Electrophysiological assessment of sexual dysfunction in spinal cord injured patients

Abstract

Study design: Survey. Objectives: To determine associations between sexual dysfunctions and electrophysiological examinations of the genital system in spinal cord injured patients. Setting: Ege University Hospital, Izmir, Turkey. Methods: In total, 25 patients (17 men, eight women) who were out of the spinal shock period were examined. Neurological levels were determined according to the American Spinal Injury Association (ASIA) impairment scale. Data about erection, ejaculation and vaginal lubrication were obtained via inquiry forms. Bulbocavernosus reflex (BCR), pudendal somatosensorial evoked potentials (pSEP) and perineal sympathetic skin responses (pSSR) were recorded by an electromyographer unaware of the sexual state or neurological level of the patient. Results: BCRs could be obtained from all patients with lesion levels above the sacral centre. A significant association was found between reflex erection and BCR positivity, while psychogenic erection was shown to have a significant association with the preservation of pSSR in men. Despite the lack of statistical significance due to the small sample size of the women examined, a similar association with lubrication was observed. Ejaculation and orgasm were not shown to be significantly associated with any electrophysiological examination. However, ejaculation was preserved in all men with a lesion level below T12 and with positive pSSR. There was no significant relationship between pSEP and sexual functions. The relationship between the existence of sacral sensation and pSEP positivity was statistically significant. Conclusion: This study has proved that BCR and pSSR have an important role in the estimation of the remaining sexual function in spinal cord injured patients. Statement on ethics: We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Neurophysiology of the pelvic floor in clinical practice: a systematic literature review

“…The sympathetic fibers controlling perineal sudomotor activity are thought to originate from the TL segments (T10-L2) of the spinal cord. Therefore, integrity of the pathway between brain centers and the TL sympathetic intermediolateral column may be tested through evaluation of pSSRs (Tas et al, 2007). These reflexes are usually absent in patients with lesions above the TL segments (T10-L2), generally preserved in patients with lesions below the TL segments or with cauda equina lesions, and more variable in the presence of lesions within segments T10-L2 (Grade B).…”

Sexual and reproductive abnormalities in patients with spinal cord injuries

“…[19] Travma, tümör, vasküler hastalıklar, disk hernisi, miyelitler ve multiple skleroz gibi nedenlerle oluşan spinal kord lezyonlarında cinsel işlevler, lezyonun lokalizasyonu ve genişliğine göre etkilenmektedir. [19,[21][22][23][24][25][26][27][28] Spinal kord lezyonları genital cinsel uyarıl-mada gösterilebilir değişikliklere yol açarak orgazma ulaşmayı güçleştirebilir. [27,29,30] Psikojenik ereksiyon işitme, görme, koklama, hissetme ve fantezi sonucu sadece beyinde oluşan uyarılmaların oluştur-duğu ereksiyon olarak kabul edilir.…”

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Torakolomber bölge ile sakral merkezler arasındaki spinal kord lezyonlarında refleks ereksiyonlar görülürken psikojenik ereksiyon oluşmaz. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Ancak bu seviyede lezyonu olan olgularda psikojenik ereksiyonların da görülebildiği rapor edilmiştir. Bu durum torakolomber bölgenin altında paravertebral gongliyonlardaki parasempatiklerin normal kalması ve azalmış hipogastrik (sempatik) tonusa bağlı nöroplastite ile açıklanmıştır.…”

Evaluation of Erectile Dysfunction in Spinal Cord Injured Patients

“…Bugüne kadar az say›da çal›flmada bu hastalar›n cinsel disfonksiyonlar› araflt›r›lm›flt›r (6,(12)(13)(14)(15)(16).…”