Spinal Cord Injury and Sexuality: The Utilization of Clinical Practice Guidelines by the WOCN

There are approximately 250,000 Americans currently living with spinal cord injury (SCI) and an estimated 11,000 new injuries occur annually. One of the profound effects of SCI involves the gastrointestinal (GI) system. Changes in sympathetic and parasympathetic enervation result in increased colorectal transit time, loss of colonic compliance, and changes in sphincter tone and pelvic floor musculature. This often leads to symptoms of constipation, fecal incontinence, and autonomic dysreflexia. GI symptoms are usually managed conservatively with fluids, diet and a scheduled bowel program.  When symptoms become severe, surgical options may include the creation of a fecal diversion. An ostomy may also be performed for management of a perianal pressure ulcer.

It is probable than that at some point, the WOCN may care for a SCI patient with a new ostomy. The successful rehabilitation of this patient should address areas such as the type of surgery, resulting effluent, pouch management, medications, diet, fluid intake, odor, and activity. 

One of the most difficult topics for education may relate to intimacy, not only implications with an ostomy, but also general changes in sexuality following SCI.  The WOCN however, may not have a good understanding of some of the issues following SCI, and thus may not feel entirely comfortable discussing sexuality. A new tool has been developed that can act as a resource for this discussion. 

The Consortium for Spinal Cord Medicine recently published “Sexuality and Reproductive Health in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-Care Professionals”.  These guidelines include recommendations that address physical, interpersonal, emotional and medical concerns.  Of particular interest to the WOCN may the recommendations pertaining to bladder and bowel, skin care, positioning, spasticity and autonomic dysreflexia. This poster will provide an overview of these guidelines with suggestions on how the WOCN can incorporate them into practice.