Sexual function among patients with spinal cord injury.

Abstract

Hundred and fifty spinal cord injury patients were interviewed concerning erections, coitus, ejaculation and orgasm. 123 (82%) were able to attain erections. 115 patients had upper motor neuron lesions (reflex activity present in the sacral segments). Seventy-five of the 115 patients had complete lesions; 9% had psychic erections, 95% had spontaneous erections, 92% had erections from penile stimulation. 44% of the patients made no attempt at coitus. Forty-two patients attempted coitus of which 24 (57%) were successful. One percent could ejaculate and have an orgasm. 40 of the 115 patients had incomplete lesions. 48% had psychic erections, 93% had spontaneous erections and 93% had reflex erections. 27% of the patients made no attempt at coitus. 29 patients attempted coitus of which 25 (86%) were successful. 25% could ejaculate and have an orgasm. Thirty-five patients had lower motor neuron lesions (reflex activity absent in the sacral segments). 33 of the 35 patients had complete lesions; 24% had psychic erections, 12% had spontaneous erections. 36% of the patients made no attempt at coitus. 21 patients attempted coitus of which 7 (33%) were successful. 15% could ejaculate and have an orgasm. Two of the 35 patients had incomplete lesions and one of the two had psychic erections. One patient made no attempt at coitus. One patient who attempted coitus was successful and could ejaculate and have an orgasm. All of the patients with complete or incomplete lower motor neuron lesions experienced psychic erections only then when the lesion was below T-12. The activity or hyperactivity of the isolated sacral segment of patients with complete upper motor neuron lesions appear to have an inhibitory effect on ejaculation. Pinprick perception in the sacral segments of patients with incomplete upper motor neuron lesions seems to be prognostically more significant for erection and ejaculation than the preservation of light touch perception or retained volitional motor function of the pelvic floor muscles. Various observations are reported, such as the relationship of spasticity and sexual function, autonomic dysreflexia during sexual activity, premature aging in regard to sexual function, and some interesting psychosexual attitudes reported by the patients. This study has essentially confirmed the findings noted in the original study from this Center.