Enhancement of sexual function and fertility in spinal cord-injured males

Trauma to the spinal cord in males may result in both erectile dysfunction and infertility. Reflex erections may be preserved in upper motor neuron lesions and psychogenic erections in lower motor neuron or incomplete lesions. There are numerous reports of abnormalities of testicular biopsies that may relate to increased scrotal temperature and other factors. Techniques to restore erections include intracavernous injections of vasoactive substances, vacuum tumescence constriction therapy and penile prostheses. All have potential adverse affects. When reflex function in the sacral cord is present, fertility can be improved by vibratory ejaculation. Subcutaneous physostigmine or electroejaculation may benefit individuals with intact fibers from the sympathetic outflow. This paper reviews sexual dysfunction in spinal cord-injured males with a focus on management techniques.