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SEXUALITY IN SPINAL INJURY: THE SPINAL CORD INJURED MALE: EJACULATION, ORGASM, AND COITUS

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     Ejaculation is a motor function which cannot take place if the particular nerves and parts of the spinal cord that control ejaculation are injured. The ability to ejaculate is controlled by nerves, which originate in the lowest part of the spinal cord; that is, segments T-12 to L-2, and sacral levels, 2, 3, and 4.

     Some spinal cord injured men can ejaculate. In men with lower level injuries, most researchers report that ejaculation occurs in up to 70% of men with incomplete lower injuries, and in up to 17% of men with complete lower level injuries. In men with upper level injuries, most researchers report that ejaculation occurs in up to 29% of men with incomplete upper level injuries, and rarely, if ever, in men with complete upper level injuries.

     SCI men who do ejaculate may experience retrograde ejaculation. Orgasm does not necessarily accompany ejaculation. Due to sensory loss, few spinal cord injured men are able to reach and experience pre-injury-type orgasm. Heightened spasticity has been experienced by some men at the point of ejaculation.

     Not all spinal cord injured men attempt coitus, for whatever reason. However, for those who do, many are successful.

     For men with lower level injuries, researchers report that 90% of the men with incomplete lower level injuries who attempted coitus were successful, and 65% of men with complete lower level injuries were successful.

     For men with upper level injuries, researchers report that 85% of men with incomplete upper level injuries who attempted coitus were successful, and 72% of men with complete upper level injuries were successful.


Interventions to Enhance and/or Maintain Erections

  • Sildenafil (Viagra) is a medicine taken by mouth for erectile dysfunction. Research studies show that sildenafil improves the quality of erections in men with erectile dysfunction due to spinal cord injury between T6 and L5. Men who have low or high blood pressure or vascular disease should not take sildenafil. Some medications cannot be taken with sildenafil so all medications should be reviewed with the prescribing physician.
  • Penile injection therapy, such as alprostadil, involves injecting the penis with medication to produce an erection. These drugs must be used exactly as prescribed by the physician. This method is not recommended to be used more than once a week.
  • Medicated Urethral System Erection (MUSE) is a transurethral medication option. A medicated pellet (alprostadil) is placed in the urethra where it is absorbed into the surrounding tissue. The medication causes the blood vessels to relax and the penis fills with blood causing an erection.
  • The vacuum pump is a mechanical option for producing an erection sufficient for intercourse. The penis is placed in a vacuum cylinder and air is pumped out of the cylinder causing blood to be drawn into the erectile tissues. The erection is maintained by placing a constriction ring around the base of the penis. It is important to remove the ring after intercourse to prevent any skin breakdown.
  • Surgical implantation of a permanent penile prosthesis is another option for erectile dysfunction. It involves inserting an implant directly into the erectile tissue.

 

Fertility

Men with spinal cord injury also experience a change in their ability to biologically father a child. The main reason for this is the inability for the spinal cord injured male to ejaculate during intercourse. Retrograde ejaculation may also occur which is when ejaculate travels back up the tube and goes into the bladder.

For those men who wish to father a child there are options. A fertility specialist experienced with spinal cord injury should be consulted. Two different ways that ejaculate can be produced are penile vibratory stimulation (PVS) and rectal probe electroejaculation (RPE). PVS uses a vibrator or massager against the penis to help produce ejaculate. The RPE is when a doctor inserts an electrical stimulation probe into the rectum, and the controlled electrical stimulation produces an ejaculation. If neither of these methods are successful, minor surgery can be performed to retrieve sperm from the testicles.

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