SEXUAL AND REPRODUCTIVE NEUROREHABILITATION

Transcription

1 SEXUAL AND REPRODUCTIVE NEUROREHABILITATION

2 CURRENT CLINICAL NEUROLOGY Sexual and Reproductive Neurorehabilitation, edited by Mindy Aisen, 1997

3 SEXUAL AND REPRODUCTIVE N EURO REHAB ILITATI ON Edited by MINDY AlSEN, MD Burke Rehabilitation Hospital White Plains, NY and Cornell University Medical College, New York, NY FOREWORD BY E. DARRACOTT VAUGHAN, JR, MD.. SPRINGER SCIENCE+BUSINESS MEDIA, LLC

4 1997 Springer Science+Business Media New York Originally published by Humana Press Inc. in 1997 Softcover reprint of the hardcover I st edition 1997 All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. All authored papers, comments, opinions, conclusions, or recommendations are those of the author(s), and do not necessarily reflect the views of the publisher. This publication is printed on acid-free ANSI Z (American Standards Institute) Permanence of Paper for Printed Library Materials. Cover design by Patricia F. Cleary. Photocopy Authorization Policy: Authorization to photocopy items forinternal or personal use, orthe internal or personal use of specific clients, is granted Springer Science+Business Media, LLC., provided that the base fee of US $8.00 per copy, plus US $00.25 per page, is paid directly to the Copyright Clearance Center at 222 Rosewood Drive, Danvers, MA For those organizations that have been granted a photocopy license from the CCC, a separate system of payment has been arranged and is acceptable to Springer Science+Business Media, LLC. The fee code for users of the Transactional Reporting Service is: [ /97 $ $00.25]. Library of Congress Cataloging-in-Publication Data Sexual and reproductive neurorehabilitation 1 edited by Mindy Aisen ; foreword by E. Darracott Vaughan, Jr. p. em. -- (Current clinical neurology; I) Includes index. ISBN ISBN (ebook) DOI / I. Generative organs--diseases--patients--rehabilitation. 2. Sexual disorders--patients--rehabilitation. 3. Nervous system- Diseases--Complications. 4. Nervous system--diseases--patients- Rehabilitation. I. Aisen, Mindy. II. Series. [DNLM: I. Nervous System Diseases--rehabilitation. 2. Nervous System Diseases--complications. 3. Sex Disorders--etiology. 4. Pregnancy Complications--etiology. 5. Infertility--etiology. WL 140 S ] RC877.S '043--dc21 DNLM/DLC for Library of Congress CIP

5 FOREWORD This well-written text thoroughly addresses two quality of life issues in patients with a variety of neurological disorders: sexual and reproductive function. The de vasta stating effects of a variety of neurological diseases are well known to both the lay and medical communities, and are treated in numerous texts. However, as we continue to experience therapeutic breakthroughs in the tields of neurology and rehabilitation medicine, physicians and patients must become more aware of the issues discussed in this text. It is particularly important, as emphasized throughout the chapters, that the physician or therapist initiate conversations with the patients concerning both the possibility of parenting a child, as well as the ability of the patient to enhance his/her sexual functioning. Commonly in the patient who is otherwise perfectly normal, there is a reluctance to discuss these topics and couples often feel embarrassed to initiate a conversation with their physicians. This reluctance to initiate a discussion is even more apparent in patients with a variety of neurological disorders, in which there are overriding fears concerning both function and survival, as well as deep concerns about their own attractiveness, and their sexual and reproductive ability. Accordingly, Sexual and Reproductive Neurorehabilitation fills a major void. It begins appropriately with chapters reviewing the basic physiology and pathophysiology of reproductive and sexual function. However, the text rapidly moves to specific neurological entities and summarizes the current literature concerning a gamut of diseases ranging from the peripheral nervous system to major central nervous system conditions, such as traumatic brain injury. Throughout the chapters, there is a common theme emphasized, which is that both the physician and the patient are frequently uncomfortable addressing these topics. Therefore, a number of pragmatic approaches are given, particularly in Chapter 5, which reviews principles of sexuality counseling. The other observation that becomes apparent is that, despite the depth of review in this text, we remain woefully lacking in validated information concerning the sexual function in patients with a variety of neurologic diseases. Putting all of this information together in a single source will, I believe, stimulate both basic scientific and clinical research in these areas. In summary, Sexual and Reproductive Neurorehabilitation should be mandatory reading for students and residents in training in all fields related to the care of patients with neurological disorders and should have a prominent place on the shelf of established physicians and therapists working in the area. Finally, the emphasis on involving the patient in a dialog intended to determine their concerns, and to involve them in a therapeutic program, not only applies in the current context, but should serve as a prototype for interactions with patients suffering from many other diseases, particularly those concerning the quality of life. E. DARRACOTT VAUGHAN, JR, MD James J. Colt Professor of Urology The James Buchanan Brady Foundation The New York Hospital Cornell University Medical Center New York, New York v

6 PREFACE Professionals in the growing field of neurologic rehabilitation are often identified as the providers of primary care to persons with chronic neurologic disability; practitioners must be prepared to address the varied issues certain to be encountered if high-quality long-term and comprehensive care is to be assured. In addition to managing the medical complications of nervous system dysfunction, a major goal of rehabilitation medicine is to "restore and maximize function," employing a multidisciplinary approach in order to permit the patient to enjoy access to a full range of activities fundamental to human fulfillment. These include the socialization, pleasure, and joy associated with sexual, reproductive, and parenting activities. It is the obligation of rehabilitation clinicians to create an atmosphere that encourages open dialog and provides accurate information about sexual issues, dissolving stereotyped assumptions concerning impaired attractiveness and capabilities, assumptions that can lead to isolation and an unwillingness to ask direct questions. This is not a straightforward task, since our societal mores contribute to attitudes that can make caregiver and patient alike uncomfortable about initiating such discussions. Moreover, although contemporary medical education addresses the pathophysiology of genitourinary dysfunction in great detail, primary caregivers rarely have formal training in, and facility with, the management of issues concerning sexual behavior. We have assembled this book for neurologists, neurosurgeons, psychiatrists, nurses, social workers, psychologists, and all others who wish to gain an appreciation for state-ofthe-art treatments of sexual and reproductive differences in the neurorehabilitation patient population. The mission of Sexual and Reproductive Neurorehabilitation is to provide all members of the clinical rehabilitation team with a concise, yet comprehensive, resource that covers the broad range of medical as well as psychological material necessary to adequately approach, educate, and treat patients with physical or intellectual impairment stemming from nervous system dysfunction. The first four chapters provide an overview of the physiology of normal and abnormal sexual responses and reproductive functions, as well as a general approach to their evaluation and treatment. Chapter I reviews the anatomy and neuroanatomy of the male genitalia, the causes of va so genic and neurogenic impotence, and the state-of-the-art treatments for impotence and infertility. Chapter 2 is similar, with a focus on female physiology. Chapters 3 and 4 address the impact of the hormonal and physical effects of menstruation, pregnancy, and delivery on disease that affect the nervous system. Chapter 5 outlines counseling principles, describing psychological approaches to treatment. Many of the subsequent chapters focus on neurologic disease categories, describing the specific impact of each condition on sexual and reproductive health, as well as the approach their treatment requires. Chapters 8 and 9 are dedicated to the problems of children and young adults with neurologic dysfunction, whereas Chapter 12 addresses the issues frequently encountered in the geriatric population, including the complications of atherosclerosis, the side effects of commonly used medications, cognitive decline, and mood disturbances. No book on this subject can be complete without injecting the notion of the responsibility required of sexually active individuals and the clinicians overseeing their care; Chapter 13 provides a current review of risk factors, preventive measures, and treatment for sexually transmitted diseases. Mindy Aisen vii

7 CONTENTS Foreword... v Preface... vii Contributors... xi 1 Male Anatomy and Physiology... 1 Mindy Aisen and Alexander Kirschenbaum 2 Management of Neurologic Diseases in Pregnancy, Delivery, and the Postpartum Period Charles E. Argoff 3 Issues of Female Physiology and Reproductive Responses in the Neurorehabilitation Setting Frances Marks and Mary Sano 4 The Role of the Menstrual Cycle in Chronic Disorders of the Nervous System Douglas R. Jeffery 5 Principles of Sexuality Counseling Audrey Sorgen Sanders and Alan D. Blau 6 Diseases of Peripheral Nerves Mary K. McDonald and Alexander W Dromerick 7 Extrapyramidal Disorders Alan David 8 Sexuality and the Adolescent with Developmental Disorders Ann Maurine Packard 9 Neuromuscular Disease and Sexuality in Adolescents Jennifer Michaels and Vicki Barnett 10 Sexual Dysfunction Following Stroke David C. Good 11 Sexual Dysfunction in Multiple Sclerosis Lee Shaughnessy, Mary Schuchman, Mohamed Ghumra, Patricia Daily, and Jack S. Burks 12 Sexual Rehabilitation Issues in Spinal Cord Injury Mindy Aisen 13 Traumatic Brain Injury Glenn Seliger and Andrew Hornstein 14 The Geriatric Population Laurie Barclay 15 Sexually Transmitted Diseases Lois Van Fleet Index ix

8 CONTRIBUTORS MINDY AlSEN, MD Burke Rehabilitation Hospital, White Plains, NY; and Cornell University Medical College, New York, NY CHARLES ARGOFF, MD North Shore University Hospital, Manhasset, NY LAURIE BARCLAY, MD Neurologic Consulting Services, Tampa, FL ALAN BLAU, PHD Department of Neuropsychology, Burke Rehabilitation Hospital, White Plains. NY JACK BURKS, MD Rocky Mountain Multiple Sclerosis Center, Englewood, CO PATRICIA DAILY, LCSW Rocky Mountain Multiple Sclerosis Center, Englewood, CO ALEXANDER DROMERICK, MD Department of Neurology, Washington University School of Medicine, St. Louis, MO LOIS VAN FLEET, RN Burke Rehabilitation Hospital, White Plains, NY MOHAMED GHUMRA, MD Rocky Mountain Multiple Sclerosis Center, Englewood, CO DA VID GOOD, MD Director of Rehabilitation, Department of Neurology, Bowman Gray School of Medicine, Winston-Salem, NC ANDREW HORNSTEIN, MD Helen Hayes Hospital, West Haverstraw, NY DOUGLAS JEFFERY, MD, PHD Department of Neurology, Bowman Gray School of Medicine, Winston-Salem, NC ALEXANDER KIRSCHENBAUM, MD Department of Urology, Mt. Sinai Hospital, New York, NY FRANCES MARKS, MD Columbia University College of Physicians and Surgeons, Columbia Presbyterian Hospital, New York, NY MARY K. McDONALD, MD Division of Physical Medicine and Rehabilitation, Washington University School of Medicine, St. Louis, MO JENNIFER MICHAELS, MD Department of Neuroscience, University of Medicine and Dentistry of New Jersey, Newark, NJ ANN MAURINE PACKARD, MD Departments of Pediatrics and Neurology, Cornell-New York Hospital, New York, NY AUDREY SORGEN SANDERS, MA Yeshiva University Graduate School of Psychology, New York, NY MARY SANO, PHD Department of Neurology, Columbia College of Physicians and Surgeons, Sergievsky Center, New York, NY MARY SCHUCHMAN, RN, MA Rocky Mountain Multiple Sclerosis Center, Englewood, CO GLENN SELIGER, MD Helen Hayes Hospital, West Haverstraw, NY LEE SHAUGHNESSY, BA Rocky Mountain Multiple Sclerosis Center, Englewood, CO Xl