Sexual function in spinal cord lesioned men

Abstract

Study design: Review of literature. Objective: To review the physical aspects related to penile erection, ejaculatory dysfunction, semen characteristics, and techniques for enhancement of fertility in spinal cord lesioned (SCL) men. Setting: Worldwide: individuals with traumatic as well as non-traumatic SCL. Results: Recommendations for management of erectile dysfunction in SCL men: If it is possible to obtain a satisfactory erection but of insucient duration, then try to use a venous constrictor band to ®nd out if this is sucient to maintain the erection. Otherwise we recommend Sildena®l. If Sildena®l is not satisfactory then use intracavernous injection with prostaglandin E 1 (some SCL men may prefer cutaneous or intraurethral application). We discourage the implantation of penile prosthesis for the sole purpose of erection. Recommendations for management of ejaculatory dysfunction in SCL men: Penile vibratory stimulation (PVS) to induce ejaculation is recommended as ®rst treatment choice. If PVS fails, SCL men should be referred for electroejaculation (EEJ). Semen characteristics: Impaired semen pro®les with low motility rates are seen in the majority of SCL men. Recently reported data gives evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCL. It is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen pro®les in men with chronic SCL. Fertility: Home insemination with semen obtained by PVS and introduced intravaginally in order to achieve successful pregnancies may be an option for some SCL men and their partners. The majority of SCL men will further enhance their fertility potential when using either PVS or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. Spinal Cord (2001) 39, 455 ± 470

Phosphodiesterase inhibitors in the treatment of erectile dysfunction in spinal cord-injured men

“…However, these erections are frequently unsuitable for satisfactory sexual activity. [1][2][3][4][5] Intracavernous injections of vasoactive drugs (such as papaverine, prostaglandin E1 or alpha-blocking agents) have constituted the first effective pharmacological management of dyserection in SCI patients. Their side effects (priapism and fibrosis of the corporal tissue) and the injection therapy, which can be unacceptable to some men, can limit their use.…”

“…Their side effects (priapism and fibrosis of the corporal tissue) and the injection therapy, which can be unacceptable to some men, can limit their use. 3,6,7 Sildenafil (Viagra s ) has represented the first effective oral drug that promotes erection in neurogenic and nonneurogenic patients, and it has been followed recently by two newer drugs, Vardenafil (Levitra s ) and Tadalafil (Cialis s ). They all have an identical mechanism of action.…”

La fertilité chez le blessé médullaire. Effet du niveau de la lésion médullaire

“…L'6jaculadon est sous d6pendance de trois centres m6dul-laires [2,3] Le centre sympathique D 10 L2 adresse par l'interm6diaire du neff hypogastrique ses fibres post ganglionnaires aux v6sicules s6minales, aux canaux d6f6rents dont il assure le p6ristaltisme, les fibres musculaires lisses de la prostate et enfin il assure la cl6ture du col v6sical. On comprend alors ais6ment qu'il est responsable de la premi6re partie de la r6ponse 6jaculatoire qui est l'6mission du sperme Le centre parasympathique sacr6 $2 $4 assure une partie de l'innervation prostatique et assure probablement une partie de la s6cr6tion prostatique.…”

“…Celle ci n'est conservEe en moyenne dans la littErature que chez environs 15% des patients [2]. Concernant la capacit6 ~ obtenir une Ejaculation rEflexe Brindley dans les premieres grandes series de la littErature notaient que la rEponse ?~ la vibration Etait corrEIEe ~ la prEsence d'une flexion de hanche [ 10].…”

Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners

“…1 However, successful pregnancies in partners of SCI men have been reported after ejaculation induced by penile vibratory stimulation (PVS), electroejaculation (EEJ) or surgical sperm retrieval followed by the use of assisted reproductive techniques (ART). 1 ART includes intrauterine insemination (IUI), and in vitro fertilization (IVF) with or without intracytoplasmic sperm injection (ICSI).…”