83 JRRD JRRD Volume 44, Number 1, 2007 Pages 83–90 Journal of Rehabilitation Research & Development Development of international standards to document sexual and reproductive functions after spinal cord injury: Preliminary report Marcalee Sipski Alexander, MD; 1* Donald Bodner, MD; 2 Nancy L. Brackett, PhD, HCLD; 3 Stacy Elliott, MD; 4 Amie B. Jackson, MD; 1 Jens Sønksen, MD, PhD, DMSci 5 1 Physical Medicine and Rehabilitation, Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL; 2 Department of Urology, Case Western Reserve University School of Medicine, University Hospitals of Cleveland, Cleveland, OH; 3 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL; 4 Departments of Psychiatry and Urology, University of British Columbia (BC), BC Center for Sexual Medicine, Vancouver, BC, Canada; 5 Department of Urology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark Abstract—Clinicians need standard terminology to communi- cate effectively about remaining autonomic function in persons after spinal cord injury. This article illustrates the development of standard nomenclature that describes the impact of injury on sex- ual functioning. A standard anatomic diagnosis and a secondary means of describing the presence of male and female sexual dys- function, genital arousal, and orgasmic function are discussed. Key words: arousal, assessment, female, fertility, male, menstru- ation, orgasm, sexuality, sexual response, spinal cord, standards. INTRODUCTION Communication about the effects of spinal cord injury (SCI) on motor and sensory functions is generally per- formed with the International Standards for Neurological Classification of Spinal Cord Injury of the American Spi- nal Injury Association (ASIA) [1]. In addition to clinicians using these standards to communicate the impact of SCI on neurological function, they have been using them as an outcome measure in a number of clinical trials to docu- ment the degree of remaining motor and sensory functions in persons with SCIs. However, these standards cannot be used to document the degree of preservation of autonomic function postinjury. In May 2004, ASIA appointed a working group to develop standards for professionals to communicate the characteristics of various aspects of autonomic function remaining in persons with SCIs. This group included international participants involved in clini- cal trials in SCI and basic science researchers. (See the Figure for members.) With the group’s agreement, the autonomic standards being developed quickly evolved into International Autonomic Standards, rather than those of just ASIA. The working group transitioned into a steering committee, and subgroups were appointed to dis- cuss bladder, bowel, and sexual and general autonomic functions. Individual subgroups functioned via Internet communication, and from 2004 to early 2005, each sub- group drafted a set of standards for its section. This arti- cle describes aspects of the preliminary draft of standards for documenting remaining sexual function of persons after SCI. This draft was presented at the ASIA meeting in May 2005. Abbreviations: ART = assisted reproductive technology, ASIA = American Spinal Injury Association, IVF = in vitro fertilization, L = lumbar, S = sacral, SCI = spinal cord injury, T = thoracic, TMS = total motile sperm. * Address all correspondence to Marcalee Sipski Alexander, MD; Professor of Physical Medicine and Rehabilitation, Spain Rehabilitation Center, University of Alabama at Birmingham, SRC 510, 619 6th Ave S, Birmingham, AL 35249-7330; 205- 934-2022; fax: 205-996-5874. Email:msipski@uab.edu DOI: 10.1682/JRRD.2005.10.0166