Sexuality is a fundamental dimension of quality of life after spinal cord injury (SCI), yet it remains insufficiently addressed in rehabilitation settings. This study aimed to evaluate the effectiveness of a structured group educational intervention in improving awareness, expectations, and perceived sexual functioning in individuals with SCI. The hypothesis was that targeted information delivered in a group setting, combined with guided discussion, would positively influence patients’ perceptions regarding sexual function, fertility, and access to professional support.

This proof-of-concept study was conducted in a spinal rehabilitation unit in Italy. A total of 55 inpatients with SCI (22 women and 33 men; mean age 57 years) were enrolled. Participants attended a structured group educational session led by an expert physician, with nursing staff supporting patient recruitment and engagement throughout the process.
The educational sessions were conducted using the ALIVE+ model (Fig.1), which provided a structured framework to facilitate communication, patient engagement, and discussion on sensitive topics related to sexuality.
A two-phase (pre–post) structured questionnaire was administered immediately before and after the intervention. The instrument explored multiple domains, including perceived sexual function (arousal/erection and orgasm), perceived fertility, interest in sexual activity, perceived barriers, and the need for medical consultation.
Data were analyzed using descriptive statistics, including absolute frequencies and percentages. For selected key indicators, 95% confidence intervals were calculated using the Wilson method to account for sample variability. The analysis focused on immediate changes observed following the intervention.

At baseline, 56% of participants reported believing they could experience arousal or erection, while 44% considered orgasm to be achievable. Following the educational intervention, these proportions increased to 76% and 80%, respectively. The perceived possibility of having children also improved, rising from 16.7% to 32.0%.
The most substantial improvement was observed among female participants, particularly in relation to orgasm perception, which increased by 60 percentage points. Additionally, the proportion of participants expressing a need for medical consultation increased from 31.8% to 50.0%, suggesting enhanced awareness and a greater propensity to seek professional support.

The findings indicate that even a brief, structured educational intervention can produce immediate and meaningful changes in patients’ perceptions and expectations regarding sexuality after SCI. Improvements were observed not only in perceived sexual functioning but also in broader domains such as fertility awareness and healthcare engagement.
The pronounced effect among women is particularly noteworthy, given the historical underrepresentation of female sexuality in SCI research and rehabilitation. Furthermore, the increase in requests for medical consultation suggests that the intervention may facilitate activation of care pathways by empowering patients to recognize and address their needs.

A structured group-based educational intervention on sexuality in individuals with spinal cord injury leads to immediate and meaningful improvements in expectations, awareness, and perceived sexual potential. Integrating sexuality into rehabilitation through shared educational settings represents a feasible and impactful strategy to support person-centered care and to activate appropriate healthcare pathways.
These findings can be summarized in the following highlights:
- Structured group education significantly enhances patients’ perceptions of sexual function, including arousal and orgasm.
-The intervention increases awareness of fertility and promotes proactive engagement with healthcare professionals.
-Incorporating sexuality education into SCI rehabilitation, with strong nursing involvement, supports comprehensive and person-centered care.

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