SPINAL cord injuries occur after blunt or penetrating injuries to the spinal cord.

Years ago, men with spinal cord injuries were confined to wheelchairs with little consideration given to their erections and fertility status. But, with improvements in neurosciences and physiotherapy, the quality of life and functional status of these men have improved.

Will every man with spinal cord injury get erectile dysfunction?

All men with spinal cord injuries will not necessarily have erectile dysfunction. Rates of preservation of erectile function of 75% have been reported in various populations. However, up to 35% of men will use aids to achieve an erection.

What causes impairment in erections in men with spinal cord injuries?

Sexual function is impaired due to nerve damage affecting motor and sensory nerves responsible for erections. Additionally, psychogenic erectile dysfunction may occur due to the man’s response to the life-altering nature of the illness. The type and level of the spinal cord injury will ultimately determine the effect on erectile function. Men who regain erectile function soon after injury are most likely to have long-term preservation of erectile function.

How do men with spinal cord injuries preserve erections?

Many men are able to get reflexogenic erections that occur with physical stimulation of the penis and genitalia, though on some occasions, the rigidity is not perfect. These erections are so called because they are due to a neurological reflex arc between the genital area and the spinal cord.

Other men with spinal cord injuries preserve the so-called psychogenic erections. Depending on the level and completeness of the injury, some men may not have these erections.

How is erectile dysfunction treated after spinal cord injury?

Treatment is similar to other men with this complaint. First-line treatment is the use of tablets which include Viagra® (Sildenafil), Cialis® (Tadalafil) and Levitra® (Vardenafil). New to the market is an agent called Stendra® (Avanafil), a second generation drug in the class.

If tablets fail, then there are vacuum erection devices, urethral suppositories – inserted into the urethra – penile injection therapy, and penile implant surgery.

Why is fertility affected in spinal cord injured patients?

Fertility is affected in men with spinal cord injuries because they are usually unable to ejaculate. This is either due to an inability to produce semen or retrograde ejaculation.

The methods to induce ejaculation may be via vibratory stimuli or electro-ejaculation.

Is the man’s sperm count affected?

The sperm count is unaffected in men with spinal cord injuries, however sperm motility is reduced. This factor combined with anejaculation severely affects normal fertility.

However, assisted reproductive techniques are possible for men with spinal cord injuries in order to achieve fertility. A publication in the Journal of Rehabilitation Medicine reported that 19% of men interviewed had achieved conception with their partners, with 26% of these requiring assisted reproductive techniques.

Erectile function and fertility may be affected in men with spinal cord injury. However, quality of life may be maintained by utilising available options.

Dr Belinda Morrison is a consultant urologist and lecturer at the University of the West Indies and Mona Institute of Medical Sciences, Mona, Kingston 6. Please send questions and comments to – belinda.morrison02@uwimona.edu.jm.