Sexual response in women with spinal cord injury: neurologic pathways and recommendations for the use of electrical stimulation.

BACKGROUND: Determination of the exact level and degree of a woman's spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI.
DESIGN: Literature review.
FINDINGS: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11-T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc.
CONCLUSIONS: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with able-bodied controls, provide valuable information regarding female sexual neurophysiology. Electrical stimulation can be used to improve sexual response, as well as bladder and bowel function. Interventions that interfere with the sacral reflex arc, such as sacral rhizotomy, can impair the ability to achieve orgasm. To develop alternative treatment protocols, further investigation of sexual response and orgasm is recommended.