Physiologic parameters associated with sexual arousal in women with incomplete spinal cord injuries

Abstract

Objective: To compare the physiologic sexual responses of women with incomplete spinal cord injuries (SCIs) with and without preservation of the ability to perceive T11-L2 pinprick sensation. Design: Controlled laboratory-based analysis of responses to varying combinations of audiovisual erotic stimulation, manual genital stimulation, and performance of a distracting task coupled with manual genital stimulation. Setting: The sexual physiology laboratory at our freestanding rehabilitation hospital. Participants: A volunteer sample of 17 women with incomplete SCIs. Interventions: Two 78-minute protocols using 6-minute baselines alternating with 12-minute testing conditions. One protocol was designed to study the effects of psychogenic and psychogenic combined with manual sexual stimulation, while the other was designed to examine the effects of genital sexual stimulation performed in conjunction with a distracting task. Dependent Variables: Vaginal pulse amplitude, subjective arousal, heart rate, respiratory rate, and blood pressure. Results: Subjective arousal increased in both groups of subjects with isolated audiovisual erotic stimulation; however, only those subjects with the ability to perceive T11-L2 pinprick sensation had concomitant increases in vaginal pulse amplitude. In contrast, when manual genital stimulation was added to the audiovisual erotic stimulation, both groups of subjects developed increases in vaginal pulse amplitude, whereas only those subjects with the ability to perceive T11-L2 demonstrated a further increase in their level of subjective arousal. Performance of manual genital stimulation in conjunction with a distracting task resulted in significantly increased vaginal pulse amplitude and arousal level only in those subjects with preservation of the ability to perceive T11-L2 pinprick sensation. With the changeover to masturbation, neither group of subjects developed significant increases in vaginal pulse amplitude. During masturbation, both groups of subjects had increases in their level of sexual arousal; however, only those subjects with T11-L2 pinprick preservation had a significant increase. Conclusions: Women with preservation of the ability to perceive T11-L2 pinprick sensation tended to maintain the ability for psychogenic genital vasocongestion. Psychogenic protocol results showed that all subjects appeared to develop reflex genital vasocongestion when manual stimulation was added to audiovisual erotic stimulation. Manual genital stimulation in conjunction with the performance of a distracting task only resulted in increased vaginal pulse amplitudes in those subjects with preservation of T11-L2 pinprick sensation. We believe that this was due to increased subjective sexual arousal and that the reason all subjects did not develop increased genital vasocongestion under these conditions was due to poor hand function. Further research examining women with lower levels of SCI is necessary to understand the neurophysiology of female sexual response after SCI.