600 Section - Autonomic Dysreflexia Triggered by Occupational Sexual Activity in a Woman With T8 Spinal Cord Injury: A Case Report

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

HB

Harbir S. Bhatti, MD

Medical Student
California University of Science and Medicine
Anaheim, California, United States
GQ

Gary Qiao, MD

Medical Student
California University of Science and Medicine
Colton, California, United States

Co-Author(s)

VJ

Vance Z. Johnson, MD

Professor of Medical Education
California University of Science and Medicine
Colton, California, United States

Case Diagnosis: Autonomic dysreflexia (AD) precipitated by sexual activity in a woman with chronic thoracic spinal cord injury who resumed occupational sexual activity following injury. This case highlights a rare, clinically significant presentation of AD associated with sexual activity as a domain of occupational participation, underscoring the need for anticipatory counseling and prevention strategies.

Case Description: A 29-year-old woman with complete T8 paraplegia (ASIA A), three years post–spinal cord injury, presented to a Physical Medicine and Rehabilitation clinic. Prior to injury, she worked as a professional escort and resumed occupational sexual activity approximately 18 months post-injury. During one encounter, she experienced her first episode of autonomic dysreflexia, characterized by acute symptoms consistent with AD. She promptly recognized the episode and managed it by assuming an upright position, resulting in symptom resolution. No prior history of AD had been reported. This episode prompted counseling regarding AD risk, trigger recognition, and preventive strategies related to sexual activity.

Discussions: Autonomic dysreflexia is a potentially life-threatening condition commonly occurring in individuals with spinal cord injuries at or above T6, though it has been reported in lower thoracic injuries, including T8. Sexual activity is a known trigger of AD, yet sexual health concerns in women with SCI remain underrecognized in rehabilitation settings. Occupational sexual activity represents an underreported context for AD. This case highlights the importance of addressing sexual activity within a functional and occupational framework, emphasizing patient education and individualized management strategies to reduce morbidity and support safe participation in meaningful life roles.

Conclusions:
To our knowledge, no prior reports describe autonomic dysreflexia occurring in the context of occupational sexual activity in women with spinal cord injury. This case underscores the need for comprehensive, nonjudgmental sexual health counseling that considers occupational participation and safety. Increased awareness and proactive management of AD risk may reduce complications and improve rehabilitation outcomes.