Sexual Function and Intimacy after SCI

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The following course content

Introduction   

When hearing the phrase spinal cord injury, what comes to mind? If you’re a nurse, you’ve probably heard about spinal cord injuries (SCI) at some point in your nursing studies and career. In fact, you might have cared for SCI patients or will in the future. Presently, patients seek guidance and information on various health topics from nurses, including SCI and its influences on sexual function and intimacy.  

The information in this course will serve as a valuable resource for nurses of all specialties, education levels, and backgrounds to learn more about SCIs and how they can influence sexual function and intimacy. 

Defining Spinal Cord Injury (SCI) 

What Is SCI? How Common Is It? 

Spinal cord injuries (SCIs) are a medical emergency that often involves severe, sudden trauma to the spine. The spine consists of several major nerve endings, bones, discs, muscles, tissues, and cells essential for human function. SCIs can occur anytime and anywhere. SCIs tend to occur more in men and among people under 30 compared to women and people over 30. However, more research indicates that more women and older people are experiencing SCI.  

The exact prevalence of SCI is not known, as SCI can vary widely in reporting for care and causes of death. It is estimated that at least 250,000 people in the United States experience some form of SCI annually, with estimates varying depending on the extent of SCI and medical care received. Globally, SCIs affect millions of people and are considered a major cause of disability since SCIs are permanent, life-changing events. Because SCIs are a severe, life-altering event, it is important to recognize the causes and influences of this condition in healthcare settings (1,2,3).  

What Causes People to Experience SCI? 

Anyone who has a spine can experience a SCI. The majority of SCI cases in the United States occur among males and people between the ages of 16 and 30. Over a third of SCIs are caused by motor vehicle accidents (MVA). Other common causes for SCI include blunt force trauma, sports injuries, falls, violent assault, and medical complications. Preventing an SCI can be possible by avoiding MVAs and other violent instances. However, SCIs are still a possible reality for many people who drive, engage in intense physical activity, or undergo medical procedures (1,2,3). 

How and Where are SCIs Managed? 

SCIs are often initially managed in an emergency room setting, intensive care unit setting, or other emergent health care settings, given the emergent nature of SCIs. Because of the critical nature of SCIs, they are often prioritized in clinical care for management to avoid further complications to the patient. If SCIs are not properly managed, the patient could experience intense cardiac, respiratory, and neurological complications or immediate death.  

Once a patient is stabilized from their SCI assessment, then the patient can be referred to neurological care, outpatient care, inpatient rehabilitation services, or other similar services. Oftentimes, patients with SCIs are managed extensively in a hospital and then triaged to outpatient rehabilitation or neurological care depending on the extent of their SCI (1,2,3,4). 

What Are the Clinical Criterium for SCIs? 

Clinical criteria for SCI can vary widely. The most straightforward clinical criterium for a SCI is any patient who has experienced severe visible SCI, such as blunt force trauma or injury. SCIs often emerge from various neurological complications with nerve damage, muscle damage, bone damage, herniated discs, blood vessel damage, and more. Because of the various clinical presentations of SCIs and various locations for SCIs, such as in the thoracic or lumbar spine regions, clinical care and patient outcomes can vary SCI case by case. Various manifestations of SCIs include central cord syndrome, spinal shock, neurological shock, conus medullaris syndrome, posterior cord syndrome, Brown-Sequard syndrome, anterior cord syndrome, and complete spinal cord transection, each of which has unique clinical criterium (1,2,3,4).  

What Are Some Side Effects and Complications of SCI? 

SCIs, depending on their location, extent, and access to prompt medical treatment, often have severe life-changing complications for the patient. Patients with SCI will never experience the life they had prior, and many patients with SCI will have a life-long recovery journey. Several complications often emerge from SCIs, such as the inability to control bowel or urinary patterns, inability to walk independently, inability to digest food without medical intervention, hemostatic instability, temperature dysregulation, blood pressure complications, and more. Because of the several complications associated with immediate SCI care, oftentimes, many lifestyle and chronic needs are addressed in the outpatient or rehabilitation centers, making these places prime opportunities to discuss sexual function and intimacy concerns (1,2,3,4,5).  

What is the Average Cost for SCI Care? 

The cost of SCI care is often expensive and is not limited to initial emergency care. For several SCI patients, care often requires extensive surgeries after the initial SCI management, rehabilitation, physical therapy, occupational therapy, psychotherapy, medications, and more. 

Cost can significantly vary depending on the type of medications dispensed, surgeries performed, rehabilitation accessed, insurance, duration of treatment, and other factors. SCI is often an expensive chronic medical condition to manage, but for many patients, it is essential care and possibly the only way to live and function after experiencing an SCI.  

Cost is among a leading reason why many patients cannot maintain their access to care. If cost is a concern for your patient, consider reaching out to your local patient care teams to find cost-effective solutions for your patients (1,2,3,4).  

How Can Patients Self-Manage SCIs? 

Initially, it is often impossible to self-manage SCIs, as they need urgent medical care to receive proper management and assessment of nerve damage. That said, after the initial surgeries and rehabilitation, many people with SCIs can return to living at home and function at home with the aid of therapies and other medical interventions.  

Many patients will require the use of chronically taking medications in an outpatient setting, using mobility devices at home, using devices to use the bathroom, using remote monitoring for vital signs, and more. Even if a patient can self-manage their SCI, they often require several consultations with various specialists, such as neurologists, physical therapists, occupational therapists, home health nurses, social workers, and more. In addition, patients can self-monitor their urine output, stool patterns, hunger levels, and overall health to detect any early changes or possible additional SCI care plan complications (1,2,3).  

Defining Sexual Function and Intimacy 

Sexual health and intimacy are considered essential aspects of health care. Despite the World Health Organization (WHO) and several other organizations discussing the importance of sexual health, function, pleasure, and intimacy in healthcare settings, there is still much stigma in the world of healthcare on these topics.  

Sexual function, like other bodily functions, can be severely diminished and most likely permanently altered as a result of SCIs. Even though SCIs have existed for centuries, within the past few decades, more research has been devoted to the realities of SCI patients and their sexual desires, sexual health, sexual function, and intimacy priorities.  

To begin with, sexual health is the health of someone related to their sexual lives, such as screening and management of sexually transmitted infections (STIs), sexual pain, sexual discomfort, changes in libido, and more. Sexual function is often defined as the ability to engage in sex. Intimacy itself does not have to be sexual, as there are many ways to be intimate with someone, such as hugging, kissing, handholding, and enjoying physical time together. Nurses need to be aware of the realities of sexual function and intimacy for SCI patients, as stigma and social norms about SCI patients and their sexual care cannot afford to be dismissed further (1,5,6,7). 

Psychosocial Implications of SCI on Sexual Function and Intimacy 

When people think of someone who has experienced a SCI, they often imagine that person being permanently unable to move, unable to think, or unable to function on their own. In fact, with the rise of many technological advances, many SCI patients can move as a result of intensive rehabilitation, surgeries, therapies, and medical devices. Furthermore, just because someone has experienced an SCI does not mean that they do not think about sex, desire sex, or have sexual health concerns. For instance, several studies have indicated that many partners of SCI patients have to adjust from being a partner to caregiver and partner, which can influence sexual activity and intimacy.  

SCI patients also can struggle with bowel function, bladder function, temperature regulation, heart rate regulation, and more, especially in the first few months or years after experiencing an SCI (1,5,6,7,8). 

While it is important to make sure the patient has an appropriate heart rate and can go to the bathroom, many SCI patients have expressed a desire from their SCI care teams to discuss sexual function and intimacy as part of their rehabilitation and care. Several studies have examined the role of sexual health and wellness in SCI patients but also have noted that several SCI healthcare workers, including nurses, are not comfortable discussing sexual health concerns with their patients. Studies have shown healthcare workers’ reluctance to discuss sexual health care with SCI patients may be due to a lack of formalized training in the workplace or via their education, lack of time with the patient, lack of awareness, and personal discomfort.  

Even if a patient has experienced SCI, if they have a uterus, they can still get pregnant. Even if a patient has experienced an SCI, if they engage in sexual activity, they are at risk of STIs. Sexual pain and discomfort do not need to be the norm for patients recovering from SCI. That said, several nurses are at the forefront of sexual health education and change for SCI patients, especially as patients can live longer lives with the rise of more medical advances (1,4,5,6,7,8). 

Several issues can affect sexual function and intimacy for patients, such as a new body image, use of medications, reliance on medical devices, changes in workplace and family dynamics, and more. Adapting a new identity is part of recovery for SCI patients, and this psychosocial aspect of nursing care can be crucial for patient recovery.  

Role of Nurses in SCI Patient Care and Sexual Function Assessment and Education 

Often, for many SCI patients in recovery, rehabilitation, or outpatient settings, nurses are the primary healthcare workers assessing their vital signs, monitoring their medication administration, and asking about their quality of life. While there is no standardized guide for the nurse’s role in SCI patient care and sexual function assessment and education, nursing care does not exist in a vacuum.  

When assessing patient care, if you are not comfortable discussing sexual health concerns with an SCI patient, ask yourself why this topic is uncomfortable for you. In addition, possibly ask other staff if they are more comfortable with this topic, as it is okay to not be comfortable with every aspect of health care.  

The reality is, for several SCI patients, nurses are the go-to for health care services. From emergency room nurses, operating room nurses, spinal rehabilitation center nurses, and home health nurses, the nursing presence, language, and tone can truly influence the quality of patient care in several ways. When assessing an SCI patient for their caregiving support, social support, or pelvic care (including bladder and bowel functions), be sure to ask about vulvar health, penile health, testicular health, contraception, fertility concerns, and pelvic pain. You would be surprised as to how many patients want to discuss these topics, but are often afraid, embarrassed, or ashamed to do so (6,7,8,9).  

Female SCI Patient Considerations for Sexual Function and Intimacy 

Historically, SCI patients tend to be younger and men, and women’s sexual function has not been a priority in several aspects of health care. In fact, much evidence-based information on SCI sexual health has noted that, even in the world of SCI care, there are several gaps in education, awareness, and knowledge of female sexual function and intimacy concerns compared to male sexual function. While there are several devices to help with male ejaculation and erection post-SCI, unfortunately, there is very little evidence or data regarding the female orgasm, vulvar health, vaginal health, contraceptive needs, fertility, pregnancy, postpartum, pelvic pain and dysfunction, and more for women with SCI. Often, women are left to suffer, find answers outside of the health care setting, or accept pain as a part of SCI life. Yet, as science evolves, so does the inclusion of female SCI patient considerations (7,8,9,10,11,12,13,14,15,16,17,18).
 

Here are some general tips for consideration for female SCI patient needs and talking points regarding sexual function and intimacy:  

• Take a detailed history of the patient. SCI patient history can be scattered through many healthcare settings and documentation. Ask the patient to express themselves to the best of their ability regarding their health needs, including sexual health needs. Be willing to offer STI testing, education on contraception, and referrals to gynecological and urological care. Ask about the patient’s menstrual cycles prior to the SCI and how they are now after the SCI. Menstrual cycles can provide insight into neurologic function, thyroid function, ovarian function, brain function, and so many other critical aspects of SCI sexual function and intimacy.  

• Regarding sexual health in particular, provide time and space to do a thorough vulvar, vaginal, and pelvic exam. Pelvic exams can provide insight into urinary or bowel leakages, pelvic floor integrity, incontinence issues, pain sensations, and more. If this is not something you are comfortable with or not within your scope of work, ask whoever is in charge of this patient’s care to prioritize an exam of this sort. 

• Educate the patient about their ability to become pregnant and maintain a pregnancy since people with a uterus can still get pregnant if they engage in vaginal sex. Be willing to offer pregnancy tests and create a referral or talk with your team about possible prenatal care providers in the area who can manage a pregnant SCI patient or fertility specialists who can assist in fertility options.  

• Provide referrals for the patient regarding pelvic floor physical therapy, occupational therapy, psychotherapy, speech therapy, sex therapy, and more as applicable. Often, many people are not aware of various therapy options, so education is important. 

• As care continues, be willing to ask questions about vaginal dryness, vulvar pain, urinary pain, rectal pain, sexual health concerns, reproductive health concerns, and intimacy concerns, as these can be taboo for patients to bring up, but can present opportunities for patient education, awareness, management, and treatment. 

• When discussing sexual health, be sure to continuously use anatomically correct language instead of slang and be sure to assess patient comfort and willingness as you discuss sexual health and intimacy. 

Male SCI Patient Considerations for Sexual Function and Intimacy 

Historically, SCI patients tend to be younger and men, and male sexual function has been a priority in several aspects of health care. In fact, much evidence-based information on SCI sexual health has noted that, even in the world of SCI care, male sexual function is often seen as a priority compared to women’s sexual function. While there are several devices to help with male ejaculation and erection post-SCI, no intervention is 100% guaranteed to provide sexual wellness and satisfaction. Yet, as science evolves, so does the inclusion of sexual health concerns for male SCI patient considerations (7,8,9,10,11,12,13,14,15,16,18).
 

Here are some general tips for consideration for male SCI patient needs and talking points regarding sexual function and intimacy:  

• Take a detailed history of the patient. Oftentimes, SCI patient history can be scattered through many healthcare settings and documentation. Ask the patient to express themselves to the best of their ability regarding their health needs, including sexual health needs. Be willing to offer STI testing, education on condom use, and referrals to urological care. Ask about the patient’s ejaculations and sexual health before the SCI and how they are now after the SCI.  

• Regarding sexual health in particular, provide time and space to do a thorough testicular, penile, and pelvic exam. Pelvic exams can provide insight into urinary or bowel leakages, pelvic floor integrity, incontinence issues, pain sensations, and more. If this is not something you are comfortable with or not within your scope of work, ask whoever is in charge of this patient’s care to prioritize an exam of this sort. 

• Educate the patient about their ability to get someone pregnant. Be willing to discuss fertility options and create a referral or talk with your team about possible fertility care providers in the area who can manage a male SCI patient.  

• Provide referrals for the patient regarding pelvic floor physical therapy, occupational therapy, psychotherapy, speech therapy, sex therapy, and more as applicable. Often, many people are not aware of various therapy options, so education is important. 

• As care continues, be willing to ask questions about penile health, erectile dysfunction, pelvic pain, urinary pain, rectal pain, sexual health concerns, reproductive health concerns, and intimacy concerns, as these can be taboo for patients to bring up, but can present opportunities for patient education, awareness, management, and treatment. 

• When discussing devices to help maintain an erection, be sure to continuously use anatomically correct language instead of slang and be sure to assess patient comfort and willingness as you discuss these devices and procedures. 

Transgender SCI Patient Considerations for Sexual Function and Intimacy 

Historically, SCI patients tend to be younger and men, and most research regarding SCI sexual function and intimacy has focused on men. Very little evidence-based research discusses the need for transgender SCI patient sexual function and intimacy. In fact, given the rise of several political and social movements, transgender people might not be comfortable seeking care on this topic for fear of personal safety or harassment and discrimination in healthcare settings. As nurses, we need to provide the best quality evidence-based care possible. As science evolves, so does the inclusion of sexual health concerns for transgender SCI patient considerations (7,8,9,10,11,12,13,14,15,16,17,18).
 

Here are some general tips for consideration for transgender SCI patient needs and talking points regarding sexual function and intimacy:  

• Take a detailed history of the patient. Oftentimes, SCI patient history can be scattered through many healthcare settings and documentation. Ask the patient to express themselves to the best of their ability regarding their health needs, including sexual health needs. Be willing to offer STI testing, education on contraception, and referrals to urological and transgender care.  

• Regarding sexual health, in particular, it provides time and space to do a thorough pelvic exam. Pelvic exams can provide insight into urinary or bowel leakages, pelvic floor integrity, incontinence issues, pain sensations, and more. Transgender people might use different terms for their body parts; to reduce the risk of gender dysphoria, open communication with your patients regarding their preferred terms and pronouns is essential. If this is not something you are comfortable with or not within your scope of work, ask whoever is in charge of this patient’s care to prioritize an exam of this sort. 

• Educate the patient about their ability to get someone pregnant (if they have sperm) or to get pregnant (if they have a uterus). Be willing to discuss fertility options and create a referral or talk with your team about possible fertility care providers in the area who can manage an SCI patient.  

• Provide referrals for the patient regarding pelvic floor physical therapy, occupational therapy, psychotherapy, speech therapy, sex therapy, and more as applicable. Oftentimes, many people are not aware of various therapy options, so education is important. 

• As care continues, be willing to ask questions about pelvic pain, urinary pain, rectal pain, sexual health concerns, reproductive health concerns, and intimacy concerns, as these can be taboo for patients to bring up, but can present opportunities for patient education, awareness, management, and treatment. 

• Because the world of transgender sexual health needs is still vastly under-researched, especially for SCI patients, take time to ask patients if they have specific questions or concerns and possibly refer them to a transgender care specialist as well.  

Managing Sexual Function and Intimacy 

Managing sexual function and intimacy can significantly vary among SCI patients. For some patients, they do not have concerns regarding sexual function and would prefer to focus on other bodily functions. For other people, they might identify as asexual or not be interested in intimacy with another person presently. For others, sexual function is a vital aspect of their identity. Fortunately, there are many pharmacological and non-pharmacological options to manage sexual function and intimacy in SCI patients. 

Pharmacological Approaches to Managing Sexual Function and Intimacy 

Pharmacological approaches to managing sexual function and intimacy in SCI patients can vary greatly depending on several factors, such as the extent of the SCI, patient gender, patient preference, patient response to other medications and non-pharmacological interventions, cost, and more. In general, PDE5A inhibitors, such as sildenafil, at various dosages and intracavernosal injections of the prostaglandin alprostadil can be used for erectile dysfunction. Other pharmacological interventions can address urinary and bowel function and mobility, which can reduce pelvic strain during sexual activity.  

Very little research has been done on women or transgender people for pharmacological approaches to managing sexual function and intimacy post-SCI. Vaginal estrogen could be a possibility for these patients, but further research is needed (6,8,10,11,14,15,16,17,18).  

Non-Pharmacological Approaches to Managing Sexual Function and Intimacy 

While there are pharmacological approaches to managing sexual function and intimacy in SCI patients, there are several non-pharmacological options as well, such as surgeries, rehabilitation, physical therapy, occupational therapy, speech therapy, sex therapy, psychotherapy, medical devices, neuromodulation, and electrical stimulation.  

For many SCI patients, surgeries can be a feasible, but expensive, extensive, and invasive non-pharmacological approach to further manage their sexual function. However, surgeries are expensive, require intense care and follow-up, and are not guaranteed to produce results, causing frustration for many patients as well. Rehabilitation is often the standard for many SCI patients since life after SCI is a significant psychological, social, financial, emotional, and physical transition. Rehabilitation includes various non-pharmacological therapies, bodily re-training and re-adjusting, consults with various health care professionals, and more. Rehabilitation can also often include physical therapy and occupational therapy depending on the type of rehabilitation center (6,8,9,10,11,12,13).  

Physical therapy is the treatment or management of a condition that involves the physical movements of body parts to restore their function and mobility to the best of their capabilities. Physical therapy is done by licensed physical therapists and done a few times a week to a few times a month depending on the severity of the patient’s needs. In general, physical therapy can vary significantly depending on the patient’s condition, patient’s finances, patient preference, health care access, and more.  

Speech therapy is the treatment or management of a condition that involves speech recognition and oral movements to restore their function and mobility to the best of their capabilities. Speech therapy is done by licensed speech therapists and can be done a few times a week to a few times a month depending on the severity of the patient’s needs. In general, speech therapy can vary widely depending on the patient’s condition, patient’s finances, patient preference, health care access, and more (1,2,3,4,5,6). Not typically done in rehabilitation centers is pelvic floor physical therapy, which is physical therapy specifically for the pelvis, which is important for sexual function and intimacy.  

Psychotherapy is the treatment or management of mental health conditions and mental health state. Psychotherapy, also commonly known as mental health therapy, can be done by licensed mental health professionals, such as licensed mental health counselors, psychiatrists, mental health nurse practitioners, social workers, and more. Psychotherapy can be done virtually or in person. Psychotherapy can be done weekly, monthly, or as needed depending on the severity of the patient’s needs. Psychotherapy is often a form of therapy that is often the most inclusive of patients and caregivers given that it is a space to talk and process several emotions. Many psychotherapy sessions can also be group or family sessions depending on the skill of the mental health professional (6,7,13,14,17).  

Medical devices, such as sex toys, vaginal dilators, rectal dilators, penile vibratory stimulation (PVS), electroejaculation (EEJ), and prostate messages are all possible non-pharmacological options to help patients with their sexual function and intimacy as well. Neuromodulation can include spinal cord stimulation (SCS) and peripheral nerve stimulation (PNS), but further research is needed to determine the long-term effects of neuromodulation. While some patients report satisfaction with neuromodulation, it is often used in conjunction with other management options. Electrical stimulation is often paired with voluntary motor training and involves and induces neuroplasticity by increasing the baseline level of spinal excitability. Electrical stimulation is often paired with other interventions for the best outcomes for patients possible (11,12,15). 

Considerations for Pediatric and Adolescent SCI Patients 

It is important to consider that there are pediatric and adolescent patients who have experienced SCI who will not have a “normal” upbringing compared to their peers. This social difference, in addition to the social changes involved with exploring one’s sexual identity and desires in adolescence, can present several complications for youth in their overall well-being. Pediatric and adolescent SCI patients often do not receive education on sexual health, pregnancy prevention, or sexual wellness, leading many SCI patients to not be aware of their fertility, menstrual cycle, and other sexual health concerns. When caring for pediatric and adolescent SCI patients, it is important to provide age-appropriate, evidence-based information for patients about sexual health and wellness, as pregnancy, STIs, sexual pain, and sexual violence can occur in this population (6,19,20). 

Considerations for SCI Patients in Existing Marriages or Partnerships 

It is important to consider that many SCI patients are in existing marriages or partnerships when the SCI occurred. For many SCI patients, their relationships have completely shifted, including the ways they engage in sexual activity and are intimate. Several studies have looked at couple dynamics for sexual wellness and dynamics with a partner with SCI.  

Having open, honest conversations about intimacy, being realistic about expectations, and working with a sex therapist and other care professionals can truly make a difference for several people with SCI. For many couples, exploring new types of sexual dynamics and intimacies can make relationships stronger and more secure.  

Many patients with SCI also report actively dating or seeking partnerships, so counseling and educating on STI prevention, pregnancy prevention, fertility, sexual pleasure, and more are aspects of healthcare patients are seeking answers for (21,22,23,24,25,26). 

Nursing Considerations 

What Is the Nurses’ Role in SCI Care on Sexual Function and Intimacy Patient Education and Medication Management? 

Nurses remain the most trusted profession for a reason, and nurses are often pillars of patient care in several health care settings. Patients turn to nurses for guidance, education, and support. While there is no specific guideline for the nurses’ role in sexual function and intimacy SCI patient education and management, here are some suggestions to provide quality care for patients who have experienced an SCI (5,6,7,8,14,15,16,17,18). 

• Take a detailed health history of the patient. Oftentimes, vital signs and history taking can be complex, especially when caring for SCI patients. Many times, given the urgent need to stabilize an SCI patient, sexual function history is not done until after the patient is more stabilized.  As nurses, it is important to be involved in the vital signs and history taking process to learn about noticing any abnormalities or medical concerns that warrant medical attention. As nurses, we are aware that complications from SCIs can lead to rapid fluctuations in vital signs, such as blood pressure and heart rate. If a patient is complaining of symptoms that could be related to their SCI, such as chest pain, trouble breathing, or headaches, inquire more about that complaint. When a patient is stabilized and you have the opportunity to provide education on sexual function and intimacy, you can do so.  

• Review medication history at every encounter, as SCI patients often have a complex medical history. Be sure to ask the patient how they are feeling on the medication, any side effects, and if they are feeling like the medication is working. Oftentimes, many medications can have unwanted side effects, so being aware of side effects and their influences on a patient is important.  

• Regardless of how long a client has since experienced the SCI, if the client complains of any new symptom, ask about how long the symptoms have lasted, what treatments have been tried, if these symptoms interfere with their quality of life, and if anything alleviates any of these symptoms. If you feel like a patient’s complaint is not being taken seriously by other healthcare professionals, advocate for that patient to the best of your abilities.  

• Be willing to answer questions about SCI, sexual function, and sexual health care. Many SCI patients want to learn more about their sexual health and sexual function but are unsure of how to address this in a healthcare setting, especially with other SCI-related concerns. Be willing to be honest with yourself about your comfort level discussing topics and providing education on sexual health care.  

• Communicate the care plan to other staff involved for continuity of care. For several SCI patients, care often involves a team of nurses, specialists, therapists, pharmacies, surgeons, caregivers, and more. Ensure that patients’ records are up to date for ease in record sharing and continuity of care. 

• Stay up to date on continuing education related to SCI and sexual function, as evidence-based information is always evolving and changing. You can then present your new learnings and findings to other healthcare professionals and educate your patients with the latest information. You can learn more about the latest research on SCI and sexual function by following updates from evidence-based organizations, such as the National Institutes of Health (NIH). You can also share any evidence-based information with caregivers.  

• Monitor the patient’s urinary output, stool, and serum blood levels for changes in function. Oftentimes, changes in urine and stool can be used to determine pelvic tone, patency, and sexual function outcomes. If you notice any concerns with lab values or outputs, assess the patient and contact the health care provider. 

How can nurses identify if someone needs more intervention regarding SCI care on sexual function and intimacy?  

Unfortunately, it is not possible to look at a patient with SCI with the naked eye and determine if they are struggling with their sexual function or intimacy. Some SCI patients will have no desire to resume or engage in sexual activity, whereas others will want to learn more about how to regain their sexual identity. In addition, sexual function and intimacy are still seen as taboo topics in healthcare, making nurses an important influence on trust and relationship building among patients. Nurses can address questions and concerns regarding sexual function and intimacy among patients and their caregivers. Nurses can also provide information on various SCI treatments, therapy options, medication options, and more. Nurses can provide quality care by completing health history, listening to patient’s concerns, and addressing caregivers’ concerns (1,3,4,11,12,13,15). 

What Are Some Ways Patients Who Have Experienced SCI Can Discuss Their Sexual Health Concerns with Their Care Team? 

While discussing sexual health and function concerns with another person, especially a nurse after a SCI, it is important for patients to feel like they can receive evidence-based, quality care to address their concerns. For SCI patients, some ways for them to discuss their sexual health concerns with their care team include:  

• Tell the healthcare provider of any existing medical conditions or concerns before the SCI (need to identify risk factors). 

• Tell the health care provider of any existing lifestyle concerns, such as alcohol use, other drug use, lifestyle before SCI, surgical history, and allergies (need to identify lifestyle factors that can influence SCI sexual function and intimacy therapy interventions). 

• Tell the health care provider if you have any changes to your body, such as pain with breathing, trouble with movement, or increased fatigue as a result of treatments or medications (potential systemic complications or medication unwanted side effects). 

• Tell the nurse or health care provider if you experience any pain that increasingly becomes more severe or interferes with your quality of life, especially if pain or discomfort is in the pelvic region. 

• Keep track of your health, medication use, sexual activity, and health concerns via an app, diary, or journal (self-monitoring for any changes). 

• Take all prescribed medications as indicated and ask questions about medications and possible other treatment options, such as non-pharmacological options or surgeries. 

• Be willing to ask questions and have your caregiver or partner or both involved in conversations regarding sexual function and intimacy. 

• Tell the health care provider if you notice any changes to your body while engaging in sexual activity (potential worsening or improving health situation). 

• Track your blood pressure and heart rate with an at-home blood pressure cuff, keep track of your readings, and report any changes to your healthcare provider (self-monitoring for any changes since sexual activity can influence vital signs more drastically in SCI patients). 

• Track your pelvic function, such as your urinary and bowel habits, with at-home monitoring or self-monitoring and report any changes to your health care provider (self-monitoring for any changes). 

• Be willing to incorporate discussions of new ways to explore intimacy with your partner(s) and have open conversations with your healthcare team regarding fertility, STIs, pregnancy, and sexual pleasure. 

Upcoming Research 

What Research on SCIs and sexual function and intimacy use exists Presently? 

There is extensive publicly available literature on SCIs and sexual health and more via the National Institutes of Health (NIH) and other evidence-based journals.  

What are some ways for people who have experienced SCI to become a part of research? 

If a patient is interested in participating in clinical trial research, they can seek more information on clinical trials from local universities and healthcare organizations. 

Case Study #1 

Vicki is a 36-year-old woman working as a lawyer at a busy law firm. She is driving to work one day and is involved in a serious MVA. Vicki was transported to the nearest emergency room, and she suffered an SCI in her thoracic area. After examination and initial surgeries in the hospital, Vicki’s care team thinks Vicki should experience rehabilitation at the outpatient spine center for at least three months.  

Vicki is married to a loving husband, but this entire situation has put a strain on Vicki’s marriage, finances, career, and life. After a few weeks of stabilization in the hospital, Vicki is transferred to the outpatient spine rehabilitation center. Vicki can still talk on her own and move her arms on her own, but she cannot walk on her own anymore. You are assigned to perform an initial assessment on Vicki after she arrives from the hospital.  

Her vitals are unremarkable: 80 bpm, 110/70 mmHg, afebrile, 160 lbs.  

You’ve been working as a nurse for a few years but started working at this rehabilitation center within the past year. You notice that Vicki is doing well with her physical therapy and that she is responding well to her current medication regime. Vicki is even eating a small meal without much assistance, much to your surprise.  

After talking with Vicki, she tells you that she is having trouble going to the bathroom on her own, especially in the wheelchair. She also notices that she is not in control of her bladder or bowels as she was before her SCI.  

You assess Vicki and discuss her pelvic concerns with the care team. They recommend pelvic floor physical therapy, some prescription medications, and possible neuromodulation. Vicki is interested in participating in all of those options, and Vicki’s husband arrives in the patient waiting area.  

Vicki is happy to see him, but her face looks sad. You ask Vicki about her relationship with her husband, and she says, “My husband returned from visiting his parents for a bit. Before all this, we wanted to start a family. Now, I don’t even know if he’ll look at me the same way anymore.” 

You talk with Vicki about her concerns, and you tell her that you will also report back to the medical care team regarding your concerns. You also ask Vicki if she would like to be intimate with her husband and if that is a priority for her.  

Vicki is very visibly happy but tells you that she has not been to a gynecologist in the past few years because of her busy work schedule. She is not on any hormonal contraception, and her periods have been very irregular since the SCI. She does not know if she can get pregnant or if the SCI influenced her menstrual cycle, and she would like more answers. Vicki would also like her husband to be involved in these conversations as well. Shyly, Vicki also mentions that “down there” has been very dry since she entered rehabilitation, and she has never had any sexual problems until now.  

After Vicki spent some time with her husband, they decided they wanted to meet with the care team regarding Vicki’s overall health. Vicki is progressing well at the rehabilitation center, but there are still many more concerns to address before Vicki can be cleared for outpatient home care. Vicki mentioned that she would like to know why her periods are irregular and if she can get pregnant despite everything that has happened.  

The care team discusses possible causes for irregular menstruation and will look into local gynecological and fertility care options for people with SCI. You, as the nurse, also bring up Vicki’s concerns regarding sexual function and intimacy after discussing it with Vicki. The care team mentions neuromodulation as an option and possibly vaginal estrogen as well. Vicki has questions about these options and would like to know if there are other ways to discuss sexual function and intimacy, as she is working on her pelvic floor control as well.  

Conclusion

SCIs are complex health emergencies and require extensive medical care and follow-up. While SCIs change patient’s lives forever, the importance of someone’s sexual function and intimacy can still be discussed in a professional, non-judgmental, compassionate manner by nurses. Education and awareness of different sexual function and intimacy options and different clinical presentations of sexual health outcomes can influence the lives of many people healthily.  

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