Sexual issues in a sample of women with spinal cord injury.

STUDY DESIGN: Semistructured interview. OBJECTIVES: To assess the degree of participation in sexual intercourse of a sample of women with spinal cord injury (SCI) in our community, to establish to what extent their sexual lives have been affected in comparison to before the injury, and to search for those factors that may have a major influence on both aspects. SETTING: Spinal Cord Injuries Unit, A Coruna, Spain. PARTICIPANTS: A total of 37 women, average age 40 years, time since onset average 10 years. RESULTS: In all, 62% claimed regular sexual activity after the injury. The women who suffered the injury before reaching the age of 18 years run a higher risk of not having physical relationships than those who were above that age when they incurred the SCI (P=0.04, OR 4.75). We discovered a significant drop in the frequency of intercourse (P=0.003) and the ability to reach an orgasm (P=0.008), after the injury. Of these women, 69% were satisfied with their current sexual activity and 77.4% considered the information they received from their doctors on the changes the SCI would cause in their sexuality to be either insufficient or nonexistent. CONCLUSIONS: There is a noticeable decrease in the frequency of intercourse as well as a significant reduction in the capability of reaching orgasm. Despite these changes and problems that ensue during intercourse as a result, most show satisfaction with their current sexual lives. On the other hand, the occurrence of the injury before the age of 18 years may imply a greater risk of not having an active sex life in adult years. We consider it is essential to provide the appropriate sexual information during the process of rehabilitation, aimed at helping women with SCI to adapt to their new situation.

Dolor crónico después de la lesión medular: prevalencia, características y factores relacionados / Chronic pain after spinal cord injury. Prevalence, characteristics and associated factors

Introducción. El objetivo de este trabajo es analizar la prevalencia del dolor crónico en pacientes con lesión medular, investigar qué factores influyen en su desarrollo o intensidad, y en qué medida el dolor crónico afecta a las actividades diarias. Pacientes y métodos. Se ha realizado un estudio observacional basado en una entrevista personal. Se registraron datos demográficos, características de la lesión medular, grado de ansiedad y depresión, presencia de dolor crónico y características de éste. Resultados. Se incluyeron 114 pacientes. El 54,4 por ciento presentaban dolor crónico y el 26,2 por ciento lo calificaron como grave. El dolor neuropático por debajo de la lesión fue el más frecuente. Se encontró relación del dolor con la edad en el momento de la lesión (p = 0,009) y con la edad en el momento de la entrevista (p = 0,022). Se observó una asociación entre la intensidad del dolor y la interferencia en las actividades de la vida diaria (p = 0,033). Los niveles de ansiedad y depresión fueron mayores en el grupo de pacientes con dolor respecto al grupo control (p = 0,045). Se realizó una regresión logística indicando que únicamente la edad en el momento de la lesión modifica significativamente la probabilidad de sufrir dolor crónico (odds ratio, 1,03; intervalo de confianza del 95 por ciento, 1,00-1,06; p = 0,042). Conclusiones. Se confirma una alta prevalencia e intensidad del dolor crónico en la población de lesionados medulares, así como su inicio precoz tras la lesión. La única variable que hemos encontrado relacionada con su desarrollo es la edad (AU)

Spinal cord infarction: prognosis and recovery in a series of 36 patients.

OBJECTIVE: To study the clinical evolution and the functional outcome of patients suffering from spinal cord infarction who were treated at the Spinal Cord Injuries Unit. To try to determine the factors that could have influence in their functional outcome. SETTING: In a Spinal Cord Injuries Unit, regionally-based, and which forms part of a general hospital with a high level of specialization. METHOD: Retrospective study of the medical records of patients suffering from vascular spinal cord ischemia, as acute anterior spinal artery syndrome or associated with aortic surgery or rupture. Cases that were due to compressive, tumoral or inflammatory pathologies were excluded. Assessment of the neurological syndrome followed the ASIA/IMSOP criteria. Age, sex, history and magnetic resonance imaging (MRI) findings were analyzed. Assessment of functional outcome was made regarding ambulatory ability or wheelchair use, and bladder/sphincter control. RESULTS: Thirty-six cases were selected, the commonest group being spinal cord ischemia due to idiopathic causes (36.1%). Following these, there were cases associated with aortic surgery (25%), systemic arteriosclerosis (19.4%) and acute deficit of perfusion (11.1%). The average age of the patients was 59.3 years, with a mortality of 22.2% during the hospital stay. Regarding the functional outcomes at the moment of discharge, it must be pointed out that 57.1% of the patients were wheelchair users, 25% were ambulatory, using technical aids, and 17.9% were fully ambulatory. The group who could perform some kind of walking was significantly younger than the group of wheelchair users (48.17 vs 61.38 years). Additionally, it became evident that those patients who did not show voluntary muscle contraction at the time of admission (ASIA groups A and B) presented a higher risk of being wheelchair users. CONCLUSION: Acute spinal cord ischemia syndrome has a severe prognosis with permanent and disabling sequelae. Initial neurological assessment following ASIA/IMSOP classification proves to be the best predictor of prognosis, and the patient's advanced age constitutes a negative factor for functional recovery.