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Beskrivelse
Spinal cord injury (SCI) is most often the result of a trauma to the spinal cord, but can also be associated with congenital or degenerative disease. In the United States alone currently there are approximately a quarter million people with SCI. Every year, approximately 10,000 people in the United States survive an acute traumatic injury to the spinal cord. The majority of these people are male and under the age of 25. In addition to paralysis, persons with SCI will likely experience problems with bladder and bowel control, as well as alterations in sexual functioning. The impact of a SCI on sexual functioning depends on the degree of the injury and its location on the spinal cord. Sexual dysfunction in persons with SCI may have both physiologic and psychological (e.g., body image, self esteem) elements that can be distressing regardless of the person's gender, age, or culture. Both men and women report a decreased desire for sexual activity following their injury. Frequency of sexual activity is also known to decrease after injury in both men and women. In men with SCI, factors affecting sexuality typically include erectile and ejaculatory dysfunction. Factors affecting women with SCI may include difficulties having comfortable intercourse, and the ability to reach or feel orgasm. Although some men with SCI are unable to have erections, many still maintain the ability to have some erectile function, albeit of insufficient quality and duration for intercourse. Possible treatments include devices such as the vacuum erection device as well as the injection of vasoactive drugs into the penis. A recent innovation to improve erectile function in men with SCI has been the approval of the drugs such as sildenafil (Viagra(R)). Infertility is an issue for men with SCI more than with women. Male infertility results from the combination of ejaculatory dysfunction and abnormal sperm quantity and quality. Techniques to remediate erectile dysfunction and ejaculation have vastly improved the fertility potential of men with SCI. Stimulation to obtain ejaculate for insemination of a partner is now routinely performed. Usually, ejaculate is obtained through the use of penile vibratory stimulation or electroejaculation, but other techniques to treat SCI-related male infertility are myriad. Health care providers have become increasingly aware of the importance of sexuality in the rehabilitation process. Current approaches to "best practices" concerning the topic of sexuality and reproductive health in persons with SCI are opinion-based, typically generated by clinical experience with small patient populations in select hospitals and rehabilitation facilities. The Consortium for Spinal Cord Medicine (sponsored by the Paralyzed Veterans of America) has identified the issue of sexuality and reproductive health to be a high priority topic for improving the quality of life for persons with SCI. Last year, at the request of the Consortium for Spinal Cord Medicine, the Agency for Healthcare Research and Quality (AHRQ) commissioned the University of Ottawa's Evidence-based Practice Center (UO-EPC) to conduct a feasibility study to determine if there is sufficient credible literature to support a comprehensive systematic review on the topic of "Sexuality and Reproductive Health Following SCI." In this feasibility report a reasonably large body of evidence was identified examining different aspects of sexuality and reproductive health following SCI.
