R - SEXUAL HEALTH & RELATIONSHIPS
Ensure that individuals with SCI are aware of the risks related to sexual services or products available without a prescription. (Adapted from CSCM 2010, p.322; Level C)
Assess the current level of erectile function in men with SCI and suggest interventions taking into consideration the level of invasiveness, cost, and side effects. (Adapted from CSCM 2010, p.322; Level C)
In men, if testosterone deficiency is determined to be a contributing factor in his lack of libido or sexual dysfunction (including lack of PDE5i response for erections), consider testosterone replacement therapy. For men wishing to be biological fathers, alternative medications can be prescribed to raise serum testosterone without interfering with sperm production. (Adapted from CSCM 2010, p.322; Level C)
Inform men with SCI about the full range of options for treating erectile dysfunction and develop an individualized treatment plan as needed. Educate men with SCI about:
- oral medications, such as PDE5i, to treat erectile dysfunction
- risks and benefits of vacuum devices for the treatment of erectile dysfunction
- intracavernosal injections for the treatment of erectile dysfunction
- Permanent penile prosthesis (also known as implantable penile protheses) for the treatment of erectile dysfunction when nonsurgical treatments are ineffective or unsatisfactory.
Clinicians should provide individuals with SCI with education and training on vibrators that are available to enhance genital arousal orgasmic potential. (Adapted from CSCM 2010, p.325; Level C)
Clinicians should discuss the benefits and risks of the use of medications such as sildenafil and flibanserin for sexual arousal disorder in women with SCI. (CAN-SCIP 2020; Level C)
Educate women with SCI about the effects of perimenopausal and menopausal changes on sexual function, bone health, accelerated metabolic aging, and metabolic syndrome after SCI. (Adapted from CSCM 2010, p.328; Level C)