Rehabilitation Evidence > Sexual Health > Key Points

Key Points

Submitted by admin on Sat, 05/22/2010 - 04:03
  • Phosphodiesterase Type 5 Inhibitors (PDE5i) can be used safely and effectively for treatment of erectile dysfunction (ED) in men with SCI and are recommended as first-line treatment. A lesion above the sacral spinal tract and a higher reflexive erection are predicable favorable parameters for a positive response to all PDE5i.  Men with tetraplegia or high-level paraplegia should be cautioned about the possibility of experiencing postural hypotension for several hours after use.
  • Intracavernosal (penile) injectable medications (ICI) are very effective for the treatment of ED in men with SCI and may be used with careful dose titration and some precautions.
  • Topical agents are not effective for treatment of erectile dysfunction in men with SCI.
  • Intraurethral preparations are not effective for treatment of erectile dysfunction in men with SCI.
  • Medically sanctioned vacuum constriction devices (VCD) and penile rings may be used for treatment of erectile dysfunction in men with SCI.
  • Penile prostheses may be effective for treatment of erectile dysfunction in men with SCI, however, should generally be reserved for situations where all reversible erectile dysfunction treatments have failed.
  • Perineal training may enhance erectile function in men with SCI who have some voluntary pelvic floor muscle contraction.
  • The use of PDE5i for treatment of ED in men with SCI is effective, safe and popular, followed by the more invasive but highly effective method of intracavernosal injection. 
  • The use of mechanical devices may be effective but are less popular, and surgical options should be reserved for cases where other ED treatments fail.
  • Implantation of a intrathecal baclofen pump, while effective in managing spasticity, may cause difficulties with erection and sexual function.
  • The least invasive sperm retrieval method should be tried first (i.e. vibrostimulation in the clinic setting to monitor for autonomic dysreflexia) followed by the more invasive procedure of electroejaculation. A cost benefit ratio analysis should be done before surgical sperm aspiration (in clinic or operating room settings) proceeds.
  • Vibrostimulation is most successful in men with SCI above T10. Electroejaculation can be done on any levels but may require anesthetic.
  • Midodrine may be an effective and safe adjunct to PVS in men not responding to PVS alone who are not at risk for significant autonomic dysreflexia.
  • Balloon catheters to tamponade the bladder neck are effective in securing antegrade ejaculate samples.
  • Vibratory stimulus results in better sperm quality.
  • Prostatic massage is a safe and easy alternative way to retrieve semen in some men with SCI above T10
  • Balloon catheters to tamponade the bladder neck may be effective in securing antegrade ejaculate samples.
  • Antegrade samples have better sperm motility than that found in retrograde samples.
  • Penile vibrostimulation (PVS) results in better sperm quality than electroejaculation (EEP). Electroejaculation with interrupted current produces better sperm motility than with continuous current.
  • Bladder management with clean intermittent catheterization may improve semen quality over indwelling catheterization, reflex voiding or straining.
  • SCI sperm quality improves by processing in able-bodied seminal plasma.
  • Aspirated sperm has better motility than ejaculated sperm. 
  • Sperm motility may improve by neutralizing receptors to various cytokines in semen.
  • Use of ejaculated sperm or aspirated sperm for reproductive purposes requires a cost- benefit analysis.
  • Men with SCI can have realistic expectations of becoming a biological father.  Depending on semen quality and female factors, a progression from intravaginal insemination to assisted techniques such as intrauterine insemination, in vitro fertilization (IVF) to IVF plus intracytoplasmic sperm injection (ICSI) is recommended.
  • Adequate anesthesia (spinal or epidural if possible) is needed with vaginal delivery, cesarean delivery or instrumental delivery is required.
  • Epidural anesthesia is preferred and effective for most women with AD during labor and delivery.
  • Sildenafil may partially reverse subjective sexual arousal difficulties in women with SCI; however, larger scale studies are required to solidify this conclusion.
  • Manual and vibratory clitoral stimulation may increase genital responsiveness in women with SCI.
  • Limited evidence exists that participation in a specialized women’s health clinic may lead to an increase in preventative gynecologic health care behaviours.
  • Continent urinary diversion in women with tetraplegia results in improved self-image, quality of life, and enables greater sexual satisfaction.