Alexander Marcalee Sipski, Aisen Carrie Mlynarczyk, Alexander Sterling Morrison, Aisen Mindy Lipson
Birmingham VA Medical Center, Birmingham, AL, USA.
Department of PMR University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.
NeuroRehabilitation. 2017;41(2):343-357. doi: 10.3233/NRE-172202.
Spinal Cord Injury (SCI) causes neurological impairment with resultant neurogenic sexual dysfunction which can compound preexisting psychological and medical sexual concerns. Understanding these concerns is important in managing the lifelong needs of persons with SCIs.
To provide an overview of the impact of SCI on sexuality along with a framework for treatment of sexual concerns. To briefly review male infertility and its treatments and pregnancy in females after SCI.
Interdisciplinary literature review and synthesis of information.
The average age at SCI is increased, thus persons with SCIs may have preexisting sexual concerns. Sexual activity and satisfaction are decreased after SCI. Psychogenic sexual arousal is related to remaining sensation in the T11-L2 dermatomes. Orgasm occurs in approximately 50% of persons with SCIs with all injuries except subjects with complete lower motor neuron (LMN) injuries affecting the lowest sacral segments A structured approach to treatment including assessing preinjury function, determining the impact of injury, education, assessing and treating iatrogenic sexual dysfunction and treatment of concomitant problems is recommended. Basic and advanced methods to improve sexual arousal and orgasm are discussed and treatment of anejaculation and issues associated with pregnancy and SCI are reviewed.
Sexual satisfaction is impaired after SCI; however, education and new therapies can improve responsiveness. Future research is warranted to improve sexual function and fertility potential in persons with SCIs.
脊髓损伤（SCI）会导致神经功能障碍，进而引发神经源性性功能障碍，这可能会使原有的心理和医学方面的性问题更加复杂。了解这些问题对于满足脊髓损伤患者的终身需求至关重要。
概述脊髓损伤对性功能的影响，并提供一个处理性问题的框架。简要回顾男性不育及其治疗方法以及脊髓损伤后女性的妊娠情况。
跨学科文献综述和信息综合。
脊髓损伤患者的平均年龄有所增加，因此他们可能原本就存在性方面的问题。脊髓损伤后性活动和性满意度会降低。心理性性唤起与胸11至腰2皮节的残留感觉有关。除了影响最低骶段的完全性下运动神经元（LMN）损伤患者外，约50%的脊髓损伤患者会出现性高潮。建议采用结构化的治疗方法，包括评估伤前功能、确定损伤的影响、进行教育、评估和治疗医源性性功能障碍以及处理伴随问题。文中讨论了改善性唤起和性高潮的基础和先进方法，并对不射精以及与妊娠和脊髓损伤相关的问题的治疗进行了综述。
脊髓损伤后性满意度会受损；然而，教育和新的治疗方法可以提高反应能力。有必要进行未来研究以改善脊髓损伤患者的性功能和生育潜力。
