[Sexual dysfunction in men with spinal injuries]

Spinal injuries may disturb men's sexual functions in various ways.

Review article based on extensive clinical experience, lecturing, research and selected articles.

A spinal injury may disrupt or disturb the connection between the brain's main centres for sexual function to the genitals. This often leads to extensive problems with erection, ejaculation, orgasm and fertility. Hormonal affection of sexuality is not much altered. Libido problems are of a more psychological nature, such as a poor self-esteem and lack of understanding from the surroundings. Sedative effects of medicines affect all aspects of sexuality. About 80% of men with spinal injuries have erection problems; mainly erection of short duration that can be treated with medicines administered orally (such as phosphodiesterase inhibitors) or by self injection of alpha-adrenergic inhibitors directly into the sinusoids in the penis. Only 10-15% ejaculate spontaneously. Ejaculation may be assisted in various ways, the vibro-ejaculation method being the most effective. The semen quality is reduced, possibly because of altered neurogen control of sperm maturation. Modern techniques for in vitro fertilisation combined with assisted ejaculation and careful control of the semen quality, has made it possible for most spinal-injured men to have their own children.