Prediction of sexual function following spinal cord injury: a case series

Abstract

Neurologic examination combined with reflex testing allows prediction of sexual responses after SCI. It would be useful for version 2.0 of the ISAFSCI to assist clinicians in determining the anticipated changes, whether their patients are functioning as anticipated sexually after SCI or whether other concerns also require treatment.

Positive sexuality in men with spinal cord injury

“…While our results confirmed the relationship between younger age at injury and sexual satisfaction, we found no effect of time since injury, probably because this time was longer than in other studies (12.8 ± 9.7 years). Our results are in agreement with other studies, showing no effect of level and severity of lesion on sexual satisfaction [8,10,13,27,31], and also highlight the poorer satisfaction of men with a cauda equina syndrome and lower motor neuron lesions [13,33,46].…”

Dartos reflex as autonomic assessment in persons with spinal cord injury

“…A comprehensive clinical neurological examination, including somatic and autonomic responses is key to determine the functional potential of each person with SCI, particularly regarding their sexual responses [5]. The DR is quick and easy to test at the bedside and provides valuable information on the integrity and excitability of the T11-L2 sympathetic spinal segment.…”

“…In males with SCI, many interconnected factors influence the possibility of orgasm, such as the level and severity of the lesion, the degree of autonomic stimulation and the occurrence of ejaculation. Thus presence of the DR and integrity of the T11-L2 segment are insufficient to predict the possibility of orgasm [5,23,24]. Finally, psychogenic erection relies on connexions between an intact T11-L2 centre and the brain.…”

“…Autonomic tests include pilomotor (piloerection or goose bumps) and sudomotor (sweating) reflexes on the legs (T10-L2 innervation) and trunk, in response to stimulations above the lesion (encephalic reflexes) or below the lesion (spinal reflexes) usually with pressor stimuli such as bladder filling or penile vibratory stimulation (PVS) [13,14]. The sympathetic vasomotor responses (skin axon-reflex vasodilatation) is evaluated by mechanically stimulating the skin (using a blunt instrument, such as the edge of a wooden tongue depressor) on both sides of the trunk, inducing a spreading flush (vasodilation or dermatographia rubra) on normally innervated skin [5,14].…”

“…The neurological classification of SCI (ISNCSCI) provides some information regarding function, but is mainly limited to sensory testing of the T10 to L2 dermatomes, with one key motor test involving the psoas muscle (L2) [4]. Complementary neurological somatic and autonomic assessments are thus required [5].…”