Sexual and climactic responses in men with traumatic spinal injury: A model for rehabilitation

SummaryObjectiveThis article describes the clinical assessment and treatment of ejaculation and orgasmic dysfunctions in spinal cord injured men. Based on a neurophysiological model, the assessment suggests that posttraumatic ejaculation and orgasm are a function of the lesion level and stimulation mode used to trigger the response.MethodA review of the literature from Pubmed served this research, as well as clinical experience and our own studies on sexual function following spinal cord injury (SCI).ResultsClincical experience suggests that the assessment should be performed in the rehabilitation setting to encourage autonomy and to investigate the best stimulation mode, reflexogenic or psychogenic, that may trigger ejaculation. The assessment may be accompanied with sex education on posttraumatic potential and home exercises accompanied with advices such as folding the legs or crossing them to increase tension and spasticity or to modulate psychogenic arousal. Upon failure, vibrator stimulation (VS) is offered and may be combined with oral midodrine. If erection is insufficient, intracavernous injections or phosphodiesterase inhibitors may be offered prior to VS. Electroejaculation (EEJ) is proposed last and may be combined with midodrine. Patients with lower lesions, often showing premature and dribbling ejaculations, are offered antidepressive drugs to postpone ejaculation. Considering these options, researches show that up to 100% of spinal cord injured men can obtain ejaculation. Our studies suggest that ejaculation is maximised in men with higher or incomplete lesions, in those preserving bladder or bowel control and in those showing spasticity. Findings on reproduction show that VS may be combined with intravaginal insemination performed without medical assistance, EEJ combined with intrauterine insemination, and vasal aspiration or MESA or TESE associated with fresh or cryopreserved specimen from the SCI patient or donor.DiscussionAs the loss of sexual function is perceived as the most severe consequence of a SCI, the evolution of research and clinical practice in rehabilitation now helps the majority of SCI men to experience a rich and satisfactory sexual life.