Erectile dysfunction in a man with a spinal-cord injury can be overcome.
Statistics show that most of the people who suffer a traumatic spinal-cord injury (SCI) are males aged between 18 and 35 years. Naturally, the effect of the SCI on erectile function is a major concern.
Although the nature of the sexual response may be altered, sexual activity persists and can be enjoyed by a large segment of the SCI population. (However, other factors may affect sexual function, including age, associated diseases, medication, partner relationships and opportunities for sexual activity.)
It is important to understand the neurology of normal sexual responses in order to grasp how the SCI individual is affected. The normal sexual response to arousal – the engorgement of clitoris and labia minora in women and penis (erection) in men – is mediated via the psychogenic route (visual stimulus) and is controlled by the sympathetic centre (T11-L2) and this requires an intact spinal cord. This mode of arousal is always impaired if the injury occurs above this level. The other mode of arousal is reflexogenic (physical stimulation), which is mediated via the parasympathetic centre (S2-4) – this is intact in SCI persons.
In the normal sexual response, erection occurs when the corpora caveronsa (the vascular chambers within the penis) fill with blood. The engorged caveronsa maintain erection. But in SCI men this engorgement is incomplete and the mechanism to maintain or prevent the release of blood from the engorged chambers is affected. There are various ways to produce reflexogenic erections and maintain erection in SCI males and these vary from manipulation and vibratory stimulation to use of a venous constriction ring, or vacuum erection device or artificial penile appliances.
This device causes blood to be drawn into the corpora. The constriction ring then prevents the “leakage” of blood from the corpora and maintains erection. The device can be purchased commercially without a doctor’s prescription, is safe and cost-effective.
Venous constriction ring
In addition to these mechanical devices, pharmacological solutions exist. Orally administered tablets, for example vardenafil (Levitra™) and sildenafil (Viagra®), promote erection through selective inhibition of the chemical cycles which allow smooth muscle relaxation and release of the blood from the engorged corpora. Many patients prefer these options as they are safe and effective. The main barrier to their use is cost. Side effects are minimal – mainly flushing and a slight headache. You should consult your doctor before using any of these medications, however, especially if you are using heart medications, as the drugs may cause more harm than good.
Finally, there are also injectable pharmacological solutions. Injections of papaverine (smooth-muscle relaxant producing vasodilation and relaxation of the sinusoidal spaces in the corpora cavernosa) and prostaglandin E1 (vasodilator and smooth muscle relaxant) are useful. These medications are readily available and can be used repeatedly if required – again, though, cost may be a limiting factor. Both options are only available on prescription. Speak to your doctor if you need more information.
Dr Ed Baalbergen is the medical officer at the Vincent Pallotti Rehabilitation Centre (Cape Town) and is a member of the International Spinal Cord Society and the Southern African Neurological Rehabilitation Association. email: email@example.com