Trip Answers

Question answered:07/09/06 Warning! this question is over two years old.

Our literature search conducted in the TRIP and Medline databases identified a number of papers on sexual dysfunction in patients with spinal cord injuries; however the type or extent of injury or vertebrae (.i.e. C6 etc) resulting in the spinal cord injuries are not detailed.

 

We found just one study specifying tetraplegic patients formed part of the study population.

 

Slot et al examined erectile and ejaculatory function in males with spinal cord injury and reported:

 

“…A questionnaire-based survey of admissions during 1980-84 was undertaken at a regional spinal cord injury rehabilitation unit. Male patients aged 20-63 years with complete or incomplete tetraplegia or paraplegia living in their own homes were included in the study; 43 complied with inclusion criteria, and 38 answered the questionnaire. Ninety-five per cent of the patients stated that they could obtain an erection, 61% on a purely reflex basis; 66% stated that erection was sufficient for coitus, and 45% that they could obtain ejaculation/emission.

 

More patients with incomplete than complete lesions reported ability to obtain ejaculation/emission. Significantly, more of the patients aged below 30 years reported erection sufficient for coitus (p less than 0.05). Forty-five per cent of the patients experienced complications of sexual activity, mainly in the form of bladder dysfunction and pain or spasms. In conclusion, SCI is usually accompanied by considerable sexual dysfunction, but most patients are still capable of functioning sexually. Thus, in the rehabilitation process after SCI, sexual counselling and information may be valuable.” [1]

 

Linsenmeyer and Perkash’a paper on infertility in men with spinal cord injury notes, in the abstract:

 

“Ejaculations are reported to occur in only 5% of men with spinal cord injury (SCI) who have complete upper motor lesions and 18% of those who have complete lower motor lesions. Ejaculations occur in up to 70% of men with incomplete lesions.” [2]

 

Finally, an article published in the journal “American Rehabilitation” offers the following information on sexuality following spinal cord injury:

 

“The effect of spinal cord injury on sexual response is generally discussed based upon the degree of completeness or incompleteness of the patient's injury and whether the neurologic damage affecting the individual's sacral spinal segments is an upper or lower motor neuron injury. Whether a spinal cord injury is considered complete or incomplete is determined by whether they have voluntary rectal contraction and whether they have the ability to perceive sensation around their rectum...

 

In males with complete spinal cord injuries and upper motor neuron injuries affecting their sacral segments, there is a loss of psychogenic erectile function in conjunction with maintenance of reflex erectile functions. In those males with incomplete upper motor neuron injuries, there is still maintenance of reflex function; however, some of these males may be able to have psychogenic erectile function. For those males with lower motor neuron injuries affecting their sacral spinal segments, it has been shown that approximately 25 percent of males will have psychogenic erectile function, whereas none of these males will have reflex erectile function. With incomplete lower motor neuron injuries affecting the sacral spinal segments, over 90 percent of the population will be able to have some type of erectile function.

 

Ejaculatory function is markedly decreased in men with spinal cord injuries. This is most likely due to the fact that coordinated neurologic impulses from the sympathetic, parasympathetic, and somatic nervous systems are necessary for ejaculation to occur. For instance, the rate of ejaculation in men with complete upper motor neuron injuries can be as low as 4 percent. Furthermore, many times men with spinal cord injuries have ejaculation which goes back into the bladder instead of coming out of the penis. Treatment of this inability to ejaculate has recently been used successfully to help men who suffer from infertility.

 

Other male sexual dysfunctions such as inability to have an orgasm, decreased sexual desire, and premature ejaculation have not been well-studied in the male population. Questionnaire studies have revealed that approximately 50 percent of males with spinal cord injuries can have orgasms and that the ability to have orgasms is not related to the degree of spinal cord injury. Furthermore, it has been documented that both sexual satisfaction and frequency of sexual activity decrease after spinal cord injury. As the focus changes from merely production of an erection to improving the quality of feeling in male sexual response, the reasons for the ability of some males to attain orgasms and others not to will need to be elucidated. Furthermore, treatment protocols for other male sexual dysfunctions will need to be developed.” [3]

 

 
Concerning the most appropriate health professional to refer this group of patients, the NLH Q & A Service would suggest referral to an urologist.

References
1. Slot O, Drewes A and Andreasen A. Erectile and ejaculatory function of males with spinal cord injury.
 Int Disabil Stud. 1989 Apr-Jun;11(2):75-7. (http://www.hubmed.org/display.cgi?uids=2630555).
2. Linsenmeyer T and Perkash I. Infertility in men with spinal cord injury. Arch Phys Med Rehabil. 1991 Sep;72(10):747-54. (http://www.hubmed.org/display.cgi?uids=1929799).
3. Sipski M. Sexuality and spinal cord injury: where we are and where we are going. American Rehabilitation 1997;23(1). (http://www.ed.gov/pubs/AmericanRehab/spring97/sp9707.html).

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