Clinical approach to erectile dysfunction in spinal cord injured men. A review of clinical and experimental data

Abstract

Despite the many developments in the area of sexual dysfunction, rehabilitation settings seldom investigate the remaining sexual function following spinal cord injury, or offer differential diagnoses of sexual dysfunction in spinal cord injured men. This article attempts to show how sexual rehabilitation should begin with a thorough assessment of the sexual function of paraplegic and tetraplegic men. Assessment includes a basic neurological examination of the perineal area and an extended clinical interview on sexual function and visceral function. The interpretation of patient evaluation is discussed in terms of a classification system adapted to sexual purposes and in terms of the differential diagnoses between sexual dysfunctions of organic, and those of predominantly psychogenic origin in the spinal cord injured patient. The organic or psychogenic contribution is discussed in terms of sophisticated procedures, where assessment of nocturnal penile tumescence (NPT) is critically evaluated and where alternatives such as urodynamic findings and skin potentials are discussed, Treatment strategies, such as intracavernous injections and cognitive-behavioural strategies adapted to different lesion types, are discussed.Keywords: erection; sexuality; spinal cord injuries; paraplegia IntroductionCentres that specialise in the area of sexual dysfunction have, nowadays, a variety of resources available to them, ranging from medical interventions -such as intracavernous injections,1-3 vacuum devices4-6 and surgery;7,8 to psychotherapeutic ones, such as couple, group and individual therapy9-11 based on cognitive behavioral,9-11 systemic-interactional ,12 existential humanistic12 and psychodynamic12 approaches. All of these approaches remain based on the initial evaluation of the patient to identify the organic and psychogenic origin of the dysfunction and to adapt treatment to the individual patient.The study of sexual dysfunctions has, in this sense, led to the development of assessment instruments aimed at improving the diagnosis of organic and psychogenic sexual dysfunctions. Instruments have evolved from the mercury plethysmograph,13,14 to the penile cuff15 and the Rigiscan device (Dacomed, Minneapolis )16,17 for the measurement of penile tumescence, and from the buckling force18,19 to the stamp rin?,20-22 snap gauge18,23 and again penile15,24 and Rigiscan1 ,17 devices for the measure of penile rigidity. Further studies have explored the advantages and limitations of daytime laboratory recordings as opposed to measurement of nocturnal penile tumescence.Strangely enough, these developments appear to have escaped the rehabilitation environment. Despite a few attempts to consider multidisciplinary approaches to sexual dysfunction in spinal cord injured patients,25,26 rehabilitation centres have tended to focus on intra cavernous injections as a sole mean of intervention and often fail to consider the differential diagnoses between organic and psychogenic dysfunction in this patient population.In this context, our France-Q...

Efficacy and safety of phosphodieterase-5 inhibitors for treatment of erectile dysfunction secondary to spinal cord injury: a systemic review and meta-analysis

“…31,32 A variety of management options could be adopted for individuals with SCI. 33 However, therapies for ED caused by SCI remain challenging, and PDE5 inhibitors, vacuum devices, penile implants, intraurethral prostaglandins, percutaneous perineal electrostimulation, transdermal nitroglycerin, intracavernous injection of papaverine and some other therapies are still under debate.…”

Erectile dysfunction in spinal cord-injured men: different treatment options

“…However, it is reported that 80-95% of these patients can achieve some type of erection: reflexogenic, psychogenic or mixed. 3,10 Treatment options for ED in patients with SCI include intracavernosal injection of vasoactive substances, VCD and surgical implantation of penile prothesis. 3,6,8 The American Urological Association Panel on the treatment of organic ED stated that the ultimate goal is a therapy that is reliable, has minimal side effects and is simple to use.…”

Specific aspects of erectile dysfunction in spinal cord injury

“…However, these erections are often less rigid and more difficult to maintain. 7,8 In men with complete SCI, more than 80% can achieve an erection, whether reflexogenic, psychogenic, or mixed; however, most of these patients require some type of treatment for ED. In men with incomplete SCI, the response varies.…”