探討影響男性脊髓損傷患者之性生活的相關因素

背景：台灣地區的脊髓損傷（spinal cord injury, SCI）人數約有六萬多人，以青壯年的男性居多，SCI所造成的合併症有運動與感覺功能障礙、大小便失禁、痙攣、性功能障礙、自主神經反射異常、疼痛等問題，亦對心理社會產生嚴重的影響，而這些問題如何影響對男性的性生活，在文獻中甚少被提及，故本研究目的為1.探討男性SCI患者於脊髓損傷前、後的性生活狀況，2.探討男性SCI患者之個人基本屬性、生理因素與心理社會因素對其性生活之影響。研究方法：採用橫斷式研究設計，以結構式問卷調查中部某醫學中心及其附設分院（為地區醫院）之復健病房，和桃園脊髓損傷潛能發展中心之外傷性SCI男性個案，調查內容含括個案的人口學資料、生理與心理資料、及其性生活狀況，所得資料以次數、百分比、平均值、標準差與範圍等敘述性統計描述之；另以成對樣本t檢定、獨立樣本t檢定、因子變異數分析及皮爾森積差相關等推論統計方法檢定個案之基本屬性、生理因素與心理因素對其性生活之相關性。研究結果：共收集61位男性SCI之個案，於損傷後有婚姻的佔32.8%，有性生活者佔39.3%，而有性生活者恢復性生活的平均時間為20.4±36.0個月，有27.8%的人會尋求輔助性活動。性慾則由損傷前100%降至60.7%，「每週一次（含）以上」的性頻率只剩6.6%，損傷後完全沒性活動者更佔了60.7%。在陰莖勃起情形方面，在刺激後可勃起的比率從損傷前98.4%降至41%，損傷後能維持至射精者只剩6.6%，有34.5%的個案在損傷後無法順利的完成射精動作。「無法滿足自己的性需求」是研究個案最關心的事，其次為「無法找到滿意的伴侶」，而最不在意的是「因性活動而引起腸道問題」。對生活感受中覺得最重要與最滿意皆為「家庭關係」，而「性生活」在重要性列居在第7位且屬較不滿意的項目。損傷後有、無性生活與損傷時年齡及自覺目前健康狀況的視覺量表是呈顯著差異(p＜.05)。在性調適與生理因素中的「日常生活功能獨立」(p﹤0.05)呈顯著關係。其性功能會因損傷部位(p﹤0.05)及損傷分類(p﹤0.05)有顯著差異，又以胸髓損傷者的性功能比頸髓損傷者好，但性功能與生理因素、生活品質彼此之間皆無明顯相關。有49.2%個案接受過有關脊髓損傷的性知識，而取得性知識的來源以其他專業人員(如：性專家、心理師、社工師)與脊髓損傷病友為最多(皆為31.4%)，其次為護理人員佔23.5%。有47.5%的個案想在受傷後改善性功能，而改善的方法較喜歡「自行嘗試」(26.2%)佔最多，其次是「與配偶(或性伴侶)一起討論嘗試」(24.6%)。整體而言，男性脊髓損傷後在性功能方面皆明顯下降，若臨床醫療人員能主動提早介入性功能障礙之照護，如給予性知識的衛教、提供輔助性活動的方法、轉介相關科別或性諮商等，期使病人能一樣擁有優質的性生活。

關鍵字

脊髓損傷；性生活狀況；男性性功能障礙

並列摘要

Background： There are more than 60,000 people with spinal cord injuries in Taiwan, most men are young. The comorbidities caused by SCI include motor and sensory dysfunction, incontinence, spasm, sexual dysfunction, autonomic reflex abnormalities, pain, etc. How these comorbidities affect the sex life of men is rarely mentioned in the literature, Therefore, the purpose of this study is: 1.to explore the sexual life of male SCI patients before and after spinal cord injury. 2. To explore the impact of male SCI patients' personal basic attributes, physiological factors and psychosocial factors on their sexual life. Methods: A cross-sectional study design was adopted and a structured questionnaire to investigate the rehabilitation ward of a medical center and its affiliated branch (a district hospital) in the central part of China, and the traumatic SCI male cases of the Taoyuan Spinal Cord Injury Potential Development Center, The content of the survey includes demographic data, physiological and psychological data, and sexual life status of the case, The data obtained is described by descriptive statistics such as frequency, percentage, average, standard deviation and range. In addition, inferential statistical methods such as paired sample t test, independent sample t test, factor variance analysis and Pearson product difference correlation are used to test the basic attributes, physiological factors and psychological factors of the case and the relevance of its sexual life. Results: A total of 61 spinal cord injury cases participated in this study.The results of the study showed that 32.8% of married persons had sex after the injury, and 39.3% had sexual life. The average time for sexual life to resume sexual life was 20.4±36.0 months. 27.8% of people would seek auxiliary sexual activities. Sexual desire decreased from 100% before injury to 60.7%. The sexual frequency of "once a week (including)" was only 6.6%, and those who had no sexual activity after injury accounted for 60.7%. In terms of penile erection, the rate of erection after stimulation decreased from 98.4% before injury to 41%, and only 6.6% of those who could maintain ejaculation after injury were injured. In 34.5% of cases, ejaculation was not successfully completed after injury. "Unable to meet one's sexual needs" is the most concerned thing in the research case, followed by "unable to find a satisfactory partner", and the least concerned is "intestinal problems caused by sexual activity." The most important and most satisfying feelings about life are "family relations", and "sex life" ranks seventh in importance and is a less satisfactory item. There is a significant difference between the visual scales of sexual life after assault, asexual life and age at the time of injury and consciousness of the current health status (p<.05). There is a significant relationship between sexual adjustment and physiological factors of "independent function of daily life" (p﹤0.05). The sexual function will be significantly different due to the injury site (p﹤0.05) and the injury classification (p﹤0.05), and the sexual function of patients with thoracic spinal cord injury is better than that of cervical spinal cord injury, but sexual function and physiological factors and quality of life are mutually different There is no obvious correlation between them. 49.2% of the cases have received sexual knowledge about spinal cord injury, and the source of sexual knowledge is obtained from other professionals (such as sex experts, psychologists, social workers) and spinal cord injury patients (both 31.4%), followed by Nursing staff accounted for 23.5%. 47.5% of cases want to improve sexual function after injury, and the method of improvement is more like "try it yourself" (26.2%), followed by "discuss try with spouse (or sexual partner)" (24.6%). Overall, male sexual function has decreased significantly after spinal cord injury. If clinical medical staff can actively intervene in the care of sexual dysfunction, such as giving health education of sexual knowledge, providing methods for auxiliary activities, and referring to related departments or sexual counseling, etc., so that patients can have a high-quality sex life.