Article: Sexual health matters. Sexual Problems of Patients with Subacute Spinal Cord Injury and Their Relationship to dimensions of Quality of Sexual Life.

BackgroundSpinal cord injuries (SCI) are associated with a range of sexual dysfunctions that impede both sexual fulfillment and reproductive capability. This study analyzes the prevalence and severity of sexual problems following SCI-classified as primary, secondary, and tertiary dysfunctions-and examines their relationships with three key components of sexual quality of life: sexual activity, sexual interest, and sexual satisfaction in both male and female patients in the subacute phase of SCI (i.e., within two years post-injury). MethodsA total of 110 patients with SCI were enrolled in the study. Analyses of primary sexual dysfunctions included 91 participants, while 81 were included in subsequent analyses. Data collection tools comprised: the International Spinal Cord Injury Male Sexual Function Basic Data Set (Version 2.0), the International Spinal Cord Injury Female Sexual Function Basic Data Set, the Ashworth Scale, SCIM III, the Numeric Rating Scale for Pain (NRSP), the Depression Assessment Questionnaire (KPD), the State-Trait Anxiety Inventory (STAI X-1), and numerical and verbal scales measuring subjective physical sexual attractiveness and the three domains of sexual quality of life. Additional data were gathered on bladder sphincter function, cardiac status, autonomic dysreflexia, and sleep apnea. ResultsAmong participants, 87.65% of men and 83.35% of women reported at least one primary sexual dysfunction. In men with AIS A classification, a negative correlation was observed between ejaculatory dysfunction and sexual activity (rho = -0.50, p = 0.028). In men with AIS B, C, or D, orgasmic dysfunction negatively correlated with both sexual satisfaction (rho = -0.41, p = 0.024) and sexual activity (rho = -0.45, p = 0.012), while reflex erection was positively correlated with sexual interest (rho = 0.45, p = 0.007). Functional independence post-SCI (SCIM III) among men with AIS B, C, or D was associated with higher levels of sexual activity (rho = 0.31, p = 0.047). In AIS A men, a significant positive correlation was found between walking independence (WISCI II) and sexual interest (rho = -0.43, p = 0.031). Among AIS A women, spasticity severity negatively correlated with both sexual satisfaction (rho = -0.74, p = 0.036) and sexual activity (rho = -0.80, p = 0.017). At the tertiary level, anxiety in women negatively correlated with sexual activity (rho = -0.79, p = 0.021 and rho = -0.84, p = 0.036), and with sexual satisfaction in AIS A women (p = 0.081). In AIS B, C, or D men, depression was associated with reduced sexual satisfaction (rho = -0.37, p = 0.017), and both anxiety and depression correlated negatively with sexual interest (rho = -0.38, p = 0.012 and rho = -0.47, p = 0.002, respectively). A strong positive correlation was identified between subjective sexual attractiveness and all three domains of sexual quality of life: interest (rho = 0.75), activity (rho = 0.82), and satisfaction (rho = 0.48) (p [≤] 0.001 for all domains). Moreover, increased age and longer time since injury among women were associated with greater reflex genital arousal dysfunction. In men, advancing age correlated with increased reflex erectile dysfunction. Interestingly, in AIS B, C, or D men, a longer duration post-injury was linked to fewer psychogenic erectile dysfunctions. ConclusionThe majority of participants exhibited at least one primary sexual dysfunction. Across all three domains of sexual quality of life, individuals with SCI scored significantly lower than the general population. Statistically significant associations were found between these domains and primary sexual dysfunctions, as well as secondary and tertiary SCI-related symptoms affecting sexual health.