Women with neurological disabilities face persistent barriers in accessing adequate gynecological, obstetric, and sexual health care. Structural inaccessibility, lack of professional training, and informational deficits contribute to significant health disparities, especially in preventive screenings and reproductive health services.
The aim of this study was to assess current care provision in a specialized spinal unit offering autonomic dysfunction services. The goal was to identify specific gaps in care and propose targeted strategies to improve gynecological and sexual health services for women with neurological disabilities.

A cross-sectional, observational study was conducted at a Spinal Unit with a dedicated Autonomic Dysfunction Unit. A 33-item structured questionnaire—designed by a physiatrist specializing in neurological rehabilitation—was administered to women with neurological disabilities.
The questionnaire covered multiple domains: access to oncological screening programs, STI prevention, reproductive and gynecological health, and sexual well-being. Both multiple-choice and open-ended questions were included to capture qualitative and quantitative data.
To ensure clarity and reduce bias, the survey was reviewed by a multidisciplinary team of healthcare professionals with expertise in autonomic dysfunction. All participants received detailed information about the study and provided written informed consent.

A total of 60 women participated in the study. Diagnoses included spinal cord injuries (45%), multiple sclerosis (32%), spina bifida (12%), and cerebral palsy or Guillain-Barré syndrome (12%).

The analysis revealed significant gaps in gynecological and sexual health care. 40% had never had a Pap smear and 20% had never had a mammogram. Among those without a Pap test, 98% cited inaccessible examination tables as the main barrier. Between 60% and 70% reported architectural obstacles limiting access to care.

80% felt poorly informed about their sexuality, and only 5% had received information on STIs, fertility, or pregnancy planning.

84% reported sexual dysfunction. When asked with whom they would feel comfortable discussing it, 46% chose physiatrists, 40% gynecologists, 12% sexologists, and 2% other. Interestingly, 30% first raised the issue with a nurse, highlighting their central role in addressing sexual health.

This study reveals ongoing inequalities in gynecological and sexual healthcare for women with physical disabilities. Despite complex needs, many had not received basic preventive care: 40% had never had a Pap smear and 20% a mammogram. Among those, 98% cited inaccessible exam tables as the main barrier. This is critical for women with multiple sclerosis, who require more frequent Pap tests due to immunosuppressive therapy and higher HPV risk.

Up to 70% reported architectural obstacles; 80% felt uninformed about sexuality, and only 5% had received information on STIs, fertility, or pregnancy.

Sexual dysfunction was reported by 84%. Most preferred discussing it with a physiatrist (46%) or gynecologist (40%), while only 12% mentioned a sexologist. Notably, 30% first raised the topic with a nurse, emphasizing the important role of nursing in sexual health conversations.

These findings highlight the urgent need to embed sexual and reproductive health into rehabilitation programs, remove access barriers, and adopt patient-centered, interdisciplinary care models that support the sexual rights and wellbeing of women with disabilities.

This study highlights urgent structural, procedural, and educational barriers limiting access to sexual and reproductive health services for women with neurological disabilities, particularly those with spinal cord injuries.
To address these disparities, three key strategies are recommended:
1.	Training healthcare professionals to deliver competent, inclusive care;
2.	Creating barrier-free, accessible care pathways;
3.	Utilizing telemedicine tools to extend support and continuity of care.
These measures are essential to ensure equitable access to gynecological and sexual health services. The findings will inform the development of an outpatient service tailored to the gender-specific needs of women with neurological disabilities, to be implemented within the Spinal Unit.

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