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Sexual and Reproductive Health

Gynecological Health

Author, Year; Country
Score
Research Design
Total Sample Size
Methods Outcome
Cramp et al. 2014; Canada
Observational Study
Level 5
N=7
Population: 7 women (age range= 24-61
years); AIS A-D, level of injury C5-L3.
Methodology: Each participant completed an
in-depth interview (average 85mins).
Outcome Measures: 13 themes regarding
sexuality, 10 themes regarding urinary
incontinence (UI) on sexuality.
  1. Themes regarding sexuality: fear of rejection, fear that their partners would leave them for able bodied women, fear of being hurt, disappointment to assume a more passive role during sex due to loss of mobility, more planning required, need to “fake orgasm” to please their partners.
  2. Themes regarding the impact of urinary incontinence on sexuality: fear UI during sexual activity, fear of darker/odorous urine during bladder infection, preparations involving a pee pad, causes some women to withdraw from sexual activities.
  3. Intimacy and the sexual experience were negatively affected by UI as a result of SCI, and by an excessive concern about autonomic dysreflexia.

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 (1982) found the majority of women had no change in menstrual discomfort. Other gynecological problems reported by women with SCI include an increase in the incidence of urinary tract infections 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 and annual Papanicolaou smears (Nosek 1996Jackson & Wadley 1999Lavela et al. 2006) 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).

Amenorrhea may occur immediately following injury, lasting 4-5 months on average (Jackson & Wadley 1999Axel 1982). 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.

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