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Spinal Cord Injury

Spinal Cord Injury

A spinal cord injury can affect a man’s sexuality both physically and psychologically. While the majority of men with spinal cord injuries experience some changes in sexual function, the type and level of injury both play a role on the impact that injury has on a man’s sexuality. After injury, physical changes can include: the inability to attain or maintain an erection (erectile dysfunction), ejaculate or orgasm. Men can also experience emotional changes that can affect their sexuality.

Fertility

Spinal Cord InjuryMen with spinal cord injury often experience a change in their ability to biologically father a child. The major factor being that they are generally incapable of ejaculating as a result of the spinal cord damage. The inability to ejaculate during intercourse is called anejaculation. Another problem men with spinal cord injury may experience is retrograde ejaculation. This is when semen does not leave the penis through its tip (the urethra), but instead goes into the bladder during ejaculation.

Additionally, although a man with spinal cord injury does not decrease his sperm production, their ability to move can be reduced.

There are several options available to assist men with spinal cord injury to improve their ability to have children.

If a man is unable to ejaculate, penile vibratory stimulation can be used to achieve an erection and eventually ejaculation. A variety of vibrators/massagers are available. Some are specifically designed with the output power required to induce ejaculation in men with spinal cord injuries. In vibratory stimulation, a vibrator applied to the tip of the penis, and the immediate surrounding area, causes vibrations to travel along the sensory nerves to the spinal cord and induce a reflex ejaculation. As a result, PVS may not work for men with certain spinal cord injuries. If a man lacks sensation in his genital area, as is the case for many men with spinal cord injuries, a vibrator must be used very carefully to avoid any bruising, bleeding or ulceration.

If vibratory stimulation fails, electroejaculation is the next in-line therapy. Rectal Probe Electroejaculation (RPE) is when a doctor inserts an electrical stimulation probe, called an electroejaculator, into the rectum, and the controlled electrical stimulation produces an ejaculation by stimulating ejaculatory nerves. General anaesthesia is usually required, except in some case of complete spinal cord injury whose pain and touch sensation is no longer present.Once the ejaculate is collected and the sperm quality is determined to be high enough, the sperm can then be used for artificial insemination.

If the above measures are not successful and fertility is the main concern, it is possible for a trained physician to extract sperm from the testicles and use in vitro fertilization (IVF) in order to initiate pregnancy (egg-sperm fertilization in a test tube and then inserted into uterus of mother) or single sperm injection can be attempted.

Men with certain spinal injuries have a better chance of response to these treatments. Therefore, men who are interested in fathering a child should get medical advice and treatment options from a fertility specialist experienced in issues of spinal cord injury to determine how successful each treatment is for each individual. The fertility specialist needs to be aware of methods that can improve sperm quality in men with spinal cord injury, as well as complications that can occur.

Conditions

Spinal Cord InjuryMost men with spinal cord injury are able to have a reflex erection with physical stimulation although rigidity is not always perfect. It is psychogenic erections that often are more problematic for men with spinal cord injuries.

Many men with spinal cord injury are capable of having an erection, however the erection may not be hard enough or last long enough for sexual activity. There are various treatments available for treating ED, but men with spinal cord injury may have particular concerns or problems with their use. It is important to see a doctor or urologist for accurate information.

Another type of physical problem that is common in some men with spinal cord injuries is a condition called retrograde ejaculation. Men with retrograde ejaculation release all or part of their semen into their bladder during ejaculation instead of it leaving through the tip of the penis. Injuries to the spinal cord can sometimes interfere with the function of the internal muscles called sphincters,preventing the bladder opening from closing properly. As a result, during ejaculation semen is propelled backward into the bladder instead of leaving the penis. This causes semen to mix with urine in the bladder and leave the body during urination without harming the bladder. Retrograde ejaculation can impair fertility since it affects the delivering of sperm to the vagina during intercourse.

Because each spinal cord injury is different, each man’s physical response is different. You should talk to your doctor openly and honestly about your particular needs.

Treating Spinal Cord Injury

There are many different treatments for men experiencing ED from spinal cord injury. Effective treatment varies greatly depending on the type and severity of the spinal cord injury. Additionally, men with spinal cord injuries may have special concerns or problems with their use. Therefore it is very important to consult your doctor or urologist to decide on the best treatment option for you.

Treatments that have been successful in treating ED for men with spinal cord injuries are:

Oral Medication

Currently, there are three oral medications (pill taken by mouth) approved for use by the U.S. Food and Drug Administration (FDA) for the treatment of ED: sildenafil citrate (Viagra®), vardenafil hydrochloride (Levitra®) and tadalafil (Cialis®).

All of these therapies, also known as phosphodiesterase-5 inhibitors (PDE5i), create an erection by increasing blood flow into the penis. Although all work in the same way to help men gain an erection, there are differences between each that should be discussed with your doctor in order to choose which drug therapy is best. Some differences between these drug therapies are: dosing, longevity of effectiveness, interaction with other medications, and side effects. When taken properly, these medications have been found to improve erections in more than 80 percent of patients.

Some of the failures in patients who do not respond to these medications are attributable to inappropriate medication usage (not paying attention to ‘instructions for use’), use of less than maximum dose, too few attempts.

Use of the orally administered PDE5i medications listed has become the first-line treatment for ED. Additionally; all three oral medicines have comparable rates of side effects. [Link to PDE5i section]

Penile Injection Therapy

Injection treatments involve the injection of medication into the base or side of the penis. The injected medication causes blood vessels within the penis to widen, or dilate, which increases blood flow to the penis and causes an erection. Injection therapy typically uses a combination of two or three drugs prescribed by a doctor, called a “bi-mix” or “tri-mix”. The most common drugs are Papavarine, Phentolamine and alprostadil. Although the thought of an injection can be unpleasant, injection is a quick and easy technique to learn and for most men the procedure’s sensation is no more than a pinch. Another benefit is that most men who do not respond to the oral drug therapies listed above find injection therapies to be effective in the treatment of ED.

Urethral Suppositories

Transurethral agents, also called intra-urethral agents, are ED treatments whose mode of administration is insertion into the urine channel, known as the urethra. The only FDA-approved urethral suppository is called M– USE® (Medicated Urethral System for Erection), which contains the drug alprostadil (also used in the injectable drugs, Caverject and Edex).

Once M– USE is inserted and absorbed into the tissue immediately surrounding the urethra (the corpus spongiosum) it is transferred into the erectile chambers (corpora cavernosa) via small veins. The medicine then causes the erectile tissue within the penis to relax and allows blood flow into the penis to increase. This increased blood flow causes an erection. [Link to M– USE section]

Vacuum Erection Devices (VED)

Also called vacuum constriction devices (VCD), are also very common because they are not invasive. The VED/VCD is a vacuum pump that causes blood to be drawn into the penis in order to create an erection. This is done by placing the penis into the vacuum cylinder and pumping air out of the cylinder. The erection is maintained by placing a constriction ring around the base of the penis. This ring also prevents urinary leakage that some men with spinal cord injuries experience. Both battery-operated model and hand pump models are available.

Some of the above treatment options may provide limitations to men with limited hand functioning due to their spinal cord injury. Therefore, assistance may be required, as in the case with injection therapy and penile suppositories, or certain options may not be possible, like having to use the battery operated vacuum devices rather than the hand operated ones.

Penile Implant

Penile prostheses, or penile implants, are an important treatment option for men with ED who have an established medical cause for ED, fail to respond to non-surgical treatments (such as oral medications, vacuum devices, injection therapy etc.) and who are motivated to have surgery to improve erectile function. Penile implant requires a permanent surgical procedure that cannot be reversed so it is important that men talk to their doctor about the advantages and possible drawbacks of having the procedure.

This procedure replaces the spongy tissue (corpora cavernosum) inside the penis that normally fills with blood to create an erection with rigid, semi-rigid, or inflatable cylinders (depending on which type of penile implant is chosen). In all penile prostheses, the surgically inserted components are totally concealed within the body. After a penile implant, when a man desires an erection, he is able to produce a rigid erection on demand that enables him to have sexual relations. Penile implants do not typically lengthen the penis.

It is best to talk to the treating physician or a urologist before any treatment since men with spinal cord injury may have special concerns in choosing the best treatment for ED. A man’s level of injury, possible treatment side-effects, other medical conditions and current medications need to be considered when deciding which treatment option is best.

Provided by WebMD

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