Sexual Function after Spinal Cord Injury: Innervation, Assessment, and Treatment

Steadman, Casey J.; Hubscher, Charles H.

doi:10.1007/s11930-016-0067-0

Cited by 13 publications

(18 citation statements)

References 137 publications

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“…Until recently, rehabilitation strategies have most commonly focused on recovery of mobility 2,3 . Following SCI, patients rank bladder/urinary, bowel, and sexual functions among the highest quality of life complications in need of better management 1,4,5 . Therefore, targeting bladder, bowel, and sexual function is of utmost importance from a rehabilitation standpoint 1,4,5 .…”

Section: Introductionmentioning

confidence: 99%

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Gumbel

Steadman

Hoey

et al. 2019

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Spinal cord injury (SCI) results in lasting deficits that include both mobility and a multitude of autonomic-related dysfunctions. Locomotor training (LT) on a treadmill is widely used as a rehabilitation tool in the SCI population with many benefits and improvements to daily life. We utilize this method of activity-based task-specific training (ABT) in rodents after SCI to both elucidate the mechanisms behind such improvements and to enhance and improve upon existing clinical rehabilitation protocols. Our current goal is to determine the mechanisms underlying ABTinduced improvements in urinary, bowel, and sexual function in SCI rats after a moderate to severe level of contusion. After securing each individual animal in a custom-made adjustable vest, they are secured to a versatile body weight support mechanism, lowered to a modified three-lane treadmill and assisted in step-training for 58 minutes, once a day for 10 weeks. This setup allows for the training of both quadrupedal and forelimb-only animals, alongside two different non-trained groups. Quadrupedal-trained animals with body weight support are aided by a technician present to assist in stepping with proper hind limb placement as necessary, while forelimb-only trained animals are raised at the caudal end to ensure no hind limb contact with the treadmill and no weight-bearing. One non-trained SCI group of animals is placed in a harness and rests next to the treadmill, while the other control SCI group remains in its home cage in the training room nearby. This paradigm allows for the training of multiple SCI animals at once, thus making it more time-efficient in addition to ensuring that our pre-clinical animal model mimics the clinical representation as close as possible, particularly with respect to the body weight support with manual assistance.

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Section: Introductionmentioning

confidence: 99%

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Gumbel

Steadman

Hoey

et al. 2019

JoVE

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“…Activation of the DNP, sensory afferents necessary for erectile and ejaculatory reflexes [23,167,197,198], causes rhythmic bursting of the BSM as seen during ejaculation in both human and rat [199][200][201]. BSM response to stimulation of the DNP is difficult to induce in a spinally intact rat, though as with PDFR it is easily elicited in a transected animal [199,202].…”

Section: Discussionmentioning

confidence: 99%

“…In summary, sexual dysfunction after SCI remains a top priority to SCI individuals, while remaining one of the least studied areas of post-SCI animal research. The current state of the field is partially due to a lack of outcome measures and assessment tools geared towards sexual dysfunction after SCI [167].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, where such response may be due to genital stimulation (reflexive erection) or mental arousal (psychogenic erection) [10,11]. The ability of such erections is dependent upon the level of the spinal lesion, where reflexive erections require an intact sacral cord, and psychogenic erections require an intact thoracolumbar sympathetic pathway [10][11][12]167]. Though such erections may be elicited, men with SCI report that they are short-lived and lack the rigidity required for penetration [8].…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, as men are over 80% of the SCI population [21], this study further narrows the focus onto sexual dysfunctions of the SCI male population. However, it should be noted that women with SCI rate sexual dysfunction with similar priority to men [21], and the field of female sexual dysfunction after SCI has received even less attention by the scientific community [167,228]. Future studies in both animal and human models regarding sexual function after SCI should share focus with female physiology and intervention.…”

Section: Discussionmentioning

confidence: 99%

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The effect of spinal cord injury on sexual function.

Steadman¹

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Spinal cord injury (SCI) causes severe neurological impairment with widespread motor, autonomic and sensory deficits, leading to a substantial quality of life impairment. The number of individuals with SCI increases by approximately 12,500 annually, and over 80% of individuals with SCI are males. SCI individuals rate sexual function as a top priority quality of life issue, and men with SCI likely suffer from sexual dysfunction, such as erectile and ejaculatory dysfunction, as well as infertility. Regardless of the high status of importance of sexual function, limited numbers of experimental studies in SCI animal models have focused on sexual function after SCI. Interestingly, human clinical research participants with SCI undergoing daily locomotor treadmill training have reported changes in sexual function. To advance targeted recovery of sexual function after SCI, a better understanding of the post-injury neural circuitry is necessary. The objective of this project was to determine the effect of activity-based training (ABT) on sexual function in a rat model of SCI and examine the effects of a contusion SCI on sexual function using improved quantifiable measures. Two wellestablished measures of sexual function were used to determine the effects of ABT on sexual function after SCI: the penile dorsiflexion reflex (PDFR) and vi bulbospongiosus electromyography. The second and third studies focused on determining the effect of a clinically relevant contusion injury of varying severities using kinematic analysis of the PDFR and real-time intracavernosal pressure recordings from the penis of rats undergoing mating behavior testing. ABT was shown to positively affect sexual function after SCI, where taskspecific stepping and/or hindlimb loading impacts the local spinal cord circuitry responsible for sexual function. ABT may strengthen the residual fibers crossing the lesion epicenter, providing better coordination of supraspinal influences on the spinal cord sexual circuitry. Sexual function after SCI was determined to be correlated with the percent of white matter spared (a measure of injury severity), further supporting the disruption of spinobulbospinal coordination as the cause of sexual dysfunction after SCI. Kinematic analysis of the penile dorsiflexion reflex and telemetric recording of intracavernosal pressure may provide improved quantifiable measures for examining sexual function after SCI.

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Sexuality Support After Spinal Cord Injury: What is Provided in Australian Practice Settings?

2022

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This study sought to understand what sexuality support Australian health professionals currently provide to people with spinal cord injury (SCI) and their perspectives on what changes may better support the sexuality needs of people with SCI. Australian Health professionals who had worked with people with SCI within the last 10 years were invited to participate in an online survey. Results were analyzed using content analysis and descriptive statistics. The 39 participants were from a range of health professions including medical, allied health, nursing, and peer support. Participants worked in various service settings, with the highest frequency in the community (33%) or inpatient rehabilitation (28%). Analysis indicated 85% of participants had provided sexuality support, however this provision was rarely routine. Discussing sexuality education topics were reported to be routinely provided for less than 16% of participants. Overall, 32% of participants felt sexuality was addressed ‘not well at all’ in their workplace. Qualitative analysis of open-ended responses produced five themes: barriers to supporting sexuality, health professionals require training, utilizing a team approach, responsibility to initiate conversation, and involving others in support. Barriers to provision included stigma and lack of education. Commonly suggested strategies to improve practice included: increasing sexuality training, utilizing a team approach, initiating the conversation of sexuality early, and consensual inclusion of significant others in sexuality support. The results therefore indicate sexuality support is not routinely provided to people with SCI and findings suggest a need for sexuality training, utilizing a team approach, initiating the conversation, and including significant others.

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Sexual Function after Spinal Cord Injury: Innervation, Assessment, and Treatment

Cited by 13 publications

References 137 publications

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

Activity-based Training on a Treadmill with Spinal Cord Injured Wistar Rats

The effect of spinal cord injury on sexual function.

Sexuality Support After Spinal Cord Injury: What is Provided in Australian Practice Settings?

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