Impaired potency in spinal cord injury

Sexual Function in Men with Spinal Cord Injury

Spinal Cord Injury SCI affects a man's sexuality both physically and psychologically. The degree of this influence largely depends on the type and level of injury. Men may experience changes in relationships, sexual activity, and ability to have children. They also experience emotional changes that can affect their sexuality. All these questions concern both the man with SCI and his partner.

Physical changes:

Erectile dysfunction.

There are two types of erection normally. The first type is psychogenic erection, as a result of sexual thoughts, exciting visual or auditory stimuli. The brain sends these signals along the pathways of the Spinal Cord to the T10-L2 level, from where they are transmitted to the penis, leading to an erection.

In spinal cord injury, the ability to have a psychogenic erection depends on the level and severity of the injury. Usually, in case of incomplete injury of the spinal cord (when elements of movement and/or sensitivity are preserved in the innervation zones below the injury site), the preservation of psychogenic erection is more likely at a low level than with a higher injury. With complete damage to the spinal cord, the ability to psychogenic erection is less likely.

The second type of erection is called reflex. It occurs through direct physical contact with the penis or other erogenous zones (such as the ears, nipples or neck). Reflex erections are involuntary and may occur without sexual or exciting thoughts. The nerve centers that control the ability to reflex erections are located in the sacral segments (S2-S4) of the spinal cord. Most men with spinal cord injury are capable of reflex erections upon physical stimulation if the S2-S4 segments or the nerves that originate from them are intact.

Many men with SCI are capable of erections, but they are not always full and long enough for full sexual intercourse. This condition is called Erectile dysfunction (ED). There are various treatment methods and assistive devices for the correction of ED. It is important to consult a sexologist or urologist in each case of erectile dysfunction in SCI.

Viagra. The latest breakthrough in the treatment of ED is the use of Viagra (sildenafil). The Federal Drug and Food Administration (FDA) approved the use of Viagra for the treatment of erectile dysfunction in 1998. Scientific studies have shown that Viagra, used exactly as directed (no more than once a day), significantly improves the quality of erections and satisfaction with sexual life in men with ED due to spinal cord injury between T6 and L5. Men who have low or high blood pressure or vascular disease should not use Viagra. Some medicines are not compatible with Viagra, and therefore any prescription must be agreed with the doctor.

Intracavernous injections. They are the introduction of vasoactive (causing vasodilation) drugs directly into the cavernous bodies of the penis. Usually papaverine or alprostadil are used. Due to cross circulation, even a unilateral injection results in bilateral penis enlargement. The injections are made with a very thin needle and are almost painless. Erection occurs 5-10 minutes after the procedure and lasts from 30 minutes to 2 hours, slightly decreasing after ejaculation. The dose of papaverine is selected individually. The most serious side effect requiring immediate attention is priapism (prolonged painful erection), which is more common after the first injection and can lead to penile damage. Alprostadil is often better tolerated than papaverine, but less readily available. Intracavernous injections are not recommended to be used more than once a week.

Medicated urethral systemic erection (MUSE) or transurethral therapy is a relatively new treatment. Drug pellets (the same alprostadil used for intracavernous injections) are injected into the urethra (urethra), from where the drug passes into the surrounding tissue, causing an erection. Reported side effects include: risk of infection, burning sensation, lowering blood pressure and fainting.

The vacuum pump is a mechanical device that allows you to achieve an erection sufficient for sexual intercourse. The penis is placed in a vacuum cylinder from which air is evacuated, which causes blood flow to the penis. After a sufficient erection occurs, the penis at the base is tightened with a rubber ring. This ring also prevents the leakage of urine that some men with SCI experience during intercourse. There are several models of vacuum pumps.The battery-operated model is more suitable for men with limited hand function, while other models require sufficient hand strength to press the pump against the skin to create the necessary vacuum.

Surgical implantation is a way to correct erectile dysfunction that is not amenable to other methods of treatment. Special implants are sewn directly into the cavernous bodies of the penis. There are three types of implants: semi-rigid or flexible rods (the penis is permanently in a semi-erect state), inflatable devices and self-contained implants. There is a risk of mechanical failure and the danger that the implants may cut through the skin. Men with SCI usually have impaired sensation in the genital area, so they may not feel pain when the implant cuts through the skin. All surgical implants also carry a high risk of infection. If infected, the prosthesis must be removed. Finally, implantation is a fairly expensive operation, not always covered by insurance.

Men with spinal cord injury should be carefully evaluated by a urologist familiar with SCI before using any medications or assistive devices. The level of damage, possible side effects, and other medical issues should be considered when choosing a treatment method. Patients with SCI should be alerted to the possibility of a life-threatening autonomic dysreflexia during intercourse. Signs of autonomic dysreflexia are: redness of the face, headaches, nasal congestion and / or changes in vision, a sharp increase in blood pressure.

Fertility (ability to have children)

The main factor affecting the ability to biological fatherhood in men with spinal cord injury is impaired ejaculation (ejaculation). In fact, 90% of men with SCI are unable to ejaculate during intercourse. Many people experience the so-called retrograde ejaculation, when the sperm does not go out through the urethra, but is thrown into the bladder, then being found in the urine.

There is a myth that the amount of sperm decreases over time after a spinal cord injury. According to studies, this is not confirmed and should not be a concern for men who seek biological fatherhood. However, the percentage of motile sperm in men with SCI is, on average, significantly lower than in healthy men (20% vs. 70%).

There are a number of methods to address the fertility problem in SCI. Men who seek biological fatherhood should see a fertility specialist who is experienced in this category of patients, knowledgeable about methods that can improve sperm quality in men with SCI, as well as complications that can occur (eg, autonomic dysreflexia).

Penile vibratory stimulation (PVS) is also used to achieve an erection, but its main purpose is to help ejaculate. For this, many models of vibrators (massagers) are applicable, some of which are specially designed for patients with spinal cord injury. It is important to consult a doctor before using a vibrator. One of the dangers of using a vibrator is the possible damage to the skin of the penis. If the sensitivity is compromised, the vibrator must be used very carefully.

Rectal Probe Electroejaculation RPE is used when the previous method is ineffective. A special electrode is inserted into the rectum, and as a result of electrical stimulation, ejaculation occurs.

If sperm cannot be obtained using PVS or RPE, a minor surgical operation may be performed to extract the sperm directly from the testis.

Once the sperm is collected in one way or another, it is used for artificial insemination.

Emotional Changes

Men with SCI often experience emotional changes that can affect sexual function. They are very concerned about their sexual abilities, the decline of which affects their relationship with a partner. Men who did not have partners at the time of the injury have difficulty finding new ones.

After a spinal cord injury, both romantic and intimate relationships with a partner can persist. Many men with spinal cord injury become irritable, depressed, moody. It is important for both partners to understand the physical changes that occur after trauma, but it is equally important to discuss how each of them experiences these changes. Without communication, without good mutual understanding, these emotions can involuntarily be directed against each other, further worsening the relationship. Partners should be open to each other, look for new opportunities for sexual communication together, and not be afraid to experiment. You should not avoid consulting a specialist who can help the couple sort out their feelings.

Safe Sex

The risk of sexually transmitted diseases (such as gonorrhea, syphilis, herpes, HIV infection) in patients with SCI is absolutely the same as in healthy people. Therefore, every precaution must be taken to protect against infection. The best remedy for this is a condom, which also protects against unwanted pregnancy.

What is spinal impotence

"What should I do if I was diagnosed with spinal impotence against the background of sexual excess?"

Spinal impotence is erectile dysfunction caused by damage to the sex centers (erection and ejaculatory) located in the lumbar spinal cord. Depending on which area is damaged, there is a clinical picture of sexual disorders:

• With increased excitability of both centers, a man suffers from frequent causeless erections and wet dreams. It is possible that premature ejaculation is combined with a weak erection;
• With reduced excitability of the ejaculatory center, a man does not complain about an erection, but practically does not achieve ejaculation;
• Decreased excitability of both centers leads to lack of erection.

In some cases, spinal impotence is accompanied by a decrease in the tone of the testicles and penis, disruption of the pelvic organs, and difficulty in motor activity.

A common cause of spinal impotence is sexual excess, leading to the depletion of the reproductive centers due to constant overexcitation. Erectile dysfunction of this kind is often diagnosed in young men who have practiced almost daily masturbation since adolescence. There is a high risk of developing this type of impotence in people who are fond of self-satisfaction while watching porn films (we answer the question whether masturbation leads to impotence).

The defeat of the genital centers can be caused by diseases:

The cause can be chronic infectious diseases (tuberculosis, syphilis), intoxication with alcohol and nicotine. These factors provoke cortico-spinal impotence (with involvement of the cerebral cortex).

Diagnosis

Spinal impotence is diagnosed by a neuropathologist (vertebrologist). An important source of information in this case is the patient's history, including trauma. To confirm the neurological nature of erectile dysfunction, a comprehensive neurophysiological examination is used:

Checking bulbocavernosus reflexes; Assessment of the reaction (potentials) of the pudendal nerve; Bulbocavernous reflex is a contraction of the bulbous-spongy muscle and the external sphincter of the anus in response to compression of the glans penis

• Study of the thermal sensitivity of the genital area, as well as the skin;

The state of the spinal cord is determined by MRI images.

The choice of methods of therapy is based on the results of the diagnosis. The easiest way to deal with the problem of overloading the spinal centers caused by sexual excesses. To restore their normal work, 5-6 weeks of abstinence are enough.

In the presence of diseases, their maximum compensation is made. Hernial infringement of the nerve roots in some cases can be neutralized with the help of medications and exercise therapy. If the spinal cord is injured, surgery will be required.

After the elimination or compensation of the main provoking factor, treatment with erectogenic drugs is carried out. Of the drugs, PDE-5 inhibitors (Viagra) are most effective. These drugs help to cope with spinal impotence in 80% of cases, provided that the reflex or psychogenic erection centers are preserved. Less effective, but also often used are blockers (yohimbine) and antipsychotics. In severe cases, intracavernous injections ("Alprostadil") are used. It is not recommended to give these injections more than once a week due to the high risk of developing priapism. Transurethral administration of vasodilators is also possible, but this method is fraught with side effects: burning in the urethra, pressure drop, infection.

Physiotherapy methods are also used:

If the problem of erectile dysfunction cannot be solved, then several options are possible:

• Using erectors or hard condoms;
• Phalloprosthesis implantation of implants in the cavernous bodies of the penis (read more information here);
• Sacral neuromodulation is the implantation of a device that affects certain parts of the nervous system.

Psychotherapeutic methods are also successfully used in the treatment of spinal impotence.

Restoration of erection after spinal injuries

Back injuries in men often lead to loss of erection. This is not surprising, because the spine is a conductor of nerve impulses from the brain to other organs and systems of the body.Nerve centers in the sacral spinal cord are responsible for sexual reflexes: the mechanisms of arousal, erection, orgasm and ejaculation. Depending on the location of the injury and its strength, the erection after a spinal injury remains at the same level, becomes weaker or disappears altogether.

It happens that a man retains the ability to one type of erection out of the existing two - reflex or psychogenic. Reflex appears from touching and stimulation of the genital organs and erogenous zones, psychogenic - from erotic fantasies or visual images.

The nerve centers of the spinal cord are responsible for both types of erection: the reflex is controlled by the area in the spinal segment S2-S4, the psychogenic one is controlled by the area T10-L2. In the case when these areas are not affected, the ability to have sexual intercourse is preserved, provided that the injury is located below them. If the damage is higher, the man is likely to have problems with sex, because the passage of the excitation signal from the brain through the injured area is difficult.

Figure for clarity:

An erection with an injured spine may occur, but be insufficient for normal sexual intercourse. A condition where the penis loses its rigidity during intercourse or does not become hard enough is called erectile dysfunction. Then, for a full-fledged sex, a man needs special pathogens.

Methods for restoring erection after spinal injury:

• medicines - Viagra and its analogues,
• vacuum pumps with erection ring,
• injections into the cavernous bodies of the penis, causing blood flow,
• administration of suppositories with a similar effect,
• vibration stimulation.

Viagra and its generics help with spinal injury only at the level of T6 - L5. Vacuum pumps with a clamping ring allow you to achieve an erection, but if you have problems with ejaculation, the pump will not help. You need special tools to help ejaculate. Especially for men with back injuries and other severe pathologies, erection and ejaculation vibration stimulators, such as Viberect or Viberect X3, have been developed.

The Viberect device is indicated after moderate and severe back injuries to create an erection and activate sexual reflexes. Andrologists have found out: the receptors of the head of the penis are very sensitive to high-frequency vibration. There is a powerful signal of sexual arousal and is transmitted through the chain to the spinal cord and brain. As a result, a powerful reflex erection appears even with serious back injuries.

If a man loses the ability not only to have an erection, but also to ejaculate, and he needs to get sperm for analysis or artificial insemination, a type of vibration stimulator is used - Viberect X3.

Manufacturers claim: Viberect is recommended not only for men suffering from partial or complete impotence, but also for physically healthy men to enhance erections. For example, when there is psychogenic erectile dysfunction or fatigue, interest in sex has disappeared.

I specifically purchased the device to test it. I don’t have any particular problems with potency, but I decided to see if he would create an erection after a long day of work in a state of fatigue, as well as with several sexual intercourses in a row.

Placing my penis between the vibrator pads, I turned it on at minimum speed. After 2 minutes, I felt a rather strong sexual arousal, the member came into an excited state. My summary: if you want to have a sex marathon or arrange a night of love when the forces are spent on labor exploits, Viberect is perfect as an activator.