SEXUALITY IN SCI-ERECTILE & EJACULATION DYSFUNCTION

SUMMARY

1. The majority of men with SCI can obtain an erection through the reflexogenic (S2–4) pathways or the psychogenic (T11–L2) pathways. However, these erections are often unreliable, inadequate and poorly sustained.

2. All men with complete SCI lack genital sensation, but many experience pleasurable feelings above the level of injury during sexual activity (phantom orgasm).

ERECTION
3. In men with complete UMN lesions above the S2–4 reflex centre, the sacral reflexes are intact and reflex erections are retained but are often unpredictable.

4. Men with complete LMN lesions below or involving the S2–4 reflex centre lose reflex erections but may be able to achieve psychogenic erections though they are poorly sustained.

5. Indeed, the presence of sensation in the T11-L2 dermatomes may indicate preserved erections.

EJACULATION
6. Men with complete UMN lesions above the emission centre (sympathetic T11–L2) retain only about a 5% chance of achieving reflex ejaculation without intervention.

7. Men with complete mixed or LMN lesions below the emission centre (sympathetic T11–L2) may retain the ability to achieve psychogenic seminal emission (often precocious) with associated partial orgasm.

Reference(s)

Lever, S. and Leong, G., 2017. Sexuality following spinal cord injury. Sydney: NSW Agency for Clinical Innovation.
Cifu, D.X. (2020). Braddom’s physical medicine and rehabilitation. Elsevier. Get it on Amazon.
Cuccurullo, S. (2019). Physical medicine and rehabilitation board review. New York: Demosmedical. Get it on Amazon.
O’Young, B., Young, M.A. and Stiens, S.A. (2008). Physical Medicine and Rehabilitation Secrets. Mosby. Get it on Amazon.