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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.
MALE--In the plateau phase, the penis increases in diameter, the
testicles become more engorged, and the Cowper's glands secrete
FEMALES-- characterized primarily by the intensification of the
changes begun during the excitement phase
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
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
There are four major categories of sexual problems:
and sexual pain disorders.
The effects of
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
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
sexuality is a learning process....sexuality can be maitained without
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
T IN FSD
Advice should be given about genital stimulation to achieve re f l ex
t h e re f o re possible appreciation of orgasm at least that above the
· 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
· Bladder management should be in keeping with improving sexual
Other considera t i o n s
- Development of ‘new’ erogenous zones above level of lesion
- Encourage ex p l o ration and experimentation with a variety of
- Peer support may be useful
ejaculate by vibrator
sperm aspiration techniques by a surgeon