Sexual Satisfaction
- Sexual satisfaction is reportedly lower in both men and women after SCI (Alexander et al. 1993; Fisher et al. 2002; Reitz et al. 2004; Kennedy et al. 2006; Sharma et al. 2006; Mendes et al. 2008).
- In an exploratory study of comparing African-American men and women with SCI, authors found that the women reported greater satisfaction with their sex lives than the men (Krause et al. 2004).
- A comparison study of women with and without SCI, found that married women with SCI are as sexually satisfied as their able-bodied counterparts (Black et al. 1998).
- In a study involving South Asian women with SCI, the women reported lack of sexual satisfaction more often than the men (Sharma et al. 2006). Conversely, in a survey study of Italian men and women with SCI, men reported significantly lesser satisfaction with sexual life post-injury than women (Sale et al. 2012).
- Moreno et al. (1995) included sexual parameters in their report of outcome of continent urinary diversion with a catheterizable umbilical stoma in women with tetraplegia (n=3). They found that sexual satisfaction improved in the 2 women who were sexually active and body image improved in all 3 women
| Author Year; Country Dates included in the review Total sample size Level of evidence Type of study Score |
Methods Databases |
Outcomes |
|---|---|---|
| Sunilkumar et al. 2015; India Systematic Review AMSTAR= N=19 |
Methods: Search key words and phrases: SCI and sexuality, paraplegia and sexuality, paraplegia and sexual functioning, Indian males and SCI, Indian males and paraplegia and sexual attitudes, and males and SCI and sexual functioning. Inclusion criteria included: English language, Indian male population with sexuality issues, all age groups history of a SCI with resultant paraplegia. The search yielded 457 articles but only 19 were specifically related to male views on sexuality. Databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Applied Social Sciences Index and Abstracts (ASSIA), and Google Scholar. |
|
| Author Year; Country Score Research Design Total Sample Size |
Methods | Outcome |
|---|---|---|
| Cobo Cuenca et al. 2014; Spain Case Control Level 3 N=165 (85 SCI) |
Population: 165 men with sexual dysfunction SD: Group A 85 with SCI (mean age= 35.61±8.13 years) and Group B 80 without SCI (mean age=46.31±10.69 years); duration of lesion 26.45±8.72 years; neurological level of injury 16 cervical, 46 thoracic, and 23 lumbar; 59 AIS A and 26 AIS B/C/D. Treatment: None Outcome Measures: The Sexual Health Evaluation Scale, the Fugl-Meyer Life Satisfaction Questionnaire scale (LISAT8), the Hospital Anxiety and Depression Scale, the Evaluation of the Sexual Health Scale, and the Rosenberg’s Self-esteem Scale. |
|
| Miranda et al. 2016; Brazil Cross-sectional Study Level 5 N=295 |
Population: 295 men (mean age 40.7±14.5 years) with SCI for more than 1 year (median time since SCI= 3.6 years; range= 1.6-7.0 years). Treatment: None Outcome Measures: Performance in various domains of sexual function was evaluated using the Male Sexual Quotient (MSQ) questionnaire and Sexual Health Inventory for Men (SHIM) questionnaires. |
|
| Sunilkumar et al. 2015; India Qualitative Study Level 5 N=7 |
Population: 7 men living with SCI/paraplegia Treatment: None Outcome Measures: Semi-structured and open-ended interviews regarding participant perspective of living with SCI in India. |
|
| Otero-Villaverde et al. 2015; Spain Observational Study Level 5 N=32 |
Population: 32 women (mean age=29.8 years, range 13.9-59 years); most common cause of SCI trauma (72%); degree of disability 44% AIS A, 19% AIS B, 9% AIS C, and 28% AIS D Treatment: None. Outcome Measures: Spinal Cord Independence Measure (SCIM) version III. |
|
| Pakpour et al. 2016; Iran Cross-sectional study Level 5 N= 93 |
Population: 93 men with SCI (mean age=37.8 years, age range=19-63 years, mean post-injury time=4.6 years). Treatment: None Outcome Measures: Levels of anxiety and depressive mood were assessed using the Hospital Anxiety and Depression Scale. Religious coping strategies were measured using the 14-Items Brief Coping Questionnaire. Erectile function was measured using the International Index of Erectile Function (IIEF). |
|
| Akman et al. 2015; Turkey Observational Study Level 5 N=47 |
Population: 47 men with spinal cord injuries (age range = 20-62 years, mean age = 35.2 years, mean time since injury=6.3±4.0 years) who were out of the spinal shock period and had their injury for more than 6 months. Treatment: None Outcome Measures: Social status, sexual activities, abilities, sexual education after injury, and erectile function evaluated by the International Index of Erectile Function-5 (IIEF-5) questionnaire. |
|
| Issues perceived to affect sexual satisfaction and/or sexual activity |
Positive or Negative Impact |
Reported in men/women or both |
Studies supporting |
|---|---|---|---|
| Age (<18 years or >30 years old) | (-) | Women | Kreuter et al. 1994; Westgren et al. 1997; Ferreiro-Velasco et al. 2005 |
| Time since injury | (+) | Both, Men | Black et al. 1998; Tepper et al. 2001; Anderson et al. 2007; Lombardi et al. 2008; Pakpour et al. 2016; Choi et al. 2015 |
| Severity of injury | (-) | Both, Men | Mona et al. 2000; Anderson et al. 2007; Kreuter et al. 2008; Sale et al. 2012; Pakpour et al. 2016 |
| Bladder management problems (incontinence/UTI’s) |
(-) | Both, Women | White et al. 1993; Richards et al. 1997; Jackson & Wadley 1999; Benevento & Sipski 2002; Blok & Holstege 1999; Anderson et al. 2007; Kreuter et al. 2008; BieringSorensen et al. 2012; Sale et al. 2012; Moreno et al. 1995; Bozan et al. 2015; Otero-Villaverde et al. 2015 |
| Spasticity | (-) | Both, Women | Jackson & Wadley 1999; Anderson et al. 2007; BieringSorensen et al. 2012, OteroVillaverde et al. 201 |
| Fecal incontinence | (-) | Both, Women | Charlifue et al. 1992; White et al. 1993; Richards et al. 1997; Kreuter et al. 2008; BieringSorensen et al. 2012; Bozan et al. 2015 |
| Autonomic dysreflexia/Blood Pressure | (-) | Women | Charlifue et al. 1992; Jackson & Wadley 1999; Anderson et al. 2007 |
| Pressure ulcers and pain | (-) | Both, Women | Biering-Sorensen et al. 2012; Otero-Villaverde et al. 2015 |
| Making a female partner pregnant | (+) | Men | Biering-Sorensen et al. 2012 |
| Altered body image | (-) | Both, Women | Bozan et al. 2015; Smith et al. 2015; Bailey et al. 2015; Merghati-Khoei et al. 2017; Richards et al. 1997; Elkland & Lawrie 2004; Reitz et al. 2004; Kreuter et al. 2008 |
| Altered genital sensation | (-) | Women, Men | Richards et al. 1997; Anderson et al. 2007; Kreuter et al. 2008, Miranda et al. 2016; OteroVillaverde et al. 2015; Akman et al. 2015 |
| Sexual desire | (+) | Both, Men | Phelps et al. 2001; Reitz et al. 2004; Miranda et al. 2016 |
| Lack of a partner | (-) | Women | Jackson & Wadley, 1999; Kreuter et al. 2008; Otero-Villaverde et al. 2015 |
| Quality of intimate relationship/relationship satisfaction |
(+) | Both/Men | Jackson & Wadley 1999; Phelps et al. 2001; Reitz et al. 2004, Lombardi et al. 2008; Smith et al. 2015 |
| Repertoire of sexual behaviour | (+) | Men, Women | Richards et al. 1997; Phelps et al. 2001 |
| Partner as caregiver | (-) | Women | Kreuter et al. 1996; Black et al. 1998; Pentland et al. 2002 |
| Perceived partner satisfaction | (+) | Men, Women | Phelps et al. 2001; Ekland & Lawie 2004; Miranda et al. 2016 |
| Partner’s understanding of sexual needs |
(+) | Kreuter et al. 1996 | |
| Level of social and vocational activity; outgoing personality; acceptance of the disability** |
(+) | Kreuter 2000 | |
| Inadequate vaginal lubrication | (-) | Women | Charlifue et al. 1992; Jackson & Wadley 1999; Anderson et al. 2007 |
| Ability to move | (+) | Both | Reitz et al. 2004; Anderson et al. 20à7; Kreuter et al. 2008; Bozan et al. 2015 |
| Mental well-being | (+) | Both, Men | Reitz et al. 2004; Kreuter et al. 2008, Smith et al. 2015, Pakpour et al. 2016 |
| Sexual education and counselling | (+) | Women, Men, Both | White et al. 1993; Westgren et al. 1997; Hess et al. 2007; Valtonen et al. 2006; New et al. 2016; Akman et al. 2015 |
| Peer support | (+) | Women, Both | Richards et al. 1997; Fisher et al. 2002; Pentland et al. 2002; Ekland & Lawrie 2004 |
| Sexual arousal | (-) | Men | Cardoso et al. 2008; Miranda et al. 2016 |
| Orgasm intensity | (-) | Men | Cardoso et al. 2008; Miranda et al. 2016 |
Discussion
Research shows that sexual function is important to people after SCI. A systematic review of 24 studies of health and life priorities for persons with SCI determined that motor function, bowel, bladder and sexual function emerged as the top four functional recovery priorities (Simpson et al. 2012). Two individual studies using community samples showed that the most common significant problem for people with SCI was sexual dysfunction (reported at 41% – New 2016; and 60.8% Park et al. 2016).
Despite the importance of sexual adjustment to overall quality of life, there have been few studies addressing this topic and few investigating the effectiveness of interventions on sexual satisfaction and adjustment to SCI. A number of studies have reported that the frequency of sexual activity and desire for sexual activity decreases after injury in both men and women (Julia & Othman 2011; Kreuter et al. 2011). The issues that are perceived to affect sexual satisfaction and/or sexual activity are multi-faceted. However, common barriers to sexual satisfaction from the effects of SCI include bladder and bowel problems, as well as other impairments resulting from the severity of injury (e.g., spasticity, lack of mobility) (Biering-Sorensen et al. 2012; Moreno et al. 1995; Anderson et al. 2007). Researchers suggest that improving sexual satisfaction, information and specific programs during rehabilitation can help women with SCI explore and investigate new erotic possibilities, thereby improving their self-esteem and social relationships (Otero-Villaverde et al. 2015).
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