• Sipski ML (2001). Sexual response in women with spinal cord injury: neurologic pathways and recommendations for the use of electrical stimulation. J Spinal Cord Med. 24 (3): 155-8. Summary: BACKGROUND: Determination of the exact level and degree of a woman's spinal cord injury (SCI) has allowed researchers to document the aspects of sexual response that are altered with specific patterns of SCI. Based on these findings, recommendations can be made regarding the development and testing of electrical stimulation systems designed to facilitate sexual responses in women with SCI. DESIGN: Literature review. FINDINGS: Studies of the arousal stages of response indicate that psychogenic vaginal lubrication is maintained with pinprick sensation in T11-T12 dermatomes, and that reflex lubrication occurs in women with upper motor neuron injuries affecting the sacral segments. Studies of the orgasmic stage support the hypothesis that orgasm is a reflex response of the autonomic nervous system that appears to depend on an intact sacral arc. CONCLUSIONS: Laboratory studies of arousal and orgasm among women with different types of SCI, and comparisons with able-bodied controls, provide valuable information regarding female sexual neurophysiology. Electrical stimulation can be used to improve sexual response, as well as bladder and bowel function. Interventions that interfere with the sacral reflex arc, such as sacral rhizotomy, can impair the ability to achieve orgasm. To develop alternative treatment protocols, further investigation of sexual response and orgasm is recommended. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11585234> Clinical Neurologic Surgery, University of Miami School of Medicine, DVA Hospital, Florida, USA. msipski@miamiproject.med.miami.edu

• Sipski ML, Alexander CJ and Rosen R (2001). Sexual arousal and orgasm in women: effects of spinal cord injury. Ann Neurol. 49 (1): 35-44. Summary: Sexual disorders are common in women; however, the neurological basis of female sexual response has not been adequately investigated. This information is necessary to characterize the impact of various neurological disorders on sexual arousal in women and to develop appropriate management strategies for sexual dysfunction. To assess the spinal mediation of sexually stimulated genital vasocongestion in women, we conducted two laboratory-based, controlled analyses: (1) of women's genital, subjective, and autonomic responses to audiovisual erotic and audiovisual erotic combined with manual genital stimulation; and (2) of women's ability to achieve orgasm. Subjects included 68 premenopausal women with spinal cord injuries (SCIs) and 21 able-bodied, age-matched controls. Results indicated that preservation of sensory function in the T11-L2 dermatomes is associated with psychogenically mediated genital vasocongestion. Less than 50% of women with SCIs were able to achieve orgasm, compared with 100% of able-bodied women (p = 0.001). Only 17% of women with complete lower motor neuron dysfunction affecting the S2-S5 spinal segments were able to achieve orgasm, compared with 59% of women with other levels and degrees of SCIs (p = 0.048). Time to orgasm was significantly increased in women with SCIs compared with able-bodied controls (p = 0.049). Independent raters were unable to differentiate between subjective descriptions of orgasm from SCI women compared with controls. This information should be used when counseling women with spinal dysfunction about their sexual potential. <http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&li st_uids=11198294> Department of Neurological Surgery, University of Miami School of Medicine, FL, USA. m.sipski@worldnet.att.net