Sexuality for Men
A spinal cord injury (SCI) affects a man’s sexuality both physically and psychologically. The type and level ofinjury both can play a role on the impact that the injury has on a man’s sexuality. After injury, men may facechanges in relationships, sexual activity, and their ability to biologically father children. Men can also experienceemotional changes that can affect sexuality. All of these issues involve both the man with SCI and his partner.
Therefore, it is very important to understand and confront these issues as a part of the overall adjustment to lifeafter injury.
concerns or problems with their use. It is importantto see a doctor or urologist for accurate information
Men normally have two types of erections. The first
on the various treatments and products as they relate
is a psychogenic erection, which results from sexual
thoughts or seeing or hearing something stimulatingor arousing. The brain sends these messages
Because each spinal cord injury is different, each
through the nerves of the spinal cord that exit at the
man’s physical response is different. Men with SCI
T10-L2 levels. The messages are then relayed to the
need to rely on their own observations and
penis, resulting in an erection. For men with spinal
experiences to fully understand the changes in their
cord injury, the ability to have a psychogenic
erection depends on the level and extent of injury.
Generally, men with an incomplete injury at a low
Sexual Aids & Options for Men with SCI
level are more likely to have psychogenic erectionsthan men with high level, incomplete injury. Men
The most recent breakthrough in treating ED is the
with complete injuries are less likely to experience
use of the medication Viagra
® (sildenafil), a pill
taken by mouth. The Food and Drug Administration(FDA) approved Viagra in 1998 for use in the
The second type of erection is a reflex erection.
treatment of erectile dysfunction. It quickly drew
This occurs when there is direct physical contact to
the interest of men because it is a noninvasive
the penis or other erotic areas such as the ears,
technique and can be self-administered. Research
nipples or neck. A reflex erection is involuntary and
studies show that Viagra, taken as required (not
can occur without sexual or stimulating thoughts.
more than once daily), significantly improves the
The nerves that control a man’s ability to have a
quality of erections and satisfaction with sex life in
reflex erection are located in the sacral segments
men with ED due to spinal cord injury between T6
(S2-S4) of the spinal cord. Most men with spinal
and L51. Men who have low or high blood pressure
cord injury are able to have a reflex erection with
or vascular disease should not take Viagra. Some
physical stimulation if the S2-S4 pathway is not
medications can not be taken with Viagra so all
medications should be reviewed with the prescribingphysician.
Many men with SCI are capable of having anerection. However, the erection may not be hard
Penile injection therapy
is another treatment
enough or last long enough for sexual activity. This
option. It involves injecting a single drug or a
condition is called Erectile Dysfunction (ED).
combination of drugs into the side of the penis. This
There are various treatments and products available
produces a hard erection that can last for one to two
for treating ED but men with SCI may have special
hours. These drugs must be used exactly as
Rehabilitation Research and Training Center on Secondary Conditions of SCI
prescribed by the physician. If not used correctly,
signs of pain to indicate that the implant is breaking
the result could be a prolonged erection, called
through the skin. All surgical implants also carry a
priapism. When priapism occurs, the blood fails to
high risk of infection. If an infection develops, the
drain from the penis. This can damage the penile
prosthesis may need to be removed. Penile implants
tissue and be extremely painful. Other risks from
are the most expensive option and some health
the injection are bruising, scarring or infection of
insurance plans do not cover the costs.
the penis. This method is not recommended for usemore than once a week. A penile injection is a
Talk to a doctor before any treatment.
difficult option for a man with limited hand function
spinal cord injury who are experiencing ED should
due to spinal cord injury. Therefore, he must have
have a thorough physical exam by a urologist
assistance in getting the injection.
familiar with SCI before using any medications orassistive devices. Level of injury, possible side-
Medicated Urethral System Erection
effects, and other medical conditions need to be
transurethral therapy, is a relatively new treatment
considered when deciding which treatment option is
option. A medicated pellet is placed into the urethra
best. With all treatments, men with SCI must be
where it is absorbed into the surrounding tissue.
watchful for signs of Autonomic Dysreflexia (AD),
This causes the blood vessels to relax and allows
a life-threatening condition. Signs of AD include
blood to fill the penis. The drug, alprostadil, is the
flushing in the face, headaches, nasal congestion
same as used in penile injection therapy. Reported
side effects include a risk of infection, a burningsensation and decreased blood pressure and fainting.
The vacuum pump
is a mechanical option for
Men with SCI also experience a change in their
producing an erection that, for most men, is
ability to biologically father a child. The major
sufficient for intercourse. The penis is placed in a
factor interfering with a man’s fertility is primarily
vacuum cylinder and air is pumped out of the
due to an inability to ejaculate as a result of damage
cylinder causing blood to be drawn into the erectile
to the spinal cord. In fact, 90% of men with SCI are
tissues. The erection is maintained by placing a
not able to ejaculate during intercourse; this is called
constriction ring around the base of the penis. This
anejaculation2. Another problem men with SCI may
ring also prevents urinary leakage that some men
experience is retrograde ejaculation. This occurs
with SCI experience. It is important to remove the
when semen does not leave the urethra but travels
ring after intercourse to avoid prolong pressure and
back up the tube and is deposited in the bladder.
the risk of sores. There are several models ofvacuum pumps available. A battery-operated model
One myth is that the the number of sperm that a man
is an option for those with limited hand function.
produces decreases the longer the time after injury.
Other models require good hand function to press
There is no evidence that this occurs and should not
the pump against the skin to create the necessary
be a concern for men who want to biologically
father a child3. However, the motility (movement)of the sperm is of concern. The average motility
is often the last treatment
rate among men with SCI is considerably lower than
option for ED because it requires a permanent
for the average man without SCI. Recent research
penile prosthesis. The surgical procedure involves
shows the average motility rate of sperm in semen
inserting an implant directly into the erectile tissues
samples from men with SCI is 20% compared to
to obtain an erection. Three types of implants are
available: semi-rigid or malleable rods, fullyinflatable devices, and self-contained unit implants.
Options are available to assist men with spinal cord
There are risks of mechanical breakdown and the
injury improve their ability to father children. Men
danger that the implant could push out through the
who are interested in fathering a child should get
skin. Men with SCI usually do not have good
medical advice and treatment options from a fertility
sensation in the genital area, so there may be no
specialist experienced in issues of spinal cord injury.
The fertility specialist needs to be aware of
about relationships after the injury. It is important
methods that can improve sperm quality in men
for both partners to understand the physical changes
with SCI, as well as complications that can occur,
that occur after injury, but it is equally important to
talk about how each person feels about the issues.
Without good communication, these emotions can be
Penile vibratory stimulation
(PVS) can be used to
inappropriately directed at each other, which can
achieve an erection, but its main purpose is to produce
result in more negative feelings. The couple can talk
an ejaculate for those who wish to become fathers. A
about, explore and experiment with different ways to
variety of vibrators/massagers are available for this
be romantic and intimate. Together, they can then
purpose. Some are specifically designed with the
discover what is sexually stimulating and fulfilling
output power required to induce ejaculation in spinal
cord injured men. It is important to consult a physicianbefore using a vibrator. One danger of using a vibrator
A professional counselor can help in processing
is it could cause swollen or inflamed skin. If the male
feelings that are common after injury. This may
does not have feeling, the vibrator must be used very
include working through feelings of anxiety over
Bladder or bowel accidents are a concern during
sexual activity. The fear of an accident may be
enough to keep a man from pursuing a physical
relationship. Maintaining a regular bowel and
bladder program is an important factor that can
help prevent accidents. This can eliminate the
fear of accidents and relieve anxiety.
and the controlled electrical stimulation produces
transmitted disease (STD) is the same both before
an ejaculation. When sperm cannot be retrieved
and after spinal cord injury. STDs include diseases
such as gonorrhea, syphilis, herpes, and the HIV
performed to remove sperm from the testicle. Once
virus. These STDs can cause other medical
sperm are collected they can be used in artificial
problems, such as infertility, urinary tract infections,
pelvic inflammatory disease (PID), vaginaldischarge, genital warts, and AIDS.
Everyone needs to take precautions to protect against
Men with SCI can experience many emotional
STDs. The safest, most effective way to prevent
changes that can influence sexual functioning. Men
sexually transmitted diseases is to use a condom with
are often concerned with maintaining their ability to
a spermicidal gel. The condom must be used
perform sexually as well as how their injury might
correctly to be most effective in preventing both
affect their relationship with a partner. Men who
STDs and pregnancy. Even if the female partner is
do not have a partner at the time of injury may also
using another form of birth control, a condom still
be concerned with how to meet and attract a
needs to be used to protect against STDs. To ensure
that both partners are disease free, each person can betested by a health care professional.
A man can continue both a romantic and anintimate relationship with a partner after a spinal
cord injury. However, good communication with
This information sheet cannot address in detail all the
his partner is essential. Many men with spinal cord
issues related to the sexuality of men with SCI. For
injury become angry, depressed, and/or uncertain
additional resources, see the following list.
Factsheets available on the Internet
Guide and Resource Directory to Male Fertility
The Facts about MUSE® (alprostadil) urethral
following Spinal Cord Injury/Dysfunction. (2000)
suppository. [Available: http://www.vivus.com/frames/products/facts.shtm].
Miami Project to Cure Paralysis. 305-243-7108[Available: http://www.scifertility.com].
Fertility and Parenting. SCI Forum, Dec, 1998.
Email: [email protected]
[Available: http://depts.washington.edu/rehab/sci/forum-fertility1298.shtml] NW Regional SCISystem.
Male Reproductive Function after Spinal Cord Injury.
Fact Sheet #10. (1996) National Spinal Cord Injury
Association, 8701 Georgia Ave, Suite 500, Silver
fertilit.htm] Sexual Health Network.
Springs, MD 20910. $2 or FREE with NSCIAassociation membership.
Reproductive Issue for Persons with Physical
Disabilities. (1995) Florence Haseltine, Sandra SCole, & David Gray. Paul H Brooks Publishing Co.
Possible Effects of SCI on Sexual Function. (1997)
[Available: http://www.sexualhealth.com/Disability/sci.htm] Sexual Health Network.
Sexual Function in People with Disability and Chronic
Illness: A Health Professional’s Guide. (1997) Marca
Sipski, MD and Craig Alexander, MD. Aspen
Publishers. Cost $57. ISBN: 0834208865.
UAB-RRTC on Secondary Conditions of SpinalCord Injury, Birmingham, AL.
Sexuality after Spinal Cord Injury: Answers to your
Sexuality and SCI: Update on Having Kids.(1999)
questions. (1996) Stanley H Ducharme, PhD and
Kathleen M Gill, PhD. Brookes Publishing Co.
Sexuality and SCI: Viagra Frenzy. (August, 1998)
Spinal Network: The Total Wheelchair Resource Book.
Barry Corbet (1998, 3rd Ed) Chapter 7, Sex,
Relationships and Parenting. Cost: $49.95+s/h.
Sexuality in Spinal Injury Series. (1998)
By the Louis Calder Memorial Library, U of Miami,
The Treatment of Erectile Dysfunction Following Spinal
• The SCI Injured Male: Ejaculation, Orgasm and
Cord Injury. (1995) Produced by SCI Video, 706
Coitus. [Available: http://calder.med.miami.edu/
Sunnybrook Dr, Edmond, OK 73034. 405-330-8657
• The SCI Injured Male: Erections. [Available:
Sexuality Reborn. (1993). Producers: Craig Alexander,
• The SCI Injured Male: Sexual Drive and
MD and Marca Sipski, MD. Kessler Institute for
Activity. [Available: http://calder.med.miami.edu/
1. Derry FA, Dinsmore WW, Fraser M, Gardner BP, Glass CA, Maytom MC & Smith MD. 1998. Efficacy and safety of oral sildenafil
(Viagra®) in men with erectile dysfunction caused by spinal cord injury. Neurology
2. Amador MJ, Lynne CM, and Brackett NL. 2000. A guide and resouce directory to male fertility following spinal cord injury/
dysfunction. Miami Project to Cure Paralysis.
3. Brackett NL, Ferrell SM, Aballa TC, Amador MJ and Lynne CM. 1998. Semen quality in spinal cord injured men: does it
progressively decline post injury? Arch Phys Med Rehab
Linda Lindsey, MEd, Phil Klebine, MA
2000 Board of Trustees of the University of Alabama
(205) 934-3283 or (205) 934-4642 (TTD only)
The University of Alabama at Birmingham provides equal
Email: [email protected]
opportunity in education and employment.
This publication is supported by grant #H133B980016 from the National Institute of Disability and Rehabilitation Research, Office ofSpecial Education and Rehabilitative Services, U.S. Department of Education, Washington, DC. Opinions expressed in this documentare not necessarily those of the granting agency.
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