Courtois F J, Charvier K F, Leriche A, Raymond D P, Eyssette M
Université du Québec à Montréal, Département de Sexologie, Québec, Canada.
Paraplegia. 1995 Nov;33(11):628-35. doi: 10.1038/sc.1995.133.
Despite the many developments in the area of sexual dysfunction, rehabilitation settings seldom investigate the remaining sexual function following spinal cord injury, or offer differential diagnoses of sexual dysfunction in spinal cord injured men. This article attempts to show how sexual rehabilitation should begin with a thorough assessment of the sexual function of paraplegic and tetraplegic men. Assessment includes a basic neurological examination of the perineal area and an extended clinical interview on sexual function and visceral function. The interpretation of patient evaluation is discussed in terms of a classification system adapted to sexual purposes and in terms of the differential diagnoses between sexual dysfunctions of organic, and those of predominantly psychogenic origin in the spinal cord injured patient. The organic or psychogenic contribution is discussed in terms of sophisticated procedures, where assessment of nocturnal penile tumescence (NPT) is critically evaluated and where alternatives such as urodynamic findings and skin potentials are discussed. Treatment strategies, such as intracavernous injections and cognitive-behavioural strategies adapted to different lesion types, are discussed.
尽管性功能障碍领域有诸多进展，但康复机构很少对脊髓损伤后的残余性功能进行调查，也很少对脊髓损伤男性的性功能障碍进行鉴别诊断。本文试图说明性康复应如何从对截瘫和四肢瘫男性的性功能进行全面评估开始。评估包括对会阴区进行基本的神经学检查以及就性功能和内脏功能进行深入的临床访谈。将根据适用于性目的的分类系统以及脊髓损伤患者器质性性功能障碍与主要为心因性性功能障碍之间的鉴别诊断来讨论对患者评估结果的解读。将通过复杂的程序来讨论器质性或心因性因素，其中对夜间阴茎勃起（NPT）的评估会得到严格评价，还会讨论诸如尿动力学检查结果和皮肤电位等替代方法。文中还讨论了治疗策略，如海绵体内注射以及针对不同损伤类型的认知行为策略。
