Rehabilitation Evidence > Sexual Health > Summary

Summary

Submitted by admin on Sat, 05/22/2010 - 04:00
  • There is level 1 evidence (from 9 RCTs, excluding 1 reported twice; Derry et al. 1998; Giuliano et al. 1999; Hultling et al. 2000; Del Popolo et al. 2004; Giuliano et al. 2006; Tuzgen et al. 2006; Giuliano et al. 2007; Ergin et al. 2008; Khorrami et al. 2009) that supports the use of PDE5i as a safe and effective treatment for erectile dysfunction in men with SCI.
  • There is level 2 evidence (from 1 low quality RCT; Renganathan et al. 1997) that supports the use of ICI as treatment for erectile dysfunction in men with SCI.
  • There is level 2 evidence (from 1 non-randomized controlled trial; Kim et al. 1995) that shows that the use of topical agents is not effective as treatment for erectile dysfunction in men with SCI.
  • There is level 4 evidence (from a post-test study; Bodner et al. 1999) that suggests that the use of intraurethral preparations is not effective as treatment for erectile dysfunction in men with SCI.
  • There is level 4 evidence (Moemen et al. 2008; Zasler and Katz 1989; Heller et al. 1992; Chancellor et al. 1994; Denil et al. 1996) that supports the use of medically sanctioned vacuum constriction devices and penile rings as treatment for erectile dysfunction in men with SCI.
  • There is level 4 evidence (Kim et al. 2008; Zermann et al. 2006; Gross et al. 1996) that suggests the use of penile prostheses as treatment for erectile dysfunction (ED) in men with SCI when other ED treatments have failed.
  • There is level 4 evidence (from 1 pre-post study; Courtois et al. 2001) suggesting that perineal training may result in improvement in erectile function in men with SCI who have some voluntary pelvic floor muscle contraction.
  • There is level 4 evidence (Denys et al. 1998; Jones et al. 2008) that implantation of intrathecal baclofen pump, while effective in managing spasticity, may cause difficulties with erection and sexual function. 
  • Oral PDE5i are the first line treatment for ED in men with SCI, with the more invasive but successful use of ICI being used most often in men who do not respond to the oral medications. Mechanical devices such as vacuum devices and rings may be effective but are not as popular.  Surgical prostheses should be reserved for refractory cases.
  • There is level 4 evidence (Beretta et al. 1989; Sonksen et al. 1994; Le Chapelain et al. 1998; Brackett et al. 2007) that semen retrieval may be assisted by vibrostimulation in men with lesions above T10. 
  • There is level 4 evidence (Soler et al. 2007) that 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.
  • There is level 4 evidence (Brindley 1984; Halstead et al. 1987; Ohl et al. 1989; Lochner-Ernst et al. 1997; Le Chapelain et al. 1998; Kolettis et al. 2002) that semen retrieval may be assisted by electroejaculation in men who failed vibrostimulation.
  • There is level 4 evidence (Brindley et al. 1989) that surgical aspiration may be used to retrieve sperm if vibrostimulation and electroejaculation are not successful.
  • There is level 4 evidence (Arafa et al. 2007) that prostatic massage is a safe and easy to use technique to retrieve semen in men with lesions above T10.
  • There is level 4 evidence (Lim et al. 1994) that the use of a balloon catheter to tamponade the bladder neck may be effective in obtaining antegrade samples in men who normally deliver retrograde samples.
  • There is level 4 evidence (Hibi et al. 2008) that retrograde vasal sperm aspiration can retrieve sperm of sufficient motility to afford pregnancy.
  • There is level 3 evidence (Kanto et al. 2008) that testicular sperm extraction followed by intracytoplasmic injection is an effective way to induce pregnancy, with fresh sperm giving better results than frozen-thawed sperm.
  • There is level 2 evidence (Brackett et al. 1997a; Ohl et al. 1997) that using a vibratory stimulus produces samples with better sperm motility than from electrostimulation.
  • There is level 2 evidence (from 1 weak RCT; Brackett et al. 2002) that sperm obtained by antegrade samples has better motility than retrograde samples and that interrupted current produces higher sperm motility than continuous current.
  • There is level 4 evidence (Rutkowski et al. 1995) that bladder management by clean intermittent catheterization (with low pressure filling and emptying) may improve semen quality over indwelling catheterization, reflex voiding or straining.
  • There is level 2 evidence that SCI sperm quality can be improved by placing sperm from SCI in able-bodied seminal plasma (Brackett et al. 1996), and that aspirated sperm from the vas deferens has better motility than that ejaculated (Brackett et al. 2000), demonstrating the etiology of poor semen quality may lie within the seminal constitutes in men with SCI. These techniques have not been studied clinically with respect to pregnancy rates.
  • There is level 4 evidence (Cohen et al. 2004; Brackett et al. 2007) that interference with receptors to all 3 cytokines in semen can improve sperm motility.
  • There is level 2 evidence (Ibrahim et al. 2009) that monoclonal antibodies and receptor interference agents do not change the degree of DNA fragmentation in sperm from subjects with SCI.
  • There is level 3 (Kanto et al. 2008) and 4 evidence (Buch and Zorn 1993; Hultling et al. 1994; Brackett et al. 1995;Dahlberg et al. 1995; Pryor et al. 1995; Nehra et al. 1996; Brinsden et al. 1997;Chung et al. 1997; Hultling et al. 1997; Sonksen et al. 1997; Taylor et al. 1999; Schatte et al. 2000; Heruti et al. 2001;Ohl et al. 2001; Shieh et al. 2003; Hibi et al. 2008) that men with SCI have a good chance of becoming biological fathers with access to specialized care utilizing reproductive assisted technology.
  • There is level 4 evidence that women with SCI may give birth vaginally.  With vaginal delivery or when cesarean delivery or instrumental delivery is indicated, adequate anesthesia (spinal or epidural if possible) is needed. 
  • There is level 4 evidence (from 1 case series and 2 observational studies) (Cross et al. 1992; Hughes et al. 1991; Cross et al. 1991) that epidural anesthesia is preferred and effective for most patients with AD during labor and delivery.
  • There is level 1 evidence (from 1 RCT; Sipski et al. 2000) that the use of sildenafil in women with SCI may be effective to partially reverse subjective sexual arousal difficulties.
  • There is level 2 evidence (from 1 weak RCT; Sipski et al. 2005) that supports the use of manual and vibratory clitoral stimulation to increase genital responsiveness in women with SCI.
  • There is level 4 evidence (Schopp et al. 2002) that suggests that comprehensive gynecologic services may improve women’s health behaviours. 
  • There is level 4 evidence (Moreno et al. 1995) to suggest that a catheterizable umbilical stoma in women with tetraplegia may improve sexual satisfaction and body image.