R - SEXUAL HEALTH & RELATIONSHIPS
Clinicians should ensure that a comprehensive medical assessment of the genital and reproductive systems is conducted after SCI. This assessment should include screening for cancers and sexually transmitted diseases per non-SCI guidelines. Additional considerations exist for prostate screening in men with SCI, as many factors may affect PSA levels. (Adapted from CSCM 2010, p.308; Level A)
The primary care provider should refer the individual with SCI to an accessible office or specialist to ensure screening is completed. If the primary care provider's office is not accessible, or they are not personally able to perform comprehensive sexual reproductive care. (CAN-SCIP 2020; Level C)
Perform a physical examination using the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI), with special attention to the preservation of sensation from T11–L2 and S2–5, along with a determination of the presence of voluntary anal contraction and reflexes to assess sexual function. Assess the impact of the individual's injury on sexual responses (i.e., genital responses, based on a neurologic examination). Full physical examinations and neurological assessments should be conducted regularly in order to detect changes over time that may affect sexual function. (Adapted from CSCM 2010, p.308; Level B)
Clinicians should routinely assess sexual and medical history (pre- and post-injury), desire, erection, ejaculation, lubrication, and pain with sexual acts. (CAN-SCIP 2020; Level C)
Clinicians should consider evaluating men with SCI for testosterone deficiency, particularly in those with a concomitant head injury, untreated sleep apnea, or in cases of chronic opioid use. (Adapted from CSCM 2010, p.311; Level C)
Clinicians should consider conducting a urethral trauma assessment in individuals with SCI who use intermittent or an indwelling catheter to empty the bladder as this may affect sexual activity. (CAN-SCIP 2020; Level C)