This project represents the first and only laboratory controlled study of physiological sexual functioning in spinal cord injured (SCI) women and will provide a foundation of knowledge about SCI and female sexual response. The four long-term aims include: (1) to understand the effects of varying degrees and levels of SCI on female sexual response; (2) to identify the specific neuronal pathways involved in sexual response in able-bodied females; (3) to develop new treatment methods to improve sexual satisfaction in SCI females; and (4) through increased satisfaction with sexual activity, to increase the frequency of sexual intercourse thereby increasing the childbearing capacity of SCI women. Thirty SCI females with injuries at or above the level of T6 with upper motor neuron dysfunction affecting the sacral spinal cord will comprise the experimental subjects. Ten able-bodied females matched on age, race and socioeconomic status will comprise the control group. Comprehensive neurologic, neurophysiologic and psychosexual evaluations to determine pre-morbid and post-SCI functioning will be performed on all subjects. Subjects will be grouped based on the presence of the ability to perceive pin prick sensation in the T11 - L2 dermatomes and will undergo three experimental protocols: (1) Manual Stimulation - to determine physiologic sexual responses to isolated reflex genital stimulation; (2) Orgasm - to determine the autonomic and genital responses accompanying orgasm including the incidence of autonomic dysreflexia during sexual activity in women with injures above the level of T6; and (3) Visual and Manual Stimulation - to determine the physiologic sexual responses to isolated psychogenic stimulation and combined psychogenic and reflexogenic stimulation. In addition, a hypertensive treatment protocol will assess the efficacy of nitroglycerin 2 % ointment in the amelioration of the dysreflexic response associated with sexual stimulation in SCI women. Results will help determine the association between neurologic degree and pattern of spinal injury with psychological and physical sexual responses including preservation of specific types of lubrication. Results will be useful in developing treatment methods for sexually dysfunctional SCI women and for delineation, of the neurologic pathways necessary for reflex and psychogenic vaginal responses.
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