Sexual Function after SCI

Question 1

How does a guy get an erection?

Answer 1

1.Vasodilation of the arteries supplying the penis and relaxation of the smooth muscle and the corpus cavernosum and corpus spongiosum (structures in the penis consisting of smooth muscle, connective tissue and vascular spaces)
2. blood fills the vascular spaces of the corpus cavernosum and corpus spongiosum
3. Engorgement of the corpus cavernosum and corpus spongiosum compresses the veins of the penis and the blood gets trapped

• the initial vasodilation of the arteries and the relaxation of the smooth muscle is under neural control from both the parasympathetic and sympathetic nervous systems

Question 2

What happens during female arousal?

Answer 2

1. vaginal lubrication caused by secretions from the greater vestibular glands (on either side of the vaginal opening)
2. vascular engorgement (Erection) of the clitoris which also contains erectile tissue (corpus cavernosum but NO corpus spongiosum)

• is under control from both the sympathetic and parasympathetic nervous systems

Question 3

What happens during male emission?

Answer 3

1. Peristaltic contractions in the vas deferens transports sperm from the testis to the end of the vas deferens
2. secretions from the seminal vesicles and prostate are added to sperm to form semen
3. further contractions of the vas deferens transports semen to the posterior urethra

*under control of sympathetic nervous system

Question 4

What happens during female emission:

Answer 4

1. Peristaltic contractions of the fallopian tubes and further contractions of the uterus

*under control of the sympathetic nervous system

Question 5

What happens during male ejaculation?

Answer 5

1. the propulsion of semen from the posterior urethra involves contractions of the muscles of the pelvic floors
   AND
   closure of the bladder neck (preventing retrograde ejaculation- into bladder)

*is under the control of somatic motor neurons

Question 6

What happens during female ejaculation?

Answer 6

occurs as a result of pelvic floor muscle contraction

Question 7

What is the neural control of erection/vaginal lubrication?

Answer 7

-There are 2 areas in the spinal cord which are associated with the initiation of erections/lubrication (erection centres)
- T11-L2 (thoracolumbar)
-S2-S4 (sacral)
-Outflow from either centre may initiate an erection/lubrication but the maintenance of the erection/lubrication requires outflow from both centres

Question 8

What is reflexogenic erection/lubrication?

Answer 8

• higher quality
  -response to touch
  -sensory afferents
  -more blood flow
  -purely a reflex
  -parasympathetic

Question 9

What is psychogenic erection/lubrication?

Answer 9

-lower quality
-psychological arousal
-brain (thoracolumbar erection centre–> SNS) (Sacral erection centre–> PNS)
-not the same amount of blood flow or lubrication
-sympathetic and parasympathetic

Question 10

Erection/lubrication after SCI:

Answer 10

-none during spinal shock
-recovery takes days-years (1 or 2)
-incomplete injuries = erection/lubrication very likely

Question 11

Complete SCI above T11

Answer 11

-no pscyhogenic erections/lubrication
-reflexogenic erection/lubrication intact (occur commonly during body care)
-erection/lubrication maintenance is an issue
-they did not feel the touch, it just causes a reflex
-not necessarily anything sexual about it

Question 12

Complete SCI between L2-S2:

Answer 12

-preservation of reflexogenic and psychogenic erection/lubrication
-erection/lubrication maintenance is an issue
-some amount of psyschogenic erection and reflexogenic erection is possible, however there is no communication between erection centres (maintaining is an issue)

Question 13

Complete SCI between T11-L2 or S2-S4:

Answer 13

-varying degrees of preservation of either reflexogenic or psychogenic erection/lubrication
-erection/lubrication maintenance is an issue
-total damage to an erection centre will eliminate the corresponding type of erection/lubrication, as will damage to the LMN’s

Question 14

Neural control of emission:

Answer 14

• both the thoracolumbar and sacral erection centres are involved, although the thoracolumbar has more influence

Question 15

Neural control of ejaculation- no sci:

Answer 15

1.First, emission must have occurred
2. semen in posterior urethra
3. afferents to sacral erection centres
4. somatic motor reflex to muscles of pelvis floor and neck of bladder

Question 16

Ejaculation after SCI:

Answer 16

• the preservation of true ejaculation after SCI is rare
  1. complete SCI above sacral erection centre: ejaculation is rare since the main pathway for emission is impaired
  2. complete SCI at sacral erection centre: ejaculation is rare since the somatic ejaculation reflex is impaired

*incomplete injuries may result in preservation of ejaculation

Question 17

Orgasm after SCI:

Answer 17

• is fairly common after SCI
• is mainly a cerebral event, not necessarily due to genital stimulation
  -may be achieved by stimulation above the level of SCI even in complete SCI some deep sensation is preserved

also..
-orgasm is reported as pleasurable and is associated with some of the normal physiological responses (flushed face and sexual tension release afterwards)
-spasticity may occur just before and during orgasm, but it subsides afterwards

Question 18

Additional points?

Answer 18

-you can ejaculate and not have an orgasm or vice versa
-ear lobes can bring about an orgasm called an eargasm
-with an incomplete injury there is some sort of sexual capacity
-ejaculation is very difficult for those with complete injury
-erogenous zones that are higher up can be targeted

Question 19

Fertility after SCI for males?

Answer 19

-spontaneous paternity rates are 5% lower due to impaired ejaculation
-ejaculation needs to occur at a certain frequency to maintain healthy sperm
-due to lower quality sperm (low motility and malformation)- infection, antibiotic use, elevated scrotal temperature due to prolonged sitting

Question 20

Fertility after SCI for females?

Answer 20

• no permanent threat to fertility; menstrual cycle may stop at time of injury but usually resumes after 5-12 months
  -most women with SCI who become pregnant deliver their babies vaginally
  -usually not a problem for women with SCI

Question 21

summary:

Answer 21

sex: very possible after SCI although males may have a problem maintaining erections and females may need extra lube
fertility: no problem for the female but males will likely have ejaculation issues due to sperm quality
orgasm: possible for both but more likely for the female and the experience may be somewhat different compared to pre-sci orgasm

Question 22

How to maintain erection in males after SCI?

Answer 22

• pump and tourniquet (ring placed around penis to keep blood in there)
  -penile implants (semi rigid or hydraulic)
  -injection of meds into penis (vasodilators)

Question 23

Ejaculation assistance techniques?

Answer 23

-vibroejaculation (high quality sperm), heavy duty vibrator, may cause spontaneous ejaculation, men cant feel it

medically induced ejaculation: use this method along with vibroejaculation (right after medicine)

electroejaculation (more successful)- probe up the rectum and electrically stimulate the prostate

testicular puncture: have to be done in hospital by a physician

Question 24

Females:

Answer 24

-possible a.d. and incontinence during sex
-spasticity and adductors during sex
-most issues arise during pregnancy and labour
-high risk of pressure sores during pregnancy
-chronic maternal hypotension may affect babys birth weight
-may be completely dilated and about to give birth without knowing
-2/3 of all women with SCI above T6 experience A.D. during childbirth