Introduction

Despite society often viewing individuals with spinal cord injury (SCI) as asexual, sex and pregnancy remain aspects of a fulfilling life. SCI itself does not necessarily preclude pregnancy for most women, and for many men with SCI, their fertility is not affected by their injury. Despite this, there is a paucity of research on pregnancy and fertility for individuals with SCI. This presentation will present results from a survey on pregnancy and fertility for men and women with SCI.

Methods

253 men and women with various levels of SCI completed a survey on family planning for individuals with SCI. Participants were from multiple areas of the United States with ages ranging from 19 to 75 (male mean = 48.74, female mean = 44.32) and years since diagnosis ranging from 2 to 57 (male mean = 13.75, female mean = 12.79).

Results

Sixty percent of the women surveyed had been pregnant at some point in their lives, and 53.5% of the men reported their partner having been pregnant. When asked about fertility, only 9.4% of the men and 4.3% of the women reported being unable to have children due to their SCI. Thirteen percent of the sample had met with a fertility specialist, 7.1% reported themselves or their partner taking part in a fertility evaluation, and 4.3% reported themselves or their partner having received fertility treatment.

Participants were asked about how their SCI affected their attitudes towards having children. For this section, only the 129 respondents who had not completed their family planning decisions are included in these analyses (78 men and 51 women). When asked about whether or not SCI affected their decisions about having children, just over 40% of men reported that their decision largely unaffected by SCI (30% of women), while 57% of women reported that their decisions were affected by their SCI (46% of men). Around 40% of men and 21% of women reported being “not at all” or “a little” worried that their SCI would affect their ability to care for a child, while 35% of men and 60% of women reported being “quite a bit” or “extremely” worried about the effect of their SCI on their ability to care for a child. Finally, over 25% of women were “extremely” worried about potentially becoming a burden on their children because of their SCI, while only 10% of men reported the same.

Conclusions

While research on pregnancy and fertility for individuals with SCI remains lacking, there is even less information about the psychosocial impact of SCI on family planning and fertility. Professionals who work with people who have sustained SCI in many settings should understand the impact of SCI on fertility and family planning. Additionally, the psychosocial concerns around pregnancy for individuals with SCI is an essential part of ensuring access to pregnancy and parenting for individuals with SCI. This presentation will help to inform our understanding of pregnancy and fertility for both men and women with SCI, providing necessary information on an under-researched topic.

Introduction: Sexuality is rarely discussed in the sphere of disability despite being a basic need and a form of human pleasure. Spinal cord injury is a devastating life event with long term functioning implications, including changes in sexuality. A host of internal and external factors impact on sexuality of those with a spinal cord injury, including physical condition, psychological wellbeing and socio-cultural dynamics. High incidence rates of spinal cord injury in South Africa, a country where inequalities are astronomically vast, results in a large number of individuals dealing with consequences in an over-burdened public health system. With a lack of equitable acute care and rehabilitation in South Africa, it remains important to gain an understanding of sexual health management in this context. The aim of this study therefore was to explore how people with a spinal cord injury experience sexual function and intimacy and further understand how they are supported in regaining sexuality.
Methods: In this qualitative study, open ended, semi-structured interviews were conducted with 10 participants in the City of Cape Town, South Africa. A combination of purposive and snowball sampling was used to identify individuals with paraplegia, who were all users of the public health system and had sustained their injury more than 1 year ago. Inductive content analysis was employed to analyse the data.
Results: In one accord, participants expressed sex and intimacy as an important life area contributing to their wellbeing post injury, with many of them in meaningful relationships today. Unanimously, participants shared numerous challenges consisting of both physical acts and emotional wellbeing which needed to be addressed in order to manage their sexual life. Challenges to being intimate with a partner included bowel and bladder activity (from both a functional and psychological viewpoint), adapting to erectile dysfunction, a loss of sensation and a lack of desire. High importance was placed on satisfying the partner often due to low self-esteem and a fear of rejection. Another important challenge related to health care insufficiency whereby the majority of men expressed a lack of information and procedures available (such as sperm extraction) surrounding fertility. As a collective, participants felt that rehabilitation and community services neglected sexual health management and importance was placed on increasing peer support which was seen to be vital to positive outcomes. There was an overall trend of stigma and society adding an extra barrier to participants reclaiming sexuality, at times appearing more influential than the direct consequences of the injury itself.
Conclusions: Sexuality and spinal cord injury together are complex but there is no reason why individuals cannot find meaning in sex and intimacy again provided that they are well supported in the process. Health systems of South Africa should be strengthened to support optimal sexual health outcomes of persons with spinal cord injury.

Introduction: Spinal cord injury (SCI) is a devastating ailment and greatly hampers the quality of life of an individual. Sexuality and fertility are affected to different degrees in SCI depending on the level, type and severity of injury and the condition of the individual.. Major challenges are faced by spinal cord injured individuals in addressing sexual and fertility health in a country like India where conservative families are predominant. Yet, most of the literature focuses on physiological disturbances and the role of self awareness (knowledge) and social issues are rarely addressed.

Objective: To identify the self-awareness, response, issues and needs related to sexual health in Indian Community.

Methodology: SCI individuals who were discharged to the community from the institution between 2017-2018 were followed up via telephonic and a personal interview. A set of open-ended questions on sexual health awareness which included family planning, psychological, social factors, risk factors, clinical barriers, patterns and positions etc. were asked and noted. Qualitative data analysis and synthesis was done and the themes on which education is required were identified.

Result: The SCI were divided into two groups 18- 45 years,( n=116, 89 males, 27 females) and > 45 years (n=95, 62 males, 33 females) were interviewed. SCI individuals above 45 years of age responded casually, showed no desire and concerns about sexual health. Over half of 79 SCI (n= 72 males and 7 females) veterans aged between 18-45 years (68.1%) were not properly aware about sexual health and not interested in knowing about sexual health needs & challenges. The main reason ascribed was the social stigma associated with discussing sexual issues. Only 37 SCI individuals (n= 20 females, n=17 males) were keen to know about sexual health and asked queries. Also 6.6 % of females were not aware of sexual health 65 % of patients were not interested in knowing about the sexual needs and challenges. 59.45% of the patients reported urinary incontinence, 27.02% reported spasticity and 13.51% reported dizziness as a risk factor for under performance during sexual activities. These qualitative findings are presented in three themes for teaching purposes: (1) Access towards sexual health education (2) SCI specific sexual follow-ups as a health priority and (3) Strategies for spouse on sexual concerns.

Conclusion: Sexual health related issues affect a large segment of SCI individuals in Indian community. Social stigma is a major component which adversely affects the sexual health of an SCI individual. Sexuality is an important aspect of holistic well being and should be addressed timely. We need to work towards addressing patient’s expectations appropriately. Health care worker training in order to increase his/her comfort while discussing about sexuality with the patient is important. This would also improve effective communication. Further research is needed to address these challenges and to identify the best possible solutions to enhance the accessibility, awareness and education towards sexual health in Indian Community.

INTRODUCTION
Management of pregnancy and delivery in women with history of complex urologic reconstruction is challenging. The aim of this study was to report pregnancy and delivery outcomes in this specific population.
METHODS
We conducted a retrospective national study in 16 expert centers, including all women who had at least one successful pregnancy after a major urological reconstructive surgery.
RESULTS
We enrolled 68 women who presented 96 deliveries between 1998 and 2019. The underlying disease was spinal dysraphism (33), spinal cord injury (20), bladder exstrophy (10) and multiple sclerosis (2). Sixty-three underwent augmentation cystoplasty, 31 continent cutaneous urinary diversion (CCUD) (4 isolated) and 6 artificial urinary sphincter (AUS) implantation (1 isolated). During pregnancy, 45 women (55.5%) were under antibioprophylaxis: febrile urinary tract infection (UIT) rate was of 34.8% (16) in the antibioprophylaxis group compared to 31.4% (11) in the non-antibioprophylaxis group (p=0.751). We observed 13.5% renal colic (13) and 14.6% (14) required ureteral stenting or nephrostomy. Ten percent reported difficulties in self-catheterization during pregnancy. Concerning patients with CCUD, we observed a higher rate of difficulties when the stoma was located in the right iliac fossae (2/9), compared to umbilical position (1/15). 13.5% (13) reported de novo or increased urinary leakage during pregnancy.
Concerning delivery mode, 51% gave birth by a planned C-section, 31% by vaginal delivery, 5% by instrumental vaginal delivery, 13% by emergency C-section for spontaneous labor or for fetal suffering. 35.3% of the newborns were preterms, with a median gestational time of 36 weeks [21-41]. Median fetal weight was 2740g [429-4090g]. Of the 96 newborns, 3 died at birth. 19 planned C-section got complicated (33%), mainly by injury of the urological reconstruction (9 C-sections through ileocystoplasty, 4 digestive injuries, 1 section of the vascularization of continent channel, 2 sections of AUS tubes, 1 vesico-cutaneous fistulae, 1 ureteral stricture, 2 surgical hernias of Pfannestiel incision).
Concerning functional outcomes after delivery, 85% (72/85) of the women were continent at 6 months, compared to 91% (62/68) before pregnancy. The mode of delivery (C-section or vaginal) did not seem to impact these results (p=0.293), nor did multi-parity (p=0.572). 6% reported persistent urinary incontinence after delivery, with no statistical difference related to delivery mode. 8.3% of them required surgical management. Four women required surgery for secondary pelvic organ prolapse.
CONCLUSION
In conclusion, in most of cases, women with LUT reconstruction have normal pregnancies and produce healthy babies. There is a greater need for monitoring during pregnancy because of a higher rate of UTI, upper tract obstruction, catheterization difficulties, and pre-term labor.
In our serie and in the literature, planned C-section still represents the predominant mode of delivery in this population, despite a very high rate of urinary reconstruction’s injury. Moreover, vaginal delivery appears to be safe, and seems not to increase incontinence.
Vaginal delivery should be proposed as the first option in this population, if there is no obstetrical, anesthesiological or neurological contra-indication. Interdisciplinary co- operation is required for a successful outcome.

Introduction: Pregnancy with spinal cord injury (SCI) poses challenges to the healthcare provider and patient. Knowledge gaps exist in many areas of obstetrical and maternal management for women with SCI.
Objectives: The primary objective of this study was to examine the incidence and prevalence of complications and other outcomes in pregnant women with SCI during pregnancy, labor, and delivery and which factors differ from their non-SCI peers.
Methods: Data was gathered prospectively, longitudinally and retrospectively through obstetrical chart review and self-reported measures in a ratio of 1 Pregnant Woman with SCI (SCI-P) to 2 Pregnant Able-Bodied Women (AB-P). Vital signs, urinalysis, and pregnancy-related complications were collected bi-monthly along with fetal, labor and delivery outcomes for all women. Autonomic dysreflexia, pressure sores, and UTIs were collected monthly from women with SCI.
Results: Eighteen patients were included: six SCI-P and twelve able-bodied (AB-P) peers matched by age (+/- 5 years), parity (firstborn vs. multiparty), and race.
Complications during the pregnancy were low however, SCI-P had statistically greater (p<.05) UTIs than the AB-P (three (50%) to 0 (0%), respectively). One SCI-P(17%) had pressure sores. None of the SCI-P reported autonomic dysreflexia during pregnancy, labor or delivery. Neither SCI-P or AB-P developed symptoms of Deep Vein Thrombosis (DVT).
Three (50%) of the SCI-P, compared to four (33%) of AB-P experienced complications at time of delivery. Newborn mean birth weight (2854 vs 3578g; p=0.12), and length (49.3 vs 45.8 cm; p=0.32) were lower for the SCI-P than AB-P, respectively, but not statistically. Newborn Head circumference however was statistically less for the SCI-P than AB-P (30.3 vs 34.5 cm, p=0.04, respectively). Mean APGAR scores at 1 minute (p=0.80) and 5 minutes (p=0.31) were similar between the two groups. None of the newborns to women with SCI-P and two (17%) newborns to AB-P women experienced breathing problems. One (17%) newborn of a SCI-P and two (17%) newborns to two AB-P required Neonatal Intensive Care admission after delivery.
Conclusions: Women with SCI tend to have more complicated courses of pregnancy, labor and delivery and smaller newborns than their peers. Their head circumference is statistically smaller—a fact never reported previously. UTI’s are greater and may have an impact on these findings. Larger, comparative studies should be performed to inform women with SCI seeking childbearing and their clinicians about challenges they may experience.

Spinal cord injury (SCI) results in severe deficits of urogenital functions, including ejaculatory dysfunction. Surveys among SCI men place recovery of sexual function as a high priority issue, but treatment development is hindered by limited understanding of effects of SCI on the spinal ejaculation generator (SEG). The SEG in rats and men consists of a population of lumbar spinothalamic cells (LSt) that control ejaculation via axonal projections to autonomic and motor centers in the lumbosacral spinal cord. LSt cells control ejaculation via release of multiple neuropeptides, including gastrin releasing peptide (GRP). In control male rats, intrathecal infusions of GRP strongly facilitate ejaculatory reflexes, while GRP antagonists prevent ejaculation triggered by stimulation of the dorsal penile nerve. We have recently demonstrated that SCI completely ablated ejaculatory reflexes in male rats. Here, we test the hypothesis that SCI causes disruption of expression of GRP, thereby leading to ejaculatory dysfunction. In a first study, male Sprague Dawley rats received either controlled spinal contusion at 200 Kdynes or sham treatment. Six-eight weeks later, spinal cords were processed to visualize GRP-immunoreactivity (n=9 Sham; n=11 SCI) and GRP mRNA (n=5 each) expression. Results showed that ejaculatory dysfunction was associated with significantly reduced expression of GRP mRNA and GRP protein in LSt cells. Next, we tested the hypothesis that GRP infusions may restore ejaculatory reflexes in SCI males. In a second study, four weeks after SCI or sham surgery (n=8 each), animals received an acute spinal transection to remove remaining supraspinal influence on the SEG and subsequent intrathecal infusions (10 µl) of saline and GRP 20-29 (0.2 nmol) while parameters of ejaculatory reflexes were recorded. In addition, the dorsal penile nerve was stimulated at frequencies that normally trigger ejaculation in control males (30 Hz) or subthreshold (5 Hz) and reflexes were recorded. Results demonstrated that GRP, but not saline triggered ejaculatory reflexes and facilitated sensory nerve-stimulated reflexes in a subset of the animal and equally in sham and SCI groups. In a third study, the effects of GRP infusions were again examined in sham and SCI male rats (n=4 each), but without the acute spinal transection prior to infusions. Results demonstrated that GRP, but not saline, triggered and facilitated ejaculatory reflexes with no differences between sham and SCI groups, but again in a subset of the sham and SCI animals. These results in male rats indicate that a reduction of GRP in the SEG following SCI may contribute to ejaculatory dysfunction. Moreover, the results indicate a partial recovery of ejaculatory function following intrathecal GRP infusions. Therefore, together these studies suggest that GRP be considered as a target for future development of treatment options for sexual dysfunction following SCI.