Psychological Assessment and Therapy for the Spinal-Cord-Injured Patient

Abstract

Disorders of sexual function occur frequently in patients with spinal cord injury, but have not until very recently been studied in a systematic fashion. The frequent occurrence of this disorder is clearly related to the fact that the sexual organs are directly controlled by components at all levels of the nervous system, ranging from the peripheral nerves to the cerebral hemispheres. In addition, it must be emphasized that sexuality is not just a biologic function, but also has complex psychological and social aspects. The work of ethnologists, such as Lorenz (25), has shown this to be true for most animal species. In humans, this aspect of sexuality appears to be particularly important. Small children, when asked to identify themselves, often respond by saying, “I’m a boy” or “I’m a girl,” their gender providing a source of personal identification. Frequently, how well individuals perform sexually determines how much of a “man” or a “woman” they see themselves to be. Given this system of beliefs with respect to the emphasis on sexuality and sexual performance, a great deal of anxiety becomes attached to situations in which sexual behavior is expected. These added meanings and expectations impart considerable importance to sexual behavior and have contributed to the fact that human sexuality consists of much more than reproductive function. These factors may help explain why sexual functions are highly vulnerable to all types of severe and chronic diseases, particularly diseases of the nervous system, which so frequently disrupt motor behavior.