Gynecological Health
Gynecological health is important following SCI. Women with physical disabilities including SCI, have fewer pap smears, mammography exams, and sexual health education (Akhavan Amjadi et al. 2021). The initial shock of SCI impacts menstruation and the menstrual cycle causing amenorrhea, a period of time where there is an absence of menstruation (Charls et al. 2022; Kriplani et al. 2017). After the acute period of spinal cord injury, most women with SCI have their periods return in an average time of 6 months (Spinalcord.com, 2020).
Discussion
Amenorrhea may occur immediately following injury, lasting 4-5 months on average (Jackson & Wadley 1999; Axel 1982). Charls et al. (2022) found that amenorrhea occurred in 77.5% and 22.5% of individuals continued with regular menstrual cycles. It is commonly believed that despite this initial delay in menstruation following traumatic SCI, fertility in women is unaffected. However, as DeForge et al. (2005) point out, there are no controlled studies comparing fertility rates with non-SCI cohorts and thus, there may be unknown effects of SCI on the rate of miscarriages and live births in couples trying to conceive. Jackson and Wadley (1999) found 70.3% of sexually active women use some form of contraception after injury and that fewer women used the birth control pill compared to before the injury.
There are conflicting reports on the occurrence of dysmenorrhea post-injury. Jackson and Wadley (1999) and Comarr et al. (1966) found a decrease and absence, respectively, whereas Axel et al. (1982) found most women had no change in menstrual discomfort. There was slight reduction in the duration of menstrual bleeding (4.88 to 4.28 days; p<0.001), dysmenorrhea decreased (67.5% to 10% of participants; p<0.001), and menstrual flow decreased slightly following SCI (p=0.041) (Charls et al. 2022).
Other gynecological problems reported by women with SCI include an increase in the incidence of UTIs and vaginal yeast infections (Jackson & Wadley 1999). One qualitative study found a common pattern of diarrhea frequently occurring in conjunction with menstruation, leading to bowel accidents during transfers, and in turn to bladder and vaginal infections (Pentland et al. 2002).
In terms of health promotion behaviour of women with SCI, women were found to be less likely to have routine mammograms, sex education, and annual Papanicolaou smears (Anmjadi et al. 2021) than women without disabilities; however, they had a similar practice of breast self-exam (Jackson & Wadley 1999). Inadequate knowledge of women with SCI regarding health care risks and health care needs, reliance on caregivers to facilitate preventative health practices and perceived access to competent health care providers were the main identified factors that had an impact on preventative health practices among these women (Persaud 2000).
Conclusion
There is level 5 evidence (Jackson & Wadley 1999) that women with SCI report an increase in the incidence of UTIs and vaginal yeast infections.
There is level 5 evidence (Anmjadi et al. 2021) that women with SCI were less likely to have routine mammograms, sex education and annual pap smears than women without disabilities.
There is level 5 evidence (Persaud 2000) that inadequate knowledge of women with SCI and their health care risks, needs, and access were main factors that had an impact on preventative health practices.
There is level 5 evidence (Charls et al. 2022) that duration of menstrual bleeding, dysmenorrhea, and menstrual flow reduces but cycle length stays the same.
