Sexual health is not restricted to the mere physical -- genital function. Sexuality comprises different facets. At the basic, instinctual level, it is the feeling of maleness or femaleness; and, how this sexuality and personality impacts and is impacted by society. (Sipski, Alexander, & Rosen, 1996) Finally, it includes such things as the right to be a sexual person following neurological injury, the opportunity to have knowledge about sexual changes and to make informed choices about appropriate options. This work involves a review of the literature associated with female sexuality following injury to the spinal cord.
Before delving into the sexual ramifications, it bears recognizing the anatomical and functional features of the Spinal Cord. The spinal cord enables the brain to communicate with every physical facets of the body -- independent action, and reaction to stimuli. When a spinal cord injury occurs, this communication between the central and afferent nervous system may be severed, resulting in a loss of function. Spinal cord injuries (SCI) occur when a traumatic event damages cells within the spinal cord. (Sipski & Alexander, 1997) The trauma may also independently (or as a consequence) sever the neuronal processes that relay signals to and from, and up and down, the spinal cord. The most common types of SCI include contusions (bruising) and compressions (pressure). Other types of injuries include nerve fiber lacerations, and central cord syndrome (damage to the cortico-spinal tracts of the cervical region of the spinal cord). Severe SCI often causes paralysis (loss of control over voluntary movement and muscles of the body) and loss of sensation and reflex function below the point of injury, including involuntary activities like breathing and bowel and bladder control. Occasionally, pain or sensitivity to stimuli, muscle spasms, and sexual dysfunction develop over time. SCI patients are also prone to develop secondary medical problems, such as bladder infections, lung infections, and bedsores.
Damage to the spinal cord due to an injury can be permanent and currently there is no cure. New research proves that spinal cord repair and regeneration is possible. More and more researchers around the world are confident that a cure for paralysis could be as close as ten years away. (Ducharme & Gill, 1997)
There two common manifestations of SCI: Paraplegia and Quadriplegia. Paraplegia is the loss of sensation and movement in legs and the trunk (or a part of it). Paraplegia results from an injury to the spinal cord below the neck. Quadriplegia (also called Tetraplegia) is the paralysis of all four limbs (from the neck down) resulting from injury to the neck. Fractures or compression of the vertebrae, which cause permanent damage to the spinal cord, may lead to loss of sensation, movement, pain management, bladder and bowel control, and sexual function. The most common causes of spinal cord injury are car and other motor vehicle collisions (54.7%), falls (17.7%), and other medical conditions and sports injuries (27.6%). SCI are caused by sudden impact that results in crushing the spine and the cord. (CureParalysis.org, 1997)
In the event of a complete spinal cord injury, for both men and women there is loss of genital sensation resulting from stimulation. Despite the physical problems, erotic sexual feelings continue to exist. Many people shift their source of eroticism so that the brain receives sexual signals from parts of the body other than the genitals. The brain learns to react sexually to pleasurable touching in other areas of the body. For example, the ear lobes and the back of the neck can be erogenous areas. This experience will be different than before but can be as fulfilling. In others the feelings in these newly discovered erogenous zones are less intense or more diffuse. For women, spinal cord injuries can affect vaginal lubrication. Women lubricate variably -- from physical stimulation or sexual thoughts. If vaginal lubrication is unsatisfactory, then a water-soluble lubricant can be recommended. Sildenafil may be of value in women with SCI by increasing blood flow to the perineum and increasing vaginal lubrication. (Crenshaw & Goldberg, 1996)
In the case of incomplete injuries, a clear picture is difficult to form. Factors such as location of the injury and the amount of sensation and motor functioning can be important in predicting changes to sexual response. A general indication of possible normal sexual function is the ability to control bladder and bowel movement.
Lesions of the spinal cord that result in paralysis of certain areas of the body, along with the corresponding loss of sensation. Complete injuries result in total loss of sensation and function below the injury level. Incomplete injuries result in partial loss. Complete injuries do not necessarily mean the severing of the cord. The cord, a continuation of the brain, is like a coaxial cable. It measures about one inch in diameter. From the spinal cord, nerves extend out to the muscles, skin and bones to control movement, receive sensations and regulate bodily excretions and secretions. (Barker, Barasi, & Neal, 2003)
The ligaments link and support the bones. The spinal cord, like the brain, is surrounded by the meninges, which are layers of tissue that have some fluid between them and protect the spine. There are main components of the spinal cord: The cervical spine consists of seven vertebrae. Joints in this region allow the head to move on the neck and turn sideways, nod and tilt. The cervical spine is the most mobile region of the spine, which is why the majority of spinal injuries occur in the neck. The thoracic spine has twelve vertebrae. These bones form the spine for the chest and upper abdomen and each one has a pair of ribs attached. Larger and stronger, thoracic vertebrae carry more weight. The rib cage region means that the thoracic spine is much less mobile than the cervical spine. Five lumbar vertebrae form the lumbar spine. The lumbar region takes the most weight. Hence these vertebrae are the biggest and strongest bones.
The sacrum is shaped like a triangle, and is five vertebrae fused into a single bone. The sacrum is the rear part of the pelvis. The coccyx (tailbone) is also triangular in shape. The final four vertebrae are fused into one.
Fractures can occur to almost any vertebra. Simple fractures are breaks that are commonly only a chip, or a crack in the bone. Simple fractures do not usually require treatment. They are stable and will not potentially injure the spinal cord. In wedge or compression fractures, the spine is compressed. The front part of the bone is compressed but the rear part stays intact forming the wedge. These injuries often need an operation and no treatment other than pain relief and rest is needed. Burst fractures result from a vertical shearing force. The bones are overloaded and one or more vertebral bodies bursts open. These fractures are not stable and require treatment.
The largest problem with cervical spine injury is damage to the spinal cord. The closer the injury to the brain, the greater the consequences of spinal injury. An injury to the spinal cord at the top of the cervical spine is likely to be fatal. These nerves control breathing. Injury at C4 results in breathing difficulties and quadriplegia. If the spinal cord at C5 is injured, the patient has partial shoulder and elbow movement, but is otherwise paralyzed. The patient with cord damage at C6 will be able to use shoulders and elbows and have partial wrist movement but no use of their hands and their legs. Injury at C7 allows shoulder, elbow, wrist and some hand movement.
Damage at T1 (thoracic spine) will affect hand movements as well but injury lower down will result in paraplegia. The lower the injury the more sensation around the torso will be retained.
The spinal cord ends at the level of L1 or L2. Cord injury with paraplegia can still occur at L1 or L2 but below this level there is more room in the spinal canal for the nerves. Nerve injury is therefore rare and isolated to individual or small groups of nerves. This can still be severely debilitating. (Vaccaro, 2003)
Injuries to the sacrum and coccyx are rare. The sacrum forms the rear of the pelvis and is therefore well protected. In pelvic trauma, the sacrum may become dislocated from the bones it is joined to but is rarely broken. Injuries to the coccyx bone are almost exclusively a result of falling directly onto the buttocks, or as a result of giving birth.
There are different treatment modalities (despite the fact that spinal cord problems are difficult to heal): The most common investigation for suspected spinal injury is X-ray. While x-rays do not show cord injury, they do indicate any bony damage. CT (Computerized Tomography) Scans are used to support and give further detail to the x-ray findings, assisting diagnosis and treatment plans. Magnetic Resonance Imaging (MRI) Scans are another form of scanning that provides doctors with additional information the injury has had on the spinal cord. Hard collars are used…
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