A spinal cord injury has an incredible impact on the physical abilities of the injured person. This is also true in the case of erectile function in men. However, not all is lost
For many men, the question of ever being able to have an erection again is one of the first on their minds following an SCI. Being able to develop and maintain an erection is an important aspect of the physical act of sex and usually closely connected to a man’s sense of masculinity.
As the penis is essentially a muscle, it is affected in the same way as other muscles below the level of injury. Depending on the level of injury and whether it is complete or incomplete, the sensation and ability to get and keep an erection will be affected.
There are three ways in which men develop erections before an SCI. The first type of erection is called a psychogenic erection and originates in the brain. It is brought on by thoughts of something that you find attractive or arousing, even when there is no physical stimulation. This type of erection can be triggered by a sight, a sound or even a memory.
The second type of erection, a reflexogenic erection, is the direct result of physical touch or stimulation of the penis. A spontaneous erection is the third type, and it occurs without the presence of any stimulation, imagined or physical. An example is when someone wakes up with an erection because his bladder is full. This type of erection is not related to anything sexual and usually doesn’t last long.
An SCI affects these three processes in different ways. The area of the spinal cord that is responsible for erections is located between T11 and L2. This means that an injury above this level could possibly prevent the message (sexual thoughts) from getting past the level of injury, preventing psychogenic erections.
Depending on the sensation of the penis, reflexogenic erections might still be possible in incomplete injuries. An erection can be triggered when a catheter is changed, when the penis is washed or even simply when clothing or blankets are pulled over the body. The ability to get a reflexogenic erection is controlled by the nerves in the lowest part of the spinal cord segments (S2, 3 and 4).
Spontaneous erections may still occur after an SCI when the bladder is full or in the same way that spasms occur in the legs. Because these erections are unpredictable and possibly won’t last very long, they are often unreliable for sexual activity.
There are numerous interventions that can be used to assist a person with an SCI to develop and maintain an erection. The options can be divided into three broad categories, namely surgical (for example penile implants), pharmacological (medicine administered as injections or pills) and mechanical (penis pumps, for instance).
Each of these interventions has its pros and cons, and depends on the person’s ability to get and keep an erection. To find the most effective and appropriate solution, it is important to consult an expert, such as a sexologist, to guide your decisions.
Danie Breedt is a passionate scholar-practitioner in the field of psychology. He divides his time between training future psychologists, research and clinical practice. Danie works from an integrative interactional approach in therapy dealing with a wide range of emotional difficulties. He is currently working as a psychologist at numerous physical rehabilitation hospitals across Gauteng for Charis Psychological Services where he does supportive counselling as well as sexual education for patients with disabilities. Column courtesy of Charis Psychological Services.