Male sexual dysfunction and infertility associated with neurological disorders

Abstract

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

“…3,4,8,10,11,15 The outstanding majority of these studies used nifedipine (Adalat) 3,4,8,10,11,15,35,37 treatment. Others however attempted prazosin, 37 sildenafil 38 and prostaglandin E 2 , 39 often with inconclusive results.…”

“…[3][4][5] Sexual options for men with SCI Ejaculation dysfunctions in men with SCI can be treated with a variety of options, starting with commercial vibrators, followed if unsuccessful by the use of the Ferticare device, 6 which has been shown much more effective, followed if still negative by vibrostimulation combined with midodrine. 7 When fertility is aimed for, rectal probe electroejaculation 8,9 and other assisted reproductive technologies can be offered, allowing intravaginal home injection, 10 intrauterine or in vitro fertilization. 11 Sexuality and fertility are therefore definite options for men with SCI, and considering the currently available treatments, more than 90% of men with SCI can achieve ejaculation.…”

Clinical evaluation of the infertile male: new options, new challenges

“…19 In some cases, erectile dysfunction is a coexistent concern and in some may is the explanation for infertility. In other settings, libido and erectile function may be normal, but the coordination of the ejaculatory process fails.…”

Metabolic syndrome and diabetes for the urologist

“…Infertility, andropause and erectile dysfunction are also known urological consequences of type 2 diabetes. 9 Recent epidemiologic and clinical data suggest a link between metabolic syndrome and prostatic diseases, such as benign prostatic hyperplasia (BPH) and prostate cancer. 10 Many of the hormones, growth factors, cytokines and other mediators associated with obesity and the metabolic syndrome enable crosstalk between macrophages, adipocytes, endothelial cells and epithelial cells, which is implicated in carcinogenesis (including growth signaling, inflammation, and vascular alterations).…”