychosocial manner and include various disciplines. The utilization of a Sexual Rehabilitation Framework (SRF) allows the medical and/or psychosocial factors that impede or improve sexual and reproductive function to be assessed (Elliott et al. 2017). The SRF is an adjunct tool to the full sexual history, and it encourages all disciplines involved in SCI rehabilitation to address the topic of sexual health in the same manner as they would other activities of daily living (Elliott et al. 2017).
The eight areas in the Sexual Rehabilitation Framework (SRF) include:
- Sexual drive/interest
- Sexual functioning
- Fertility and contraception
- Factors associated with Spinal Cord Injury that may affect sexual function (e.g., spasticity, pain, autonomic dysreflexia, medication side effects)
- Motor and Sensory function
- Bladder and Bowel function
- Sexual self-view and self-esteem
- Partnership issues
Relevant medical (e.g., low testosterone in persons assigned male at birth), surgical, psychological, and relationship status information should also be obtained at assessment, as well as any sexual issues prior to SCI (Elliott et al. 2017). Using the SRF highlights the values of including different disciplines in sexual and fertility rehabilitation, ensuring that sexual health rehabilitation is touched on and followed through (Elliott et al. 2017). All individuals, including people with SCI, should have sexual health care examinations, including genital/prostate examination for men, and genital/pelvic examination, pap smears, mammograms, and menstrual function assessment for women. Accessing routine screening assessments relevant to age, body parts and history/risk factors is important, yet accessibility issues can make these tests seem daunting for persons with SCI.
There is no one measurement tool that can assess the multitude of complex issues of sexual health, function, and satisfaction after SCI (Abramson et al. 2008). For an assessment to be comprehensive, neurological bases for sexual health dysfunction are necessary. For a list of Outcome Measures validated for SCI in Sexual Health, please visit the Outcome Measures page on SCIRE.
Regarding sexual function and SCI, three of the most important developments include:
1) The International Standards of Neurological Classification of Spinal Cord Injury (ISNCSCI) is a comprehensive assessment of motor function and sensation (via light touch/pinprick) following SCI. The ISNCSCI can provide estimation of sexual functioning based on an individual’s level of injury and completeness. Of particular importance to sexual functioning include:
- Sacral Sensation (S4-S5): sensation at these vertebral levels is a strong indicator of the potential for reflexogenic (physical) arousal and orgasm.
- T11-L2 Dermatomes: sensation at these points indicate potential for psychogenic (mental/visual) arousal.
- S2-S5 Dermatomes: an intact sacral arc is a strong indicator for reflexogenic arousal and orgasm (Alexander et al. 2017; Hess & Hough 2012).
2) The International Standards to Document of Remaining Autonomic Function after SCI (ISAFSCI) (Krassioukov et al. 2012) was designed to describe the diagnosis (supraconal, conal or cauda equina) of the spinal cord lesion and impact of the injury on the components of autonomic nervous system, including sexual function. The patient’s ability to experience arousal, orgasm, ejaculation (male) or sensation of menses (female) are rated on a scale of 0 (no function), 1 (impaired function) or 2 (normal). After assessment, if the patient is not experiencing sexual function that is unaffected by their injury, a clinician should consider other factors that could be further interfering (e.g., medication or spasticity).
3) The International SCI Data Sets on Male Sexual Function and Female Sexual and Reproductive Function are a standard for data collection and clinical intake that is valid internationally. Both data sets are measures and indicators that clinicians and researchers would need regarding SCI and Sexual Health. Complete instructions for data collection, data sheet, and training cases are available at the ISCoS page.
In regards to sexual and relationship satisfaction and body self-esteem, a few tools have been validated in persons with SCI, however, they are all dated, have limited clinical usefulness and/or are hetero-centric in design. The Physical Disability Sexual and Body Esteem (PDSBE) scale (Taleporos & McCabe, 2002) was shown to have high reliability and good convergent and divergent validity and has been applied in the population of persons with SCI. The author concluded that sexual and body esteem are useful constructs in evaluating the impact of spinal cord injury on sexuality (New, 2019).
