Slides inspired by my presentation
made on December the 5th 2014
at the Hollister Academy
lancement
Dr Vincent HUPERTAN, MD
hupertan@gmail.com

Photo by Lynn - Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/apophysis_rocks/652600648/in/photostream/

Photo by Alessandro Pautasso Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License
Photo by Ynot-Na- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/
Lovers

Sexual
responses =
Sexual arousal
and orgasm
Body image
and
perception of
attractivenes
s
Self-esteem
Sexual
identity =
Appropriation
of his home
sex
Fertility
Emotional
intimacy =
Feeling
understood and
close to the other
Photo by Wally Gobetz- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License Les Demoiselles d'Avignon, Paris, June-July 1907

….a women:
attractive,
voluptuous,
bellissime
Colostomy bikini photo 'goes viral' www.bbc.com A photograph of woman with Crohn's disease who posed wearing a bikini, revealing her
colostomy bags, is seen by more than nine million people online.

Colostomy bikini photo 'goes viral' www.bbc.com A photograph of woman with Crohn's disease who posed wearing a bikini, revealing her
colostomy bags, is seen by more than nine million people online.

Fears
For three years, Bethany Townsend was
too afraid to share bikini pictures, even
with friends.
The stunning 23-year-old suffers from
Crohn's disease and in 2010 doctors had
to fit two colostomy bags after she nearly
died.
Colostomy bikini photo 'goes viral' www.bbc.com A photograph of woman with Crohn's disease who posed wearing a bikini, revealing her
colostomy bags, is seen by more than nine million people online.

If a woman with
stoma is
considered
cured, his body is
certainly healed
…
healed
but
- wounded
- bruised
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1
2
3
4
5
What is the « best » attitude?

The integrity of the female sexual
response
Depends on the anatomic integrity,
hormonal, vascular, nervous,
muscular, metabolic
" "
Photo by Lorando Labbe- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/

• The menopause is resilience!
• The sexual instinct will help.
• It will have to relearn her
sexuality.
Photo: bononobo

Misconceptions (to fight!!)
• There’re no "natural" sexual behavior
neither "sexual instinct"
• The diktat of the « normality »
Credit photo heraldpost

Wunsch S., Rôle et importance des processus de renforcement dans l'apprentissage du
comportement de reproduction chez l'homme, Thèse, EPHE, Paris, 2007
Wunsch S. et Brenot P., Does a sexual instinct exist ? Sexologies, 13(48):30-36, 2004

« Less of a woman » sentiment
1. In his own eyes
2. In the eyes of the partner
3. In the eyes of society (including
caregivers !!)
Photo by JustCallMe_♥Bethy♥_- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License
https://www.flickr.com/photos/

Sexuality
and disease
-
false
beliefs
Photo by Kathryn- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/

Sexuality
and disease
-
fears!
Photo by Kathryn- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/

3 levels of interventions on sexology
1. Information and sexual education
2. « Councelling »
3. Appropriate therapies: sexologists
Photo by Richard Standford Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/

Photo by DewFrame ДьюФрейм Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License https://www.flickr.com/photos/

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Sexuality
of the man with
The
Spinal
Cord Injury
(SCI)

If ’INTOUCHABLES' is a fiction, it is
inspired by a true story…
That of a man ….
…passionate about
paragliding

SCI
≠
asexual?
≠
impotent
infertile

Relevant questions: when to start the
treatment of sexual disorders?
• Not a priority
• ASAP
• Being patient listening
Photo by Alexander Kesselaar- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License The Moon tonight

Relevant questions:
In SCI, the only possible erection is:
• « Instrumental »
• « Psychogenic »
• « Reflex »
Photo by Gemma Llorensí Torrent- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License L' home desdibuixat

Relevant questions:
In SCI, ejaculation:
is absent
is « slobbering »
without erection
Photo by Pere Koniec- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License Orgasmos en París (contabilizados por Amelie Poulain)

Particularities of erection in
paraplegics
• Between 50 and 95% of patients have erections
• Can penetrate up to 75% of patients
• Erection often unstable in the SR
• Is based on the type of lesion and stimulation
Photo by Víctor Nuño- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License Reflection of Truth / Reflejo de la Verdad

Photo by Víctor Nuño- Creative Commons Attribution-NonCommercial-NoDerivs 2.0 Generic License Reflection of Truth / Reflejo de la Verdad

Lumbar sympathetic:
T10 - L1 = psychogenic erection
and
sperm emission
L3-L4
Spinal ejaculation generator
Somatic and sacral
parasympathetic
reflex erection
expulsion sperm

Somatic and sacral
parasympathetic
reflex erection
expulsion sperm
L3-L4
Spinal
Ejaculation
generator
Lumbar sympathetic:
T10 - L1 = psychogenic
erection
sperm emission

Relationship between the level of the lesion and sexual dysfunction
Reflex erection +
ejaculation +
sensitivity -
Psychogenic erection +
Reflex erection +
ejaculation often ± often premature

The lack of genital
sensitivity is replaced by
the enrichment of the
erogenous zones

Magali
Thank
Kamel
Merci
Joelle
Aude
Isabelle
Valerie
Julie
Corinne
Helene
Agnes
Lionel
Franck
Lauriane
Marie
Hollister
Academy
Nantes 3-5 dec 2014
Nathalie
Aurelie
Celine
Martine
Sandrine
Sylvie
Anne
Cynthia
Fabienne
Nadege
Anne-Marie
Brigitte
Carole
Caroline
Catherine
Cathy
Charlotte
Chloe
Christine
Emmanuelle
Jocelyne
Katia
Michel
Mireille
Olivier
Pascale
Sophie
Stephanie
Vanessa
Alain
Alexandra
Alice
Allan
Amaury
Angelique
Anne-Blandine
Anne-Claire
Anne-Cecile
Annie
Ariane
Arnaud
Aurore
Beatrice
Beatrice
Bernadette
Bertrand
Blandine
Christiane
Christopher
Claudine
Clementine
Coralie
Damien
Danielle
Delphine
Delphine
Veronique
Roche
Florence
Dimitri
Dominique
Edith
Elisabeth
Fatna
Floreal
Florian
Frederique Francoise
Gaelle
Gautier
Giovanna
Guillaume
Ingrid
Guy
Hayette
Jean-Francois
Jean-Marc
Jerome
Johanne
Karine
Laura
Laurie
Leocadie
Luc
Maeva
Magali
Magalie
Manuela
Manuela
Maria
Marie
Marie-Christine
Marie-Claude
Marie-Laure
Marie-Lucie
Marie-Lucie
Marie-Olympe
Marnie
Martyne
Melanie
Monique
Murielle
Myriam
Nadine
Nancy
Nelly
Nora
Odette
Olivia
Pascale Orencine
Pierre-Mickael
Regine
Renaud
Roland
Sabrina
Sal
Sandra
Sebastien
Severine
Sibylle
Silvana
Stella
Vincent
Virginie
Thank Hollister for inviting me.
Thank Maeva and Isabelle (Kephren) for their logistical support.
Thank Isabelle C for his critical reading.
Thank all for the feedback.

Made by @hupertan
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