Perrouin-Verbe B, Courtois F, Charvier K, Giuliano F
Service de MPR neurologique, hôpital St-Jacques, CHU de Nantes, 85, rue St-Jacques, 44093 Nantes cedex, France.
Prog Urol. 2013 Jul;23(9):594-600. doi: 10.1016/j.purol.2013.01.004. Epub 2013 Mar 7.
The prevalence of sexual dysfunction in spinal cord injured (SCI) women is high.
Medical literature on sexuality in women with SCI was reviewed and combined with expert opinion of the authors.
The physiology of the female sexual response including vasocongestion and muscular contractions occurring during sexual arousal and orgasm, and their innervation through somatosensory and autonomic pathways (pudendal, pelvic, hypogastric, vagus nerves) is described. Studies on women with SCI demonstrate the presence of a sacral reflex vasocongestion and/or thoracolumbar psychogenic vasocongestion. Fifty percent of women with SCI report orgasm, most often with genital stimulation, suggesting that an autonomic reflex response, but which can be perceived by vagus nerve transmission. Studies on sexual experience show that the frequency of sexual activities decreases, but interest for intercourse remains. More emphasis is placed on oral-genital stimulation, kisses, cuddling, caresses, fantasies, and erogenous stimulation above the lesion level. Sixty-nine percent of women with SCI report sexual satisfaction. Limitations concern positions during intercourse, spasticity, incontinence and autonomic dysreflexia. Alteration of the sexual sense of self and body image are also reported. Facilitating factors include education level, having a stable partner, occurrence of the lesion in adulthood, and increased posttraumatic delay. Treatment should emphasize neurological assessment of thoracolumbar sensitivity and presence of sacral reflexes. Sexual education should be encouraged during rehabilitation and cover the female sexual response, procreation and pregnancy (risks, prevention), along with precautions concerning various contraceptives. Treatment should include a refined assessment of perineal sensitivity to allow a mental image of the vulva, and trials with vibrostimulation and medication (PDEI5, midodrine) to maximize sexual responses and facilitate perception of sexual pleasure and orgasm.
Management of sexual dysfunction in SCI women must be holistic and biopsychosocial.
脊髓损伤（SCI）女性性功能障碍的患病率很高。
回顾了关于SCI女性性行为的医学文献，并结合作者的专业意见。
描述了女性性反应的生理过程，包括性唤起和性高潮期间发生的血管充血和肌肉收缩，以及它们通过躯体感觉和自主神经通路（阴部神经、盆腔神经、腹下神经、迷走神经）的神经支配。对SCI女性的研究表明存在骶反射性血管充血和/或胸腰段心理性血管充血。50%的SCI女性报告有性高潮，最常见的是通过生殖器刺激，这表明存在自主神经反射反应，但也可通过迷走神经传导被感知。关于性体验的研究表明，性活动的频率降低，但对性交的兴趣仍然存在。更多的重点放在口交刺激、亲吻、拥抱、爱抚、幻想以及损伤水平以上的性感刺激上。69%的SCI女性报告有性满足感。限制因素包括性交姿势、痉挛、尿失禁和自主神经反射异常。也有关于性自我意识和身体形象改变的报告。促进因素包括教育水平、有稳定的伴侣、成年期发生损伤以及创伤后延迟增加。治疗应强调对胸腰段敏感性和骶反射存在情况的神经学评估。在康复期间应鼓励性教育，内容应涵盖女性性反应、生育和怀孕（风险、预防）以及各种避孕措施的注意事项。治疗应包括对会阴敏感性进行精细评估，以形成外阴的心理图像，并尝试使用振动刺激和药物（磷酸二酯酶5抑制剂、米多君）来最大化性反应，并促进性快感和性高潮的感知。
SCI女性性功能障碍的管理必须是全面的，包括生物心理社会方面。
