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Sexuality in spinal cord injury patients

brief outline regarding sexuality in spinal cord injury patients

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Sexuality in spinal cord injury patients

  1. 1. SEXUALITYAND SPINALCORD INJURY DR MUHAMMAD ISHFAQ (FCPS UROLOGY)
  2. 2. TWO DIFFERENT THING sex & sexuality
  3. 3. HUMAN CYCLE
  4. 4. EXCITMENT  MALE----The male sexual response cycle starts in the excitement phase; two centers in the spine are responsible for erections. Vasoconstriction in the penis begins, the heart rate increases, the scrotum thickens, the spermatic cord shortens, and the testicles become engorged with blood  FEMALE---can last from several minutes to several hours. Characteristics of this phase include increased heart and respiratory rate, and an elevation of blood pressure. Flushed skin or blotches of redness may occur on the chest and back; breasts increase slightly in size and nipples may become hardened and erect.The onset of vasocongestion results in swelling of the clitoris, labia minora, and vagina.The muscle that surrounds the vaginal opening tightens and the uterus elevates and grows in size.The vaginal walls begin to produce a lubricating liquid.
  5. 5. PLATEAU  MALE--In the plateau phase, the penis increases in diameter, the testicles become more engorged, and the Cowper's glands secrete pre-seminal fluid.  FEMALES-- characterized primarily by the intensification of the changes begun during the excitement phase
  6. 6. ORGASM  MALE...The orgasm phase, during which rhythmic contractions occur every 0.8 seconds, consists of two phases; the emission phase, in which contractions of the vas deferens, prostate, and seminal vesicles encourage ejaculation, which is the second phase of orgasm. Ejaculation is called the expulsion phase; it cannot be reached without an orgasm.  FEMALE... During the orgasm stage the heart rate, blood pressure, muscle tension, and breathing rates peak.The pelvic muscle near the vagina, the anal sphincter, and the uterus contract. Muscle contractions in the vaginal area create a high level of pleasure, though all orgasms are centered in the clitoris.[3][40][41][42]
  7. 7. RESOLUTION  In the resolution phase, the male is now in an unaroused state consisting of a refactory (rest) period before the cycle can begin. This rest period may increase with age
  8. 8. SEXUAL PROBLEMS  There are four major categories of sexual problems:  desire disorders,  arousal disorders,  orgasmic disorders,  and sexual pain disorders.[3]
  9. 9. CONTROLOF ERECTION  PSYCHOGENIC (visual, auditory, olfactory, imagined, or tactile stimuli)...cerebral controle  reflexogenic...(mechanical stimulation)
  10. 10. The effects of SCI onSexual Function  Changes in arousal re s p o n s e  - Changes in org a s m  - Decreased or absent sensation  - Decreased lubrication  - Er e ctile dys f u n ct i o n  - Decreased clitoral engorg e m e n t
  11. 11. spinal cord  Spinal cord centres are :  · E re ct i o n sympatheticT11-L2 (psychogenic)  p a rasympathetic S2-4 (re f l ex )  · E m i s s i o n sympatheticT11- L 2  · E j ac u l a t i o n somatic S2-4
  12. 12. management  counseling  position  physical/furnitu re  erectile dysfunction
  13. 13. sexuality is a learning process....sexuality can be maitained without sex....
  14. 14. counseling  PLISSIT
  15. 15. Position
  16. 16. furniture
  17. 17. MANAGEMEN TOF ED  1ST LINE(ORAL DRUGS,VACCUME DEVICES)  2ND LINE(INTRACAVERNOSAL DRUGS,PER URTHRAL)  3RD LINE(SURGERIES,PROSTHESIS)
  18. 18. SCIAND FEMALESD  Focus of spinal injured women is not just that of fertility potential  · Loss of genital sensation  · Lubrication pro b l e m s  · Changes in arousal and org a s m
  19. 19. MANAGEMEN T IN FSD  Advice should be given about genital stimulation to achieve re f l ex lubrication and  t h e re f o re possible appreciation of orgasm at least that above the lesion.  · Use of wa t e r-soluble lubricant may be helpful for interc o u r s e .  · Positioning will also be important especially if spasm is significant.  ·The risk of autonomic dys re f l exia (lesions aboveT6) must be ra i s e d .  · Bladder management should be in keeping with improving sexual activity  Other considera t i o n s  - Counselling  - Development of ‘new’ erogenous zones above level of lesion  - Encourage ex p l o ration and experimentation with a variety of techniques  - Peer support may be useful
  20. 20. FERTILITY  SPERM RETRIEVAL  ejaculate by vibrator  electroejaculation  sperm aspiration techniques by a surgeon
  21. 21. female insemination
  22. 22. ART  ivf  icsi
  23. 23. thank you  next time.........................

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