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SEXUALITY IN SPINAL INJURY: THE SPINAL CORD INJURED FEMALE: FERTILITY, CHILDBIRTH, AND CONTRACEPTION

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     Women with paraplegia or quadriplegia and of childbearing age usually regain menses; nearly 50% do not miss a single period following injury. Pregnancy is possible, and if pelvic measurements are adequate, most spinal cord injured women can have normal vaginal deliveries.

     A SCI woman may be subject to certain complications of pregnancy and should discuss these with her physician. Among potential complications are premature delivery in women in whom injury occurs during pregnancy and above the T-10 level and autonomic dysreflexia (high blood pressure, sweating, chills, and headache) during labor. The problem is also greater during pregnancy. Loss of sensation in the pelvic area can prevent the woman's knowledge that labor has begun. With a low level injury, the woman can assist in childbirth.

     Choice of a contraceptive method should be discussed with a woman's physician, since there are some special considerations related to the spinal cord injury. Oral contraceptives are linked to inflammation and clots in blood vessels and the risk of these is greater SCI. Intrauterine devices cannot be felt in the SCI woman, who has lost sensation in her pelvis, and may cause medical complications that would go undetected. Use of diaphragms and spermicides can be difficult for the woman with impaired hand dexterity. Tubal ligation can be considered for the woman who does not wish ever to become pregnant.

     Routine annual examination and screenings to include PAP smears, pelvic exams and mammograms should still be conducted for health maintenance.

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