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

Abstract

Study design: Systematic review. Objectives: Review the literature on the acute or prophylactic treatment of autonomic dysreflexia (AD) in the context of sexual activities. Setting: International Methods: Medline search using AD and spinal cord injury (SCI). Selected titles for AD treatment included all levels of evidence (randomized placebo control studies, case reports, literature reviews) and all years of publication. Results: Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. Conclusion: Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.

Sexual Health in Men With Traumatic Spinal Cord Injuries: A Review and Recommendations for Primary Health-Care Providers

“…Spinal cord injuries are life-altering experiences, with far reaching physical, emotional, psychological, and social consequences ( Anderson, Borisoff, Johnson, Stiens, & Elliott, 2007 ; Myburgh, Fourie, & van Niekerk, 2010 ; Simpson, Eng, Hsieh, Wolfe, & Spinal Cord Injury Rehabilitation Evidence Research Team, 2012 ). Given that young men who are typically at the pinnacle of their reproductive lives comprise the vast majority of individuals who suffer traumatic spinal cord injuries, sexuality and fertility are frequently identified as salient concerns ( Courtois et al, 2012 ; Ibrahim et al, 2016 ; Sinha, Elliott, Ibrahim, Lynne, & Brackett, 2017 ).…”

Iatrogenic urological triggers of autonomic dysreflexia: a systematic review

“…The cause is sometimes iatrogenic if, for example, the AD occurs during cystoscopy, cystometry, cystography, electroejaculation, penile vibration, 15 urodynamic evaluation and extracorporeal shock-wave lithotripsy (ESWL). 12 As sexual procedures related to AD were already reviewed, 22 the aim of this study was to review the literature on the iatrogenic urological triggers of AD.…”

Promoting Long-Term Health among People with Spinal Cord Injury: What’s New?

“…Nugget #19—Sexuality in Spinal Cord Injury —Sexual activity, sexual function and reproductive issues often arise post-rehabilitation, and the family physician is the best person to ensure that conversations take place and the appropriate resources are sought [ 25 ].…”