SEXUAL FUNCTION OF WOMEN AFTER SPINAL CORD INJURY: PRACTICAL PREPARATIONS FOR SEX

Sexual activity after a spinal cord injury is usually more successful if you do some advanced planning. You need to consider mobility issues, such as transferring and positioning, and muscle spasms. More importantly, you probably want to minimize the risk of a bowel or bladder accident during sex. Emptying your bladder before sexual activity will help. If you are on a regular bowel program, the chance of a bowel accident is small. But if your bowels are not regular, you may want to empty them before sex. Protective pads on the bed make quick clean up easier in the event of an accident. Keeping towels on hand is also useful. Avoiding eating or drinking just before sex, or limiting your fluid intake for several hours before sex, can help minimize bladder and bowel accidents.If you use intermittent catheterization, you can catheterize just before sex to empty your bladder. Both men and women can have sex with an indwelling catheter in place. A woman should tape the catheter to her abdomen with surgical tape to avoid dislodging it during sex. A man can fold the catheter back along the side of his penis and cover both with a condom before intercourse. Of course, if you prefer, the catheter can be removed before sex and then reinserted.A woman using a diaphragm for birth control may need help from her partner to insert it. You may want to include this in your sexual encounter, or prepare ahead by inserting the diaphragm yourself or getting assistance.If you have any questions about how to make physical preparations for sex, how to minimize accidents, or how to avoid spasms during sex, ask your doctor. Once you are fully informed, communicate with your partner about the necessary preparations, who will perform them, and the possibility of accidents and how you’ll deal with them. The better you prepare your partner, the more relaxed both of you will be and the greater the likelihood of a pleasurable experience.
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HEALTHY BONES, HEALTHY BODY: BONE LOSS

Over the course of your life, you go through four phases of bone development. For the first part of your life, you build bone. You then have a relatively short plateau phase, when you’re maintaining the bone mass you’ve built up at basically peak levels. As you age, resorption overtakes formation, giving you a third phase, this one of bone loss. The fourth stage is also one of loss, but with the additional complication of formation and deposition slowing down (as well as breakdown picking up).Throughout infancy and childhood and into young adulthood, your bones are growing longer, wider, and thicker, and getting denser (phase one). Adolescence is a particularly busy time for your bones, as the sex hormones that drive puberty also spur bone growth. Half of all bone is made during the teen years. Even after you stop growing taller (and your bones stop growing longer), bone mass still increases as long as formation stays ahead of resorption. By the time you are 20, 90 percent of your bone mass is set. You still build, slowly, for a few more years, and reach peak bone density in your mid to late 20s. You generally stay there for about a decade (phase two).But by age 35 or so, you start phase three. Just about everyone begins to experience a slow decline in bone mass—0.5 to 1 percent a year—as resorption proceeds faster than deposition. For women, there is a drastic increase in the rate of bone loss for the first five to ten years after menopause—jumping to 3 to 5 percent lost each year—because of the decrease in estrogen (for women not taking hormone replacement therapy) and progesterone. Postmenopausal osteoporosis shows up in women between the ages of 50 and 65, generally. It is no surprise that the fracture rate accelerates greatly ten to fifteen years after menopause.Women who undergo surgical menopause (having their ovaries removed) lose twice as much bone as other women at menopause, because even after menopause the ovary produces a small amount of estrogen, along with other hormones important to bone health. Women who have a hysterectomy but keep their ovaries also lose bone at an accelerated rate (though not as quickly as women with no ovaries), probably because the uterus makes vitamin D, which is necessary for healthy bones. Rapid bone loss may begin a year or two before your period actually stops, especially in the spine (and other trabecular bone). In fact, the rate of hip fractures rises dramatically for women in their early 40s, well before the average age of menopause. Over a third of premenopausal women lose bone faster than even the expected rate of loss, and for them, taking action is particularly important.Men, too, have an acceleration in bone loss, but not until much later, around ages 60 to 65, probably connected to the decrease in testosterone. Without additional complications, they never lose as much as women do in menopause, but still, losing 1 percent of bone mass a year really adds up.Eventually, the rate of loss slows again (for women) to about 1 percent a year throughout the rest of their lives, putting men and women on an equal footing by that point. But now you have an additional problem (phase four): your rate of bone formation is slowing down too, so you have more to contend with than just overenthusiastic bone breakdown. We absorb less calcium as we get older and make less vitamin D, meaning that bodies have less in the way of raw material to work with in building bone. On top of that, the older we get, the poorer our overall diets tend to be, for a variety of reasons. Combined with lower than optimal levels of hormones, low bone density becomes a serious risk.Over an average lifetime, a woman loses 30 to 40 percent of her total bone mass, and a man about 20 to 30 percent. By age 80, many women have lost two-thirds of their skeletons. Because trabecular (spongy) bone is softer to begin with, most bone loss begins there. Loss in the spine begins as early as the 20s. Cortical bone is denser to begin with, and loss there generally doesn’t occur at all until after age 50. Overall, more trabecular bone than cortical bone is lost. In the years just after menopause when the most bone is lost, women lose about 10 percent of their cortical mass and 25 percent of their trabecular bone mass, before the rate of loss slows again, and end up with a lifetime decrease of about 35 percent of cortical bone and 50 percent of trabecular. It is the dramatic decrease in trabecular bone (predominant in the spine) that causes women to shrink—losing up to 6 inches of height by the time they are 80. Men lose about 25 percent of the total of both kinds of bone over their lifetimes.After bone loss starts, each decade increases your risk of fracture about one and a half times. A high rate of bone turnover puts you at increased risk regardless of your bone density, and low bone density most certainly ups your risk. The younger you are when your bone loss begins or quickens, the higher your risk of fractures will be later in life. That’s just another way to say it’s never too early to start on the 6-Week Bone Density Program. It is also never too late.*16\228\2*

THORACIC AND SACRAL SPINAL CORD INJURY

Thoracic Spinal Cord Injury
The thoracic spinal cord is protected by vertebrae that are stabilized by a marvelous anatomical bracing system – the rib cage. Because of this protection, thoracic spinal cord injuries are uncommon, but this region can be injured in shootings, stabbings, and severe accidents. Some patients require surgery to decompress the thoracic spinal cord, and surgery can be difficult because this part of the spinal cord is so close to the lungs and kidneys. Most patients need to wear a brace on the trunk after surgery, to provide extra stability to the healing vertebral column.
Traction is typically not needed, given the stability provided by the rib cage.

Lumbar or Sacral Spinal Cord Injury
With trauma to the lower back (sacral vertebrae); the injury often occurs in the cauda equina, not the spinal cord itself. If the injury involves the uppermost part of the lumbar vertebrae, the lowermost portion of the spinal cord, the conus medullaris, may be damaged. Injuries of the conus medullaris and the cauda equina usually cause weakness of the lower limbs and loss of bowel and bladder control.
These injuries often require surgery and external spinal stabilization, because the lower back has no bony protection to hold the vertebrae in alignment. Several kinds of external stabilization are used. The first is the thoraco-lumbar-sacral orthosis (TLSO), or “clam shell” brace. The TLSO is a custom-molded, form-fitting device that surrounds the body, front and back, extending from the upper back and chest down to the lower back and groin. It usually has Velcro straps so that it can be removed for bathing. For lesser degrees of external stabilization, various other back braces and corsets with metal stays are used. These are more comfortable than the TLSO but provide less support to the spine.

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