Spinal Cord Injury and Sexuality

Male sexual function is a product of optimal physical, sexual and emotional stimulation that is mediated by hormones and spinal nerves. There are several physiological and neurological factors that may present with sexual deficits.According to a new study published in the International Journal of Impotence Research (1), the effectiveness of an individual’s erotic sense can be significantly altered after an acute or chronic injury to the spinal cord. Investigators compared the sexuality of 187 males with or without spinal cord injury and concluded that males with spinal damage have a much higher prevalence of erectile dysfunction, premature ejaculation and other disorders such as:

• Anejaculation/Anorgasmia
• A substantial decrease in the quality of sexual desires and arousal
• Pain during sexual intercourse (or dyspareunia)
• Retrograde ejaculation

Pathophysiology of Sexual Dysfunction after Spinal Cord Injury

Injury to spinal cord affects the neurological component of sexual activity, but may also involve psychological and physiological components in poorly managed cases. Here’s how:For optimal sexual functioning, two spinal pathways are very important; these are parasympathetic sacral pathway (S2 –S4) and sympathetic afferents of D10–L2. The sacral part of the neurological pathway is activated as a result of tactile or touch stimulation; whereas sympathetic pathway of sexual stimulation responds to visual, auditory and psychological impulses (such as sexual thoughts).In simple words, any spinal injury that directly or indirectly involve these nerve roots can present with sexual dysfunction. It is imperative to understand that the intensity of sexual dysfunction is dependent on several factors such as:

• Severity of spinal damage
• Level or site of spinal damage and involvement of nerve roots

For example, if sacral part of the neurological pathway is damaged, the erections can still be achieved with psychogenic pathway (visual or auditory stimulation or watching/ listening to erotic material). Likewise, if sympathetic roots are damaged, tactile stimulation (or penile stimulation) would help in achieving erections.  The quality and duration of erections will be compromised in most cases.Other causes:It has been observed that spinal cord injury to other nerve roots can also lead to sexual dysfunction due to:

• Visceral Pain or urogenital discomfort due to radiated pain
• Anxiety/ depression
• Agitation/ mood changes/ frustration
• Bowel and bladder dysfunction
• Poor body image or inferiority complex

Can you Still Impregnate Your Partner after Spinal Cord Injury?

The mobility of sperm and the ability to ejaculate may be affected but spinal cord injury does not lower the sperm count. Ejaculation may be severely compromised and some individuals may also experience retrograde ejaculation (a condition that is marked by backward ejaculation into the bladder instead of urethra). However, pregnancy can be achieved by artificial means and assistive techniques.Speak to your primary care provider to learn various functional options.

Caution and Care While Having Intercourse

It is important to seek help regarding self-training regarding maintenance of normal sexual function with spinal cord injury. For example:

• Certain exercises and techniques are fairly helpful at controlling your bowel and bladder activity during the act of intercourse. This can also be prevented if you monitor your bowel habit and plan intercourse accordingly.
• You may be advised by your physician to not drink anything two hours prior to having sex. If a urinary catheter is placed, it should be taken out before any sexual activity to stop the balloon of the catheter from moving. Because catheter movement can cause urinary injuries.

Additionally, individuals who experience erectile difficulty after spinal cord injury can get benefited from a variety of interventional tools like prosthetic vacuum implants (artificial implants that can be manually used to maintain steady erection) and vasoactive chemical agents that are mostly available in the form of injectable drugs. These drugs can increase the duration of erection up to 30 minutes (2).

When to Seek Help

You must seek help from a primary care provider; if:

• You are experiencing symptoms of urinary tract infection (marked by symptoms of cold, high grade fever, shivering, increase frequency of urination during the day or even at night, presence of e blood or foul smell in your urine, pain in the loin or lower part of the back or leakage of urine.
• If you need help or assistance regarding your sex life.
• If you have queries regarding your illness and its appropriate care.

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive.References:

1. Virseda-Chamorro, M., Salinas-Casado, J., Lopez-Garcia-Moreno, A. M., Cobo-Cuenca, A. I., & Esteban-Fuertes, M. (2013). Sexual dysfunction in men with spinal cord injury: a case–control study. International journal of impotence research, 25(4), 133-137.
2. Alexander, M. S., Biering-Sørensen, F., Elliott, S., Kreuter, M., & Sønksen, J. (2011). International spinal cord injury male sexual function basic data set. Spinal cord, 49(7), 795-798.