Sexual function during primary rehabilitation after spinal cord injury: A descriptive analysis from a population-based cohort.

Abstract

To describe the distribution of and risk factors for sexual dysfunction and its symptoms, including altered arousal and orgasmic dysfunction, female menstrual dysfunction, and male erectile and ejaculatory dysfunction during primary spinal cord injury (SCI) rehabilitation. Cross-sectional analyses of population-based cohort data. Four specialized SCI centers in Switzerland. 605 individuals, 140 females, aged ≥18 years with newly diagnosed SCI, who underwent inpatient post-acute rehabilitation between May 2013 and July 2024. Not applicable. Outcomes were assessed using the International Spinal Cord Society female sexual and reproductive function as well as the male sexual function basic data set. At 4.8 months post-SCI (Q1-Q3: 3.3-5.8), 67% of females and 46% of males indicated at least one sexual function outcome was 'unknown'. Among females, altered or absent reflex genital arousal and orgasmic function were reported by 57% and 60%, respectively, with 35% aged ≤51 years having menstrual dysfunction. In males, altered or absent psychogenic erection, reflex erection, ejaculation and orgasmic function were reported by 75%, 70%, 76%, and 70%, respectively. Multivariable regression analyses yielded an association between SCI severity and dysfunction. In females American Spinal Injury Association Impairment Scale (AIS) grades A and B (vs. AIS C and D) nearly perfectly predicted both reflex arousal (p=0.016) and orgasmic dysfunction (p=0.07). In males AIS A (vs. AIS D) was highly predictive of sexual dysfunction in all symptom domains (all post-hoc p<0.001) as was older age (p≤0.016, all). This study revealed high rates of sexual dysfunction in both females and males during inpatient rehabilitation after SCI. Future well-powered longitudinal studies are needed to generate accurate estimates of the prevalence of post-SCI sexual dysfunction, determine the optimal timing for sexual function assessment, and provide comprehensive biopsychosocial evaluations of sexual health after SCI.