The elephant in the bedroom

Depending on the level of their injury and whether it is complete or not, men who have suffered a spinal cord injury might experience erectile dysfunction – but all is not lost.

There are numerous interventions available to treat erectile dysfunction after a spinal cord injury, depending on the level of injury, sensation and whether the injury is complete or not.

“Broadly speaking, there are three categories for interventions available, namely surgical (implants), medication administered either orally (pills), or through injections and mechanical interventions such as vacuum pumps or similar devices,” says Danie Breedt, director at Charis Psychological Services and ROLLING INSPIRATION contributor.

Before attempting any of the potential interventions, it is important to consult a sexologist or medical professional to ensure that the intervention will be effective and that it won’t do any harm.

“I don’t know of many SCI patients that have gone for penile implants, as it is very expensive and certainly not covered by the medical aids. Of course, they are successful in achieving erection, but in SCI there are still the residual problems of poor or no sensation, and poor or no orgasm and ejaculation, which of course these implants don’t change,” notes Ed Baalbergen, medical doctor at the rehabilitation unit of the Life Vincent Pallotti Hospital and regular ROLLING INSPIRATION contributor.

“I have had some patients who have gone for the semi-rigid implants to assist them with retaining the external catheter on the penis if there is a problem with a retractile penis – it can be a solution to this problem.”

According to Baalbergen, a penile implant most commonly works mechanically, with hollow shafts implanted into the corpora cavernosa – the blood-filled chambers that allow normal erectile function. The implants are then mechanically filled with fluid to allow the penis to become erect.

Alternatively, a malleable prosthesis – a flexible silicone rod available in various sizes – can be implanted into the corpora cavernosa to offer adequate rigidity for penetration. When not in use, it can be bent to resemble a flaccid penis.

A two-piece inflatable device can be implanted in a similar way, with a pump reservoir placed in the scrotum. There are also non-mechanical or semi-rigid alternatives that can be manipulated to alter the erect form of the penis,” Baalbergen adds.

Post surgery, the patient can resume normal sexual activity after four to six weeks. The surgery could lead to some complications, including autonomic dysreflexia (AD), erosion of the prosthesis through the glans of the penis and infection, or pain if the patient has some retained sensation. Thus patients who undergo the surgery need to look out for any signs of infection, swelling, AD, elevated temperature, and erosion through the skin following the surgery.

If surgery is not for you, consider some of the alternatives, like pumps or medication.

Keep a lookout for information in an upcoming Sexuality column by Breedt.

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