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Sexual and Reproductive Health

Sexual and Reproductive Health in Women

For many years the sexual and reproductive health of women with SCI was not studied. Although few intervention trials exist on this topic, there are observational studies of clinical importance, which provide information as well as serve to highlight the major sexual and reproductive health issues that exist for women with SCI.

Author Year; Country
Dates included in the
review
Total sample size
Level of evidence
Type of study
Score
Methods
Databases
Outcomes

Ghidini & Simonson 2011; USA
Reviewed published articles from 1990 to 2010
N=13
Level of evidence
methodological quality not
assessed
Type of studies
Case control (n=1), Case series (n=12)
AMSTAR=3

Method: Literature search for peer-reviewed original articles published in English
concerning pregnancy in women with SCI;
references selected based on relevance to
effects of pregnancy on SCI and the outcome
of pregnancy in women with SCI.
Databases: PubMed, MEDLINE, The
Cochrane Library.
  1. Worsened spasticity, autonomic dysreflexia, urinary tract infections, and thrombosis are reported more often than expected during pregnancy in women with SCI.
  2. SCI increases the risk of obstetric complications such as preterm delivery, low birth weight, and rates of admission to the neonatal intensive care unit.
  3. The only case-control study on the subject found that women who became pregnant after SCI had nearly double the rates of preterm delivery as those who became pregnant before SCI.
  4. The rate of Caesarean sections and the incidence of post-partum depression are higher among with SCI than expected in the general obstetric population.
Pannek and Bertschy
2011; Switzerland
Reviewed published
articles from PubMed and Medline with no date restrictions
N=14
Level of evidence
Assessed using the Oxford
Center of Evidence-Based
Medicine criteria
Type of studies
1 prospective cohort,
9 retrospective case
series, 4 case reports
AMSTAR=3
Method: Searched for studies published in English or German on the urologic
management of pregnant women with SCI.
Databases: Medline and PubMed
  1. SCI was cervical in 34.7%, thoracic in 61.2% and lumbar in 4.1% of the pregnant women.
  2. 34.7% used indwelling catheters, 25% performed intermittent catheterization, 11.5% used the Credé maneuver and 28.8% voided spontaneously.
  3. Urinary tract infections (UTIs) were more common in women with indwelling catheters (100%) than in those performing intermittent catheterization (38.5%), using the Credé technique (17%) or voiding spontaneously (53.3%).
  4. A total of 64% of the patients had at least one symptomatic UTI during pregnancy.
  5. A single study with 66 patients, of which 40% had an indwelling catheter, reported leakage around the catheter in 15% of patients, bladder spasms being so significant that catheters were expelled in 9.1% and there was a necessity to change the mode of bladder management in 25%.
Lombardi et al. 2010;
Italy
Reviewed published
articles from 1993 to 2009
N=not stated
Level of evidence
Methodological quality not assessed
Type of studies
Not described
AMSTAR=1
Method: Searched for internationally
published studies from the PubMed database
with keywords related to female SCI sexual
function. Searches were also done with
oneco-morbidity or one behaviour risk factor
together with SCI female or female sexual
dysfunction.
Databases: PubMed
  1. Females with complete tetraplegia require special attention immediately at initial recovery as sexual intercourse is much more difficult for them compared with other women with SCI mainly because of autonomic dysreflexia and urinary incontinence.
  2. Sexual satisfaction increases as duration of injury increases. The likelihood of a woman with SCI taking part in a sexual relationship also increases as duration of injury increases.
  3. 40-80% of women continued to be sexually active after injury, but much less so than before injury. The ability to reach orgasm decreased significantly after injury.
  4. One paper reported that sildenafil has no significant benefit on sexuality.
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