Associação entre sintomas depressivos e disfunção sexual em homens com lesão medular traumática / Association between depressive symptoms and sexual dysfunction in men with traumatic spinal cord injury

INTRODUÇÃO: A lesão medular acarreta em perda da independência funcional, autonomia e status social. Essa enorme mudança contribui para o aparecimento dos sintomas depressivos nessa população. OBJETIVO: Avaliar os sintomas depressivos e disfunção sexual em homens com lesão medular traumática, analisando a associação entre eles. MÉTODOS: Estudo observacional, realizado com 44 homens com lesão medular traumática, idade entre 18 e 60 anos, tempo de lesão superior a um ano e vida sexual ativa. O grau de comprometimento neurológico foi avaliado através da versão revisada em 2011 da ASIA Impairment Scale, os sintomas depressivos através do Inventário de Depressão de Beck e a função sexual através do Índice Internacional de Função Erétil. Foram aplicadas técnicas de estatística descritiva e análise bivariada para verificar associação, utilizando um nível de significância de 0,05. RESULTADOS: Os voluntários possuíam média de idade de 34,1 anos, e tempo médio de lesão de 7,7 anos. Todos os indivíduos da amostra tinham nível de lesão acima do segmento medular L2, sendo as incompletas as mais frequentes (68,2%). O tempo médio da última relação sexual foi de 56,5 dias e a frequência semanal de relação sexual foi a mais relatada (65,9%). Da amostra, apenas 17,6% tinham sintomas depressivos, sendo 6,8% com disforia e 6,8% apresentando sintomas leves a moderados. Não foi encontrada associação entre sintomas depressivos e disfunção sexual, exceto para o domínio da disfunção de satisfação geral (p=0,02). CONCLUSÃO: Não existe associação entre sintomas depressivos e disfunção sexual em homens com lesão medular crônica.

INTRODUCTION: Spinal cord injury results in loss of functional independence, autonomy and social status. This enormous change contributes to the appearance of depressive symptoms in this population. OBJECTIVE: To evaluate depressive symptoms and sexual dysfunction in men with traumatic spinal cord injury, and to analyze their association. METHODS: Observational study was performed with 44 men with traumatic spinal cord injury, age between 18 and 60 years, injury time over 1 year and active sexual life. The degree of neurological impairment was assessed through the revised 2011 ASIA Impairment Scale, depressive symptoms through the Beck Depression Inventory, and sexual function through the International Erectile Function Index. Descriptive statistics techniques and bivariate analysis were applied to verify association, using a level of significance of 0.05. RESULTS: The volunteers had a mean age of 34.1 years, and an average injury time of 7.7 years. All individuals in the sample had lesion level above the medullary segment L2, with incomplete injury being the most frequent (68.2%). The mean time of the last sexual intercourse was 56.5 days and the weekly frequency of intercourse was the most reported (65.9%). Only 17.6% of the sample presented depressive symptoms, ranging from dysphoria (6.8%) to mild to moderate symptoms (6.8%). No association was found between depressive symptoms and sexual dysfunction, except for the domain of general satisfaction dysfunction (p=0.02). CONCLUSION: There is no association between depressive symptoms and sexual dysfunction in men with chronic spinal cord injury.

Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury.

STUDY DESIGN: Observational study (Ethics Committee Number 973.648). OBJECTIVE: Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction. SUMMARY OF BACKGROUND DATA: Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation. METHODS: Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level. RESULTS: Forty-five subjects with mean injury time of 7.5 years (CI 5.2-9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07-0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02-0.66), masturbation (OR: 0.13; 95% CI: 0.02-0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01-0.92). Ejaculation (OR: 0.01; 95% CI: 0.00-0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38-178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01-0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0-62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1-44.8) are associated with satisfaction. CONCLUSION: Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction. LEVEL OF EVIDENCE: 3.