SPINALCORD: Research Update: A Multi-Center Study on Women's Self-Reported Reproductive Health Following SCI

This article is from the Pushin' On Newsletter, Vol 18[2], Summer, 2000.

This column updates research conducted by 10 Model Regional Spinal Cord Injury Systems of Care. The work was supported by grant #H133N50009 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, DC. For more information call 205-934-3283 or email: rtc@uab.edu.

Perhaps because only 20% of individuals with spinal cord injury (SCI) are women, information on specific gynecological, menopausal, sexual, and obstetrical concerns have evolved slowly. This is Part 2 of 2* updates on a self-reported study documenting these unique reproductive health concerns. 472 women with SCI were interviewed. The average age of those interviewed was 40, and their average age at the time of injury was 32. Participants in the study were demographically similar to previously published data on age of injury, level of injury, extent of injury and bladder management methods after SCI.

Sexual Behavior

Sexual Intercourse: 87% of all women pre-injury (before SCI) and 67% of all women post-injury (after SCI) reported participating in sexual intercourse. The duration and level of injury was a significant predictor of sexual intercourse post-injury. 49% of women 1 year post-injury, 65% 2 - 10 years, and 76% of women 11 years or more post-injury reported participating in sexual activity. Also, 62% of women with cervical injury, 70% with thoracic injury, and 82% of women with lumbar/sacral injury reported participating. The extent of injury (complete or incomplete) was not a significant predictor of participation in sexual intercourse.

Problems: Problems reported by all women while engaging in sexual intercourse were compounded after injury. Autonomic dysreflexia (AD) and bladder incontinence are complications that differ depending on level of injury. 18.9% of women with cervical injury, 5.8% of thoracic injury, and 7.1% of women with lumbar/sacral injury reported problems with AD while participating in sexual activity. Similarly, 12% of women with cervical injury, 21.9% of thoracic injury, and 7.1% of women with lumbar/sacral injury reported problems with bladder incontinence while participating. 12.4% of women who were 11 years or more post-injury reported a problem during intercourse with foley catheters when compared to 3.1% of women who were less than 11 years post-injury.

Orgasm: 79.1% of all women responding reported experiencing orgasm pre-injury, and 37.3% reported experiencing orgasm post-injury. Among women who were sexually active post-injury, 54.2% reported experiencing orgasm. In this same group, 71% reported experiencing pleasure above the level of injury during sexual activity, 29.6% reported extra genital pleasure without orgasm, and 41.4% reported extra genital pleasure with orgasm. Additionally, 12.8% of women post-injury reported experiencing orgasm without extra genital pleasure, and 16.2% reported neither extra genital pleasure nor orgasm.

Birth Control: 70.3% of women who were sexually active post-injury reported using various methods of birth control, while the remaining 29.7% reported using no birth control. There were no statistically different methods of birth control reported by women pre- and post-injury.

Obstetrical Experience

Pregnancy: 52.1% of women reported at least one pregnancy pre-injury with an average of 2.7 pregnancies per woman. The percentage of women who reported at least one pregnancy post-injury fell to 13.9% with an average of 1.53 pregnancies per woman. A majority of women (63.5%) post-injury became pregnant for the first time, which represented 8.9% of all women who reported at least one pregnancy. 36.4% of women who reported pregnancy post-injury had had a pregnancy pre-injury. 29.3% of women reported having had only one pregnancy before injury compared to 60.6% of women with SCI. Pregnancy outcome trends were interesting. 78% of all women reported giving live births. However, there were a reported 12.7% of miscarriages before injury compared to 6% after injury. The frequency of abortion was 6.5% pre-injury and 14% post-injury.

Complications: 45.5% of women post-injury reported complications with urinary tract infection (UTI) during pregnancy compared to 8.2% pre-injury. 75% of women with SCI reported at least one complication during pregnancy, which was statistically greater than reported by women pre-injury (49.8%). Other complications exclusive to women with SCI included AD (12%), pressure ulcers (6%) and increased spasticity (12%). About 11% of women post-injury reported having difficulty with transferring near the end of pregnancy, and 4.5% reported to no longer be able to push a wheelchair. 15% of women reported having added leakage around their indwelling catheter, and 9.1% reported having an onset of significant bladder spasms that actually expelled the catheter. 27.3% of women on intermittent catheterization reported a more frequent need to catheterize, and about 25% reported a change in bladder management.

Labor and Delivery: 62% of women pre-injury experienced typical labor symptoms of uterine contraction, labor pains, and/or rupture of the membranes. Women with SCI reported symptoms such as pain above the level of injury (41%), abnormal pain (29%), ruptured membranes (53%), increased spasticity (15%), AD (18%), and increased bladder spasms (17%). Some women with SCI reported normal symptoms during labor, and some reported having no sensation. 62% of women reported a higher frequency of spontaneous vaginal delivery pre-injury compared to 48% of women with SCI. In addition, women with SCI reported more frequent c-section and forceps or vacuum delivery. 1.9% of women pre-injury and 4% of women post-injury reported breech presentation. Women with SCI reported having more problems with blood pressure instability during delivery than women pre-injury. Women with SCI also reported an increase in frequency of premature (prior to 36 weeks gestation) labor and delivery.

Baby at Birth: Pregnancies post-injury were more likely to produce non-premature low birth weight babies of less than 5 lbs 6 oz. There was a trend for women with SCI to have infants that have difficulty breathing at birth. Although not statistically significant, other problems of the baby at birth reported by women with SCI included the baby having a fever, the need for a blood transfusion, or jaundice.

Breast Feeding: 28% of women pre-injury reported breast-feeding their babies compared to only about 11% post-injury.

Conclusion

This study serves as a description of the unique reproductive health concerns of women pre- and post-spinal cord injury. Although the complete consequences and effects of injury are still unknown, some health concerns may be more problematic for women with spinal cord injury.

Jackson AB, Wadley V. A multicenter study of women's self-reported reporductive health after spinal cord injury. Archives of Physical Medicine & Rehab. 1999;80:1420-8.

*Part 1 of this study is available in the last Research Update and included gynecological and menopausal issues.

Pushin' On is supported by grants #H133B980016 and #H133N50009 from the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education, Washington, D.C. Opinions expressed in Pushin' On are not necessarily those of the granting agency.

Research Update: A Multi-Center Study on Women's Self-Reported Reproductive Health Following SCI - Part 2