Evaluation of sexual function and associated clinical factors in women with spinal cord injury: a cross-sectional controlled study.

Abstract

Study design: Prospective, cross-sectional, comparative study.

Objectives: To evaluate sexual function in women with spinal cord injury (SCI) using Female Sexual Function Index (FSFI) and to compare results with healthy controls. Secondary objectives were to determine prevalence of sexual dysfunction and to examine associations between sexual function and neurological level, functional independence, bladder and bowel function, and medical complications.

Setting: Ankara Bilkent City Hospital, Türkiye.

Methods: Twenty-six women with SCI and 23 age-matched healthy controls were included. Demographic and obstetric characteristics (age, marital status, educational level, employment status, pregnancy history, number of deliveries, mode of delivery, menstrual status, and contraceptive use) were recorded. Sexual function was assessed using the Female Sexual Function Index (FSFI). Functional independence was evaluated with the Spinal Cord Independence Measure III (SCIM III), and bowel dysfunction was assessed using the Neurogenic Bowel Dysfunction (NBD) score. Group comparisons were performed using non-parametric tests and correlations were analyzed using Spearman correlation analysis.

Results: Women with SCI had significantly lower FSFI total and domain scores than healthy controls (p < 0.001). Sexual dysfunction (FSFI < 26.55) was highly prevalent in SCI group. FSFI total scores were not significantly associated with neurological level or ASIA classification. FSFI scores showed a strong positive correlation with SCIM III (r = 0.77, p < 0.001) and a moderate negative correlation with NBD scores (r = -0.44, p = 0.024). Urinary incontinence was associated with significantly lower FSFI scores (p = 0.008). FSFI scores differed significantly according to bladder management method with highest scores in spontaneous voiding and lowest in indwelling catheter users (p < 0.001).

Conclusions: Sexual function is markedly impaired in women with SCI and is strongly related to functional independence, bladder and bowel function and urinary management than to neurological injury level, highlighting need for a multidisciplinary approach in SCI rehabilitation.