Spinal Cord Injury - Patient Education Manual
Contents
1. Must not be used gt during menstruation Toxic Shock risk gt if you have had Toxic Shock Syndrome gt for 12 weeks after giving birth Often less effective Diaphragm PONE Can be used only when needed Very effective when used correctly No side effects More effective if used with condom Can cause pressure against bladder leading to infections or unexpected urination May become dislodged in women with relaxed vagina Fit must be re examined periodically Cervical Cap ee ae No side effects May be worn longer than diaphragm Less spermicide needed than with diaphragm Can be used by women who cannot use a diaphragm due to loose vaginal muscles or bladder problems More effective if used with condom 8 19 Requires full hand function for insertion Cap cannot be used if you have had an abnormal PAP smear Toxic Shock or vaginitis cervicitis Which Birth Control Methods Might Suit You AIR ONE Advantages Protection against sexually transmitted diseases Easy to obtain no prescription Easy to use and dispose of No side effects Can use only when needed More effective if used with spermicide or barrier such as diaphragm Spinal Cord Injury Disadvantages May leak or tear especially if dried out Preparation necessary may limit spontaneity May decrease sensation for male Requires cooperation of male May require u2. gt Thickening gt Any changes If You Notice A Change See your doctor What To Check Vaginal discharge Who Does Check You or a carer When Daily How To Do Be aware of discharge that is gt Very thick gt Like cottage cheese gt Bubbly gt Grey green or yellow gt Bad smelling gt Causing redness or a rash If You Notice A Change See your doctor 10t Edition Dec 2008 8 18 Which Birth Control Methods Might Suit You Spermicides Advantages Easy to obtain no prescription Can use only as needed More effective if used with a condom Provides vaginal lubrication m Spinal Cord Injury Disadvantages Must be used at time of intercourse can limit spontaneity Somewhat messy may discourage oral sex Insertion may be difficult if hand function limited Chemicals may irritate both partners Often considered less effective Contraceptive Sponge 1 2 3 4 5 6 7 8 Easy to obtain no prescription May be used for repeated intercourse May be inserted several hours before Easy to insert and remove if full hand function Do not need to add spermicide Sponge absorbs semen making method less messy String loop assists removal More effective if used with a condom OP WN FIJOT ROUN May have difficulty removing sponge may tear Requires full hand function to insert Must be left in 6 hours after intercourse Occasionally irritates male partner
3. A amp P Workbook A Complete Study Guide to Anatomy and Physiology Marieb E 8 30 Spinal Cord Inju The Vulva Mons Pubis Labia Majora spread Clitoris hral orifi Urethral orifice Labia Minora Vaginal orifice Hymen Anus Illustration reproduced from The A amp P Workbook A Complete Study Guide to Anatomy and Physiology Marieb E 8 31
4. cause skin irritation and give you better protection during transfers You should change them often at least three times a day to avoid the risk of toxic shock syndrome If you have trouble inserting a tampon due to limited hand function try using a lubricated tampon or get your carer to assist you If you use napkins check regularly for signs of skin irritation and pressure between your legs Exploring Your Sexuality Despite changes in sensation and response people with spinal cord injuries report that they have a satisfying sexual life following injury As is true with any relationship the key to satisfactory sexual experience is good communication Being aware of your partner s likes and dislikes and being able to express your own are fundamental to good communication Some experimentation can enhance sexual pleasure Experimentation can involve physical contact such as changes in sexual positioning or techniques or it can involve emotional options such as courting Some options will appeal to you and others will not the important thing in every case is that you use ideas that are comfortable for you 10 Edition Dec 2008 8 11 Spinal Cord Injury Many spinal cord injured people have found that the traditional position of the man on top is not the most satisfying for either partner This can be especially true if the injured partner is male Using a side to side or women on top position in this case allows the woman to b
5. fertilise the female s egg and result in pregnancy Testes also produce hormones that cause male sex characteristics such as a deep voice and facial hair gt Sperm moves from the testes into the epididymis a coiled tube where sperm is stored gt As sexual excitement builds sperm moves from the epididymis through a tube called the vas deferens During this movement sperm is joined by fluids released from the seminal vesicles the cowpers glands and the prostate gland Sperm and these lubricants together form semen gt Semen moves into the urethra a tube that allows both semen and urine to pass out of the body gt The urethra runs through the penis The penis is the external male sex organ filled with spongy tissue that can retain blood It contains two shafts called the corpora cavernosa During sexual excitement these shafts fill with blood making the penis larger and harder causing an erection gt During orgasm and ejaculation muscle contractions force semen out through the 8 22 Spinal Cord Injury urethra When ejaculation occurs during sexual intercourse the sperm travels up into the woman s body and can fertilise an egg if one is present The Female Reproductive System The parts of the female reproductive system are described below They are gt The ovaries two oval shaped female sex organs one of which releases an egg each month When the female s egg combines with the male s sperm fertilisation
6. have occurred using this method You can be taught this technique and any associated risks in an outpatient clinic at Hampstead Rehabilitation Centre For most couples this technique can be managed in the privacy of your own home without any further medical intervention Still another method used is electroejaculation This procedure is carried out by a physician A probe that conducts electrical impulses is inserted into the rectum These electrical impulses stimulate an ejaculation The external or retrograded ejaculations semen entering the bladder are collected and processed for use in insemination Again numerous pregnancies have resulted from this technique There are other less used techniques including drugs that stimulate ejaculation All methods of assistance to obtain a pregnancy should be discussed with your SIU doctor first The SIU Outpatient Department may be able to offer techniques for no or minimal cost These avenues should be tried before assistance from often expensive other hospital agencies is explored Some techniques may have associated complications such as triggering autonomic hyperreflexia Your SIU doctor will be aware of this and monitor the likely effects 10 Edition Dec 2008 8 7 Spinal Cord Injury The cost of assisted pregnancies increases with the degree of clinical processing and all methods should be discussed with a physician since medical complications can result from any of the
7. occurs The ovaries also produce hormones that generate female sex characteristics such as breast development and a wider pelvis gt As an egg is released from an ovary it is drawn into one of the fallopian tubes where it can be fertilised gt From the fallopian tube the egg moves into the uterus whether it has been fertilised or not The uterus is a pear shaped mass of muscle located deep inside the lower abdomen The primary function of the uterus is to house and protect the developing baby During pregnancy muscle fibres of the uterus stretch as the foetus grows gt The uterus lining is called the endometrium This lining nourishes the baby as it grows If no egg is fertilised the endometrium is shed during menstruation This becomes monthly bleeding gt The uterus has a narrow neck called the cervix In the centre of the cervix is a tiny hole called the os which leads to the vagina gt The vagina is a muscular tube 5 or 6 inches long that connects the uterus to the outside of the body It has a moist lining that allows the vagina to perform three major functions entryway for the penis and for sperm during intercourse exit for menstrual fluid and passageway for the baby during birth 8 23 Spinal Cord Injury gt The vulva is the name for a woman s external sex organs These include the major labia lips which protect the opening of the vagina and are covered with hair as added protection The minor labia lips dir
8. Her breasts will become more sensitive and her nipples will become erect Phase Two is called the plateau phase It is a combination of the pleasurable feelings begun in the excitement phase Both sexes may have an increased heart rate heavier breathing and a sex flush In men the sperm begins to travel though the urethra This movement is called emission Phase Three is called the orgasmic phase In this phase both sexes can experience contractions in the genital area that may be viewed as very pleasurable In men these contractions can lead to ejaculation or forcing of the semen out through the urethra However neither an erection nor an orgasm are necessary for emission and ejaculation to occur Similarly the woman can become pregnant when the sperm enters her vagina whether or not she experiences orgasm Phase Four is called the resolution phase This phase is a return to the normal body state as blood pressure heart rate and breathing all return to normal Both sexes may feel sleepy and relaxed Reproductive System amp Response Cycle After Spinal Cord Injury It is difficult to know what your sexual experience will be like after your injury We are all individuals and no where more so than in the area of sexual response Studies of men with spinal cord injuries indicate that what is felt or not felt depends on the level and completeness of injury There has been little study of sexual response in women with 8 25 Spi
9. Spinal Cord Injury CHAPTER8 Sexuality amp Fertility For most people who are newly spinal cord injured life and death decisions physical comfort and settling into a regime of rehabilitation often take priority over issues of sexual functioning However when the immediate trauma has passed people often begin to question what the future holds for employment socialisation recreation and intimate relationships In other words they begin to question their sexuality It is difficult to define sexuality and specifically sexual functioning because each person s combination of injury and personality creates an individual picture It has been said that while sex is something you do sexuality is everything you are your personhood It may include the intimacy of the sexual act but it also includes your personality and the social roles you play in your home and community The biggest boost to sexuality has been rehabilitation that enhances mobility and health Both contribute by allowing people to put their sexuality into action In addition people who are mobile and healthy find themselves in circumstances where relationships can develop People may notice the wheelchair first However they will soon notice your sexuality your interest in them your manner and your shared interests 10 Edition Dec 2008 8 1 Spinal Cord Injury Common Questions About Sexuality After Spinal Cord Injury Questions From Both Sexes Wil
10. birth control methods with your gynaecologist or GP What Is A Gynaecologist A gynaecologist is a doctor that specialises in examining and treating a women s reproductive organs Every woman whether she is disabled or able bodied should see a gynaecologist at least once a year A gynaecologist will give you an assessment that includes a PAP smear a test of the mucus in your cervix a pelvic examination checking the cervix vagina uterus and ovaries and a breast examination checking the breasts for lumps or any changes in texture Your GP Women s Health Centre health worker or SHINE Sexual Health Information and Networking Education Inc formerly Family Planning Association can also do this How Do I Find A Gynaecologist You can ask your doctor staff at a rehabilitation centre or other disabled women for suggestions You should check on two things when you call for an appointment 1 Is the office wheelchair accessible 2 Can staff members assist you with transfers and undressing as needed 10 Edition Dec 2008 8 9 Spinal Cord Injury If I Decide To Have A Baby Will I Have Special Problems There are special considerations but none should prevent you from having a baby Most women with spinal cord injuries can have a normal delivery However most women stress the importance of preventing urinary tract infections due to bladder changes during pregnancy They also cite increased problems that can occur including pres
11. e the more active partner and gives the man free use of his hands Some people with spinal cord injuries find that they have increased sensitivity in the area just above their loss of sensation Having their partner stroke and caress this area can be very pleasurable Others mention that fantasy and even sharing these fantasies with their partners enhance their sexual experience Couples also enjoy manual or oral stimulation as part of their sexual activity Sexual devices such as vibrators may also increase enjoyment Again personal values and preferences should be your guide Some people with spinal cord injuries say that their sex lives are better after injury One reason for this is that they feel they develop a greater closeness with their partner Many rediscover the joys of courting the slow process of getting to know each other as individuals Still other persons find that they are willing to explore new areas of sensuality They are open to using body oils or lotions or to giving a massage all of which enhance the sexual experience in ways that are difficult to describe As we said in the introduction sex is an act and sexuality is who you are The more you and your partner can share your uniqueness in a sexual relationship the more satisfying that relationship will become 10 Edition Dec 2008 8 12 Spinal Cord Injury Suggestions for Managing your Menstrual Cycle Women who use tampons Always make sure the tampon is in
12. ectly cover the opening to the vagina gt The clitoris located on the minor labia is the female counterpart to the penis because it is capable of erection and stimulation can lead to orgasm However orgasm is not essential for fertilisation to take place gt The urethra located below the clitoris allows urine to pass from the body It is not connected to the sexual process Sexual Response Cycle The sexual response cycle is the term used to describe the phases and bodily changes that result from sexual stimulation The sexual response cycle has four phases Both men and women can experience all the phases but their partners may be different Phase One is called the excitement phase This is the beginning of sexual stirring s and could involve sexual thoughts and fantasy as well as actual physical touch During the excitement phase the man s penis fills with blood and becomes erect An erection can be caused just by thought and this is called a psychogenic erection An erection also can be caused by touch or response to another physical stimulation like a full bladder This is called a reflexogenic erection An able bodied male in the excitement phase usually has an erection caused by a combination of mental and physical stimulation The woman s clitoris also becomes erect during the excitement phase Her vagina will 8 24 Spinal Cord Injury become more moist to make intercourse easier This is called lubrication
13. ership 10 Edition Dec 2008 8 2 Spinal Cord Injury roles What Do I Do With My Catheter During Sex It depends on what kind of catheter you use Many leave their catheters in often moving or taping them out of the way during intercourse Some men fold the catheter over along the penis and keep it in position with a condom Some people with indwelling catheters remove them before sex and replace them afterwards However you or your partner should be competent with catheter changes if you plan to remove your catheter each time You may also increase the risk of urine infections with this option What About Bowel and Bladder Accidents During Sex Bowel and bladder accidents during sex can happen Most people with spinal cord injury find that keeping to a regular bowel program helps prevent bowel accidents If you are planning sexual activity ensuring that the bladder is completely empty before sexual activity can prevent bladder accidents Can I Still Get Sexually Transmitted Diseases Like Syphilis Herpes amp Aids Yes You are just as likely to get any of these as a non injured person A chart at the end of this section describes common symptoms of sexually transmitted diseases and tells you what to do if you have symptoms How Do I Take Care Of This Part Of My Body How Will I Know If Something s Wrong The best way to take care of your genital area is to wash regularly with soap and water 10 Edition Dec 2008 8 3 Sp
14. in cost Some systems are designed to enhance already existing erections Medications There are also some medications that may be able to assist in gaining or maintaining an erection These can be discussed with your consultant or urologist In general experts suggest that you take your time before deciding to pursue any of these options It s important to understand the advantages and disadvantages before making your decision If you re married or have a regular sex partner that person should be involved in your decision as well SIU staff can provide more information about erection devices But if you are interested in these options talk with your doctor or your urologist the doctor who helps you with your catheter and bladder management What Can I Do If My Wife And I Want To Have A Baby It is possible for men with spinal cord injury to father children However special methods may need to be used to get ejaculates or to do inseminations Some men report that they are able to obtain ejaculations through masturbation Others say that if they remain erect sufficient for intercourse they can sometimes trigger a reflex ejaculation This is evidenced by the number of men who have fathered children through intercourse 10 Edition Dec 2008 8 6 Spinal Cord Injury Others have achieved success using a commercial electric vibrator to trigger a reflex ejaculation which is then used for artificial insemination Many pregnancies
15. inal Cord Injury and dry thoroughly As with other areas of your skin inspect yourself closely for any signs of redness or infection Where Can I Get More Information The list of books at the end of this section will provide more information Feel free to ask questions You can ask the doctor nurse peer support advocate or any therapist if you have questions Questions Often Asked By Men Will I Be Able To Get An Erection Men and women approach sexuality issues with different perspectives Men with spinal cord injury inquire most about the ability to obtain erections Once they are assured that most men with a spinal cord injury can achieve spontaneous reflex erections their question then becomes how to sustain them What Can I Do To Increase The Number Of My Erections And How Long They Last Many medications may alter erection ejaculation function In particular medications used for the management of spasm spasticity and bladder If you are having trouble with the number of erections or how long they last first ask your consultant to discuss with you whether your medications may be responsible Unfortunately an optimal system to help men obtain and maintain erections has not been 10 Edition Dec 2008 8 4 Spinal Cord Injury developed but work is being done to find a safe and effective solution There are many kinds of sexual aids to help men obtain erections There are basically two types external or interna
16. l I Still Enjoy Having Sex Will I have Orgasms Both men and women question the ability to feel orgasmic Will the sensation of ejaculation or genital stimulation result in a physical rush Most people admit that this sensation is missing or altered following spinal cord injury However a majority of individuals find other avenues for sexual expression or release Some have equated certain physical reactions to orgasmic response others have found non genital areas of their body that are highly sensitive Will I Be Able to Satisfy My Partner In addition to wanting functional information most individuals with spinal cord injury admit that their changed functioning creates a new focus They rediscover their sexuality not just lovemaking but in their daily lives People willing to look at the total picture are reminded of the importance of courting despite being married for many years They are reminded of the importance of touch even if it is not felt the importance of visual images the importance of complimenting of saying the other person s name in fondness the importance of a simple I love you and the importance of not making every sexual contact end in genital focus Many individuals become preoccupied with the question of function and whether they can please their partner Interestingly partners often report that this was not a concern before injury It is unfortunate that only after crisis do most of us assess our partn
17. l systems Internal Systems When injected into the base of the penis some chemicals such as prostaglandin E 1 or papaverine can stimulate an erection However these chemicals can have side effects and should be used only with physician guidance One advantage of chemicals is that they are not permanent so you can try them to see if you are satisfied with the results A penile implant uses rods that can be placed inside a man s penis through surgery There are different kinds of implants with different advantages Penile implants have a good success rate but as with all surgery there is a risk of complications The surgery is permanent until the rods are removed It is not known how men will function following the removal of these rods External Systems Some men have indicated that simple positioning such as hyperextending their legs lying on their side or finding certain trigger points can assist in successful intercourse However other men may need vacuum entrapment devices to create the erection and constrictor rings to hold the erection for an extended period of time These external management systems to aid erections have been in existence for quite some time Only recently have they been accepted by the medical community which may be due to the fact that there can be serious side effects if they are not used properly However they are not 10 Edition Dec 2008 8 5 Spinal Cord Injury permanent and they are relatively low
18. n that direction while you are sitting Before catheterising gently wipe away the blood with soft toilet tissue or cloth and always wipe downwards to avoid any faecal contamination After this you may be a little dry so you may require a little gel on your catheter Remember Always make sure you wash your hands before and after and be as clean as you can be For ladies who would like to use pads and have an indwelling catheter if you are someone who has heavy periods and requires using a thicker pad you may have trouble fitting it around the catheter A suggestion could be to cut down the middle of the pad so it can fit more easily around the catheter tube Make sure you have more pad sitting back towards your anus as blood tends to flow back more than if you were walking around Try and wear firm fitting underpants to lessen the movement of the pad If someone is assisting you with putting the pad on make sure it is sitting flat and evenly so it is not causing pressure you will also lessen the chance of getting blood on your clothes If you do experience having trouble with this you could use incontinence pads as they are thicker and longer and thus provide you with more protection Sanitary napkins for nighttime use are also longer than normal You can purchase any of these items at larger supermarkets 10 Edition Dec 2008 8 14 Spinal Cord Injury Other choices Depend pads If you are going out these are also good for extra p
19. na which takes place during the excitement phase also may change after spinal cord injury Some women find they lubricate less some find it takes longer Finally as in men with spinal cord injuries women with spinal cord injuries may experience orgasmic sensations differently than before injury Although some physical sensation is lost some people with spinal cord injuries say they still have orgasmic sensations and that these are similar to the experiences before injury Some women may experience pain during sex There is a gel that can be used to dull the pain You should ask a doctor if this is an issue for you 8 27 Spinal Cord Injury Cross Section View of Male Teste Illustration adapted from The A amp P Workbook A Complete Study Guide to Anatomy and Physiology Marieb E 8 28 Spinal Cord Inju Bladder si y R Seminal vesicle Symphysis Pubis Prostate Gland Ejaculatory Duct Vas Deferens Rectum ny Cowper s gland an Epididymis Jn Testis Penis Gil Scrotum Prepuce NG i p Cross Section View of Male Pelvic Cavity amp Reproductive organs Illustration reproduced from The A amp P Workbook A Complete Study Guide to Anatomy and Physiology Marieb E 8 29 Spinal Cord Inju Fimbriae Ovary Fallopian Tube Sacrum Broad Ligament Uterus Cervix Bladder Urethra Symphysis Pubis Rectum Clitoris Anus Vagina Labia Majora Illustration reproduced from The
20. nal Cord Injury spinal cord injuries so we can only assume that level and completeness of injury also will affect their response Some Changes That Are Common For Men Erections are usually caused by a combination of mental and physical stimulation After spinal cord injury a man s erections may be mentally stimulated only or physically stimulated only depending on the level and completeness of his injury Also erections may not last long enough for intercourse There also may be changes in the emission of sperm when sperm starts to travel through the urethra and in the ejaculation of sperm when it is forced out the end of the penis These changes can cause fertility problems Finally orgasmic feelings may be experienced differently Although some physical sensation is lost some people with spinal cord injuries say they still have orgasmic sensations and that these are similar to their experiences before injury Some Changes That Are Common For Women A womans menstrual periods often stop temporarily after spinal cord injury but usually start again within six months or less Once her menstrual periods resume she is as fertile as she was before the injury 8 26 Spinal Cord Injury Genital stimulation in the woman is influenced by both mental and physical stimulation After spinal cord injury this stimulation may be mental or physical only depending on the level and completeness of the injury Lubrication of the vagi
21. oes not interfere with hormone production sex drive or orgasmic response After initial surgery health risks are low Spinal Cord Injury Disadvantages Fertility can seldom be restored some chance with vasectomy Possibility of swelling bleeding hyperreflexia or infection during or after surgery Norplant Very effective as effective as birth control pills Easy insertion procedure Can be in place for up to 5 years Allows spontaneity No hand function required Side effects may include irregular bleeding No long term studies regarding blood clots in SCI persons 3 1 2 3 4 5 1 2 Very effective Can be in place for 5 to 8 years depending on the type Allows spontaneity Easy insertion procedure 8 21 May cause heavier more painful menses Increased risk for pelvic infection in women with multiple sexual partners Spinal Cord Injury The Reproductive Systems And Sexual Response Cycle This section lists the parts of the male and female reproductive systems and describes how they work It also describes the normal sexual response cycle and how things can change following spinal cord injury The Male Reproductive System The parts of the male reproductive system are described below They are gt The testes or gonads two oval shaped male sex glands contained in a pouch of skin called the scrotum The testes produce sperm which can
22. rotection when travelling if you are concerned regarding incontinence problems Tena also has large incontinence pads that are longer than a normal sanitary pad and can be used for heavier periods Other choices can be discussed with your Spinal Injuries Doctor GP or Gynaecologist who will provide medical options to suit your individual needs 10 Edition Dec 2008 8 15 Spinal Cord Injury Where Can You Get More Information Within the Spinal Injury Unit gt Any member of your rehabilitation team gt During your Outpatient Department visits gt Resources of books articles etc are available from PQA Peer Support Advocates SPARC Rec n Rehab Liaison Officer Clinical Psychologist Your Consultant Your Social Worker Within the Community gt Women s Health Statewide Centre 64 Pennington Tce 8239 9600 North Adelaide Freecall 1800 182 098 gt Men s Information and Support Torrens Building 8212 0331 Centre 220 Victoria Square gt SHINESA 17 Phillips St Kensington 8431 5177 gt Relationships Australia SA Inc 55 Hutt St Adelaide 8223 4144 gt Gay Lesbian Psychology and Sturt Road Marion 8411 0996 Counselling Services gt Gay Men s Health 64 Fullarton Road 8334 1617 Norwood 10 Edition Dec 2008 8 16 Spinal Cord Injury Charts amp Resources Sexually Transmitted Diseases Symptoms gt Unusual discharge from penis or vagina discharge could look milky bubbly be a
23. se procedures Questions Often Asked By Women Women with spinal cord injuries generally want to read books or articles by women in a similar situation to review peer videos and participate in women s information or community support groups Their questions include issues such as personal hygiene techniques bladder management contraception management of monthly periods clothing styles vocational pursuits and home management They also want to know if their genitals will respond to sexual stimulation and whether they will be viewed as satisfying sexual partners Can I Still Get Pregnant Yes a woman s reproductive system is controlled by systems outside of the central nervous system so it is unaffected by spinal cord injury If you have intercourse you are just as likely to get pregnant following injury as you were before injury Why Did My Period Stop After spinal cord injury a woman s menstrual period may stop for a few months because of the shock her body has undergone Periods should resume within six months of injury 10 Edition Dec 2008 8 8 Spinal Cord Injury Does This Mean I Need Birth Control What Kind Is Good You will need to use birth control if you do not want a pregnancy However your injury can make some types of birth control harder to use There may be other considerations as well A chart at the end of this section lists different methods and the advantages and disadvantages of each You should discuss
24. serted correctly Depending on your sensation you may not be able to feel were the tampon is positioned A suggestion to help you with this would be learning on the bed like you would learn to do self catheterisation Using a mirror look at your vagina and practice inserting the tampon so you become familiar with your vaginal shape Everyone is shaped differently so you will have to become aware of what is right for you Once you have become familiar with inserting the tampon and you have proceeded with doing self catheterisation it may be easier to remove the tampon before doing a catheter This can remind you to remember to remove the tampon as it is recommended to replace the tampon every 4 hours After removing the tampon you may be a little dry so if you don t normally use gel on the catheter you may need to use a little bit on the catheter before you insert it You can also use a little gel on the tampon if you still are a little dry Please refer to The Spinal Injury Rehabilitation Manual in the glossary section in regards to Toxic Shock Syndrome 10 Edition Dec 2008 8 13 Spinal Cord Injury 1 Sanitary Napkins The thickness of the pad you would use would depend on how heavy your periods are For ladies doing self catheters make sure you use pads that stick well to your underpants When you are sitting always make sure the pad is positioned even and back more towards your anus This is because the blood tends to flow i
25. sing artificial lubricant Failure rate great if used alone Birth Control Pills Make periods more regular with less cramping Shorter period with less blood Convenient to use Decreased risk of ovarian and endometrial cancer Less chance of pelvic inflammatory disease Less chance of benign breast disease Very effective in preventing pregnancy Can predict start of menstrual periods Weight gain possible causing mobility problems Possible interaction with other medication that reduce effectiveness of pill High risk of blood clots in SCI women SCI women may be unaware of pain associated with blood clots Potential risk of cardiovascular disease strokes high blood pressure breast cancer A ON PION DAUR WNPR May be acceptable to couples having religious concerns about other forms of birth control No side effects Minimal cost Can predict start of menstrual periods 8 20 Taking the temperature daily and record keeping may be a problem Temperature or mucus checks may be difficult if hand function is limited Must have regular cycle to use Certain life stresses may alter monthly cycle Requires self control and planning limiting spontaneity Considered least effective method Which Birth Control Methods Might Suit You Sterilisation Advantages Surgery 99 9 effective no other method ever needed D
26. strange colour or be bad smelling gt Lumps or bumps in genital area gt Sores in genital area Other Symptoms gt Itching in genital area You may or may not gt Burning during urination feel these depending on gt Abdominal pain the level and gt Fever completeness of your injury What To Do gt See your doctor If you have a symptom gt Take the medicine the doctor prescribes Take all of it If you have an STD gt Tell all of your sexual partners Encourage them to have check ups whether they have symptoms or not gt Go back to the doctor for a follow up exam Make sure the infection is totally gone 10t Edition Dec 2008 8 17 Spinal Cord Injury Signs of Disease Infection Male What To Check Testicles Who Does Check You or a carer When Monthly How To Do gt Feel for lumps or swelling of testicles or scrotum gt Look for reddened skin on scrotum gt Notice any change If You Notice A Change See your doctor What To Check Bladder drainage Who Does Check You When Daily How To Do Be aware of gt An unusually large amount of clear drainage if you have a urethral catheter gt Drainage that is thick pus like grey green or yellow gt Blood in drainage If You Notice A Change See your doctor Signs of Disease Infection Female What To Check Breasts Who Does Check You or a carer When Monthly How To Do Feel breasts and surrounding area for gt Lumps
27. sure sores anaemia constipation increased spasticity and potential for blood clots Maintaining a modified diet is also important to prevent excessive weight gain To deal with these problems it is important for your doctor to understand spinal cord injury Also plan ahead Will you need help getting around while you re pregnant Or will you need help taking care of your baby How much will this cost Talking with other disabled women who have had children can help in your planning Will I Need A Caesarean Section To Deliver The Baby Testimony by mothers with spinal cord injury indicate that they felt delivery was more natural since the body doesn t fight against the delivery process In general vaginal delivery was preferred with no indication for Caesarean section in most cases If pre planning is done with the physician and staff complications generally can be avoided Most women with injuries T 10 and above reported painless labour without the need for anaesthesia Are There Risks To The Baby There appears to be no greater risk for birth defects or other health problems in babies 10 Edition Dec 2008 8 10 Spinal Cord Injury born to women with spinal cord injury Most problems that may happen during labour and delivery can be prevented with planning and with knowledgeable physician care Should I Use Tampons Or Napkins During My Menstrual Periods You can use either Some women prefer tampons because they don t
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