Sexual function

Some cord-injured men already in the intensive care unit ask about their ability to have an active sex life and become fathers. The erectile dysfunction in men after spinal cord injury has different characteristics depending on level of lesion, and mainly follows the pattern of bladder dysfunction. The person with an upper motor neuron lesion usually has the capacity for reflex erection by tactile stimulation. The person with a lower motor neuron lesion has loss of all erectile function. The capacity of psychogenic erection is lost in all cord-injured men with a complete lesion. Retrograde ejaculation is the rule when there is an ejaculation at all. Today, we can offer drugs and different stimulations in order to improve erectile function and to produce an anterograde ejaculation. Vibration and electro-stimulation need careful monitoring of blood pressure since these methods readily evoke autonomic dysreflexia. By the means of vibration and electro-stimulation in combination with insemination or in vitro fertilization, men after spinal cord injury can become fathers. At our Spinal Cord Injury Unit, with 35-50 newly injured patients admitted every year, we have about 75 children who have cord-injured fathers (Agneta Siosteen, personal communication).

Sexual function is impaired also in women. The female analogue to erectile dysfunction, that is, loss of lubrication, needs treatment. Fertility is unaffected, but the autonomic disturbances make the woman with spinal cord injury at increased risk of urinary incontinence, urinary tract infection and pressure sores during child bearing. They are also at risk of developing severe autonomic dysreflexia during labor.

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