Sexual and Reproductive Health

Sexual Behaviour

Author Year; Country
Dates included in the
review
Total sample size
Level of evidence
Type of study
Score		 Methods
Databases		 Outcomes
Cramp et al. 2014; Canada
Systematic Review
AMSTAR=
N=40		 Methods: The first search used the following
search terms ‘‘spinal cord injury, women, and
sexuality”. Articles were included if they were
published in 1990 or more recently, had a
term related to sexuality or sexual function in
the title, were written in English, and were
available in full text. Forty articles were
accepted and are included in this review.
Databases: PubMed
  1. A woman’s relationships, sexual desires, frequency of participation in sexual activities, the types of sexual activities she participates in, stimulation and arousal, orgasm and sexual satisfaction, as well as psychological influences on image and esteem have all been shown to be affected by SCI
  2. Spinal cord injury and its related consequences have a greater effect on the marital status of women than men and the marriage rate is considerably lower for women with SCI than for men with SCI.
  3. Women’s sexual desire and the frequency of sexual activity has been found to decrease after SCI
  4. The ability for a woman with SCI to become sexually aroused and to experience orgasm seems to occur less frequently after injury, but also seems to depend on the lesion level and completeness and on the type of stimulation that is used to induce the response.
  5. Women with SCI will typically experience a decrease in sexual satisfaction after injury.
  6. Having an active and satisfying sexual life after injury is associated with improved quality of life.
  7. After SCI, two types of neurogenic bladder exist, those being overactive and hypotonic bladders
  1. Fisher et al. (2002) showed a significant increase in sexual activity between discharge from inpatient rehabilitation and 6-months later, while no further changes were found in the remaining 18 month followup and they suggested that the first 6 months post-discharge are optimal for sexual health interventions.
  2. For women with SCI, psychological barriers to engaging in sexual activity include: feeling unattractive, low self-esteem, low sexual desire, lack of confidence in sexual ability and ability to satisfy a partner, and difficulty meeting a partner (Julia & Othman 2011; Kreuter et al. 2011; Kreuter et al. 2008).
  3. Physical problems women with SCI cite as barriers to sexual activity include: impaired genital sensation, difficulty with positioning oneself, bowel and bladder problems, and vaginal lubrication (Julia & Othman 2011; Kreuter et al. 2011).
  4. For women, longer duration of injury and lower level of injury (not extent of injury) were significant positive predictors of participation in sexual intercourse (Jackson & Wadley 1999).
  5. For men, level and extent of injury have not been found to affect frequency of sexual activity (Alexander et al. 1993).
  6. The preferred type of sexual activity for men and women changes after injury. Preferred activities for women are kissing, hugging and touching, instead of penile-vaginal intercourse (Sipski & Alexander 1993) and for men, oral sex, kissing and hugging (Alexander et al. 1993).
  7. Males reported engaging in masturbation significantly more often than females whereas females indicated being involved in intimate touching more often than males (Mona et al. 2000).
  8. Males with SCI used condoms during penile-vaginal intercourse more often than females with SCI with their male partners. More females with SCI used condoms during oral sex behaviour with their partners compared to males with SCI (Mona et al. 2000).
  9. Both women and men remain interested in sexual activity after SCI, but level of desire decreases (Charlifue et al. 1992; Alexander et al. 1993; Julia & Othman 2011).
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