300 Section - Impact of Spinal Cord Injury on Sexual Well-being: A Systematic Review

PRISMA 2020-compliant systematic review (PROSPERO CRD42024512418). Searched six databases (PubMed, CINAHL, Scopus, Embase, APA PsycNET, Web of Science) August 7-8, 2024, for 2000–2024 English cross-sectional studies on SCI sexual well-being in adults ≥18 years; included reference/grey literature checks. Included peer-reviewed original data only; excluded non-cross-sectional, pediatric/pregnant, reviews/protocols. Rayyan for deduplication and dual independent screening (four reviewers); data extraction by three using piloted Excel; AXIS quality assessment (84.6% high quality). Narrative synthesis (sexual activity/adjustment); no meta-analysis due to heterogeneity. 26 studies, 3805 participants.

Results:

From 26 cross-sectional studies (n=3805 adults with SCI), sexual activity declined markedly post-injury: frequency dropped (e.g., >50% reduction in intercourse), erectile function impaired in most men (60-100% dysfunction), ejaculation/orgasm capability fell (20-50% retained), women reported reduced arousal/lubrication (30-60% affected) and altered sensation. Many shifted to non-genital stimulation, kissing/touching, or fantasy for intimacy.

Sexual adjustment was more psychosocial than physical: key barriers included body image issues, low self-confidence, fear of rejection, and decreased libido (affecting 40-70%). Positive adjustment correlated strongly with partner support, relationship quality, and communication; stable partnerships reduced embarrassment/dysfunction. Over time, some improved via mutual adaptation. Psychological/relational factors outweighed injury level/severity in predicting satisfaction and reintegration.

Conclusion:

Spinal cord injury severely impairs sexual well-being, reducing activity (frequency, arousal, erection/ejaculation in men, lubrication/orgasm in women) and satisfaction. Psychosocial factors—body image issues, low confidence, fear of rejection—often outweigh physical limitations. Positive adjustment relies on partner support, communication, and adaptive intimacy strategies; injury severity matters less than relational quality. Comprehensive rehabilitation must include sexual counseling, psychological support, and partner involvement to promote reintegration, intimacy, and quality of life. Sexual health integration into routine SCI care is critical.