Abstract
Background: Neurogenic sexual dysfunction (NSD) is a frequent yet underdiagnosed consequence of neurological disorders such as spinal cord injury (SCI), multiple sclerosis (MS), stroke, and Parkinson’s disease (PD). Despite its significant impact on psychosocial well-being and quality of life, NSD remains insufficiently addressed in standard rehabilitation protocols.
Objective: To describe an original, context-adapted clinical algorithm for the diagnosis and management of neurogenic sexual dysfunction during the rehabilitation phase, based on the PLISSIT model and augmented by a structured feedback mechanism.
Methods: A modified diagnostic and therapeutic protocol was developed and implemented in a neurorehabilitation center in Russia, addressing systemic barriers such as the absence of sexual health professionals, lack of guidelines, and limited physician training. The model utilizes the first three stages of PLISSIT—Permission, Limited Information, and Specific Suggestions—and introduces a home-based feedback protocol to replace the Intensive Therapy phase. This protocol includes functional evaluation, educational counseling, environmental adaptation, and structured self-assessment after the first sexual attempt.
Results: All ten participants (aged 23–52) with chronic spinal cord injury and their partners completed the diagnostic protocol, including a structured feedback questionnaire. Sexual activity was conducted either in a home environment (8 couples) or in a designated guest room within the rehabilitation facility (2 couples). Among six male participants, five achieved erection and four reported successful penetration; two experienced orgasm, and one reported ejaculation. Among four female participants, three reported vaginal dryness and two reported discomfort during intercourse. Spasticity was noted in seven participants, and positioning difficulties were reported in six cases. Genital hypoesthesia or altered sensation was identified in nine participants. Eight participants reported post-activity fatigue, and two noted transient cardiovascular symptoms. All couples followed at least one clinical recommendation; lubricants were used in six cases and positioning aids in eight. Three male participants used phosphodiesterase type 5 inhibitors. Feedback forms were fully completed in all cases, with high adherence across physiological, emotional, and partner-related domains.
Conclusion: This adapted PLISSIT-based algorithm provides a feasible, replicable approach to the early diagnosis and treatment of sexual dysfunction within rehabilitation settings. The structured feedback loop enhances ecological validity, empowers patients, and facilitates targeted, multidisciplinary care. Further multicenter studies are warranted to validate its broader applicability.