Side effects of chronic intrathecal baclofen on erection and ejaculation in patients with spinal cord lesions

Abstract

Objective: Assess modifications of sexual function in men treated with intrathecal baclofen for spinal spasticity. Design: Prospective before-after trial. Setting: A rehabilitation department of a university hospital; follow-up was on an outpatient basis. Patients: A convenience sample of nine consecutively recruited men with spinal cord injury or multiple sclerosis who were receiving intrathecal baclofen by an implantable pump; average follow-up was 44.4 months. Main Outcome Measures: A questionnaire focusing on: libido; ability to sustain reflexive and psychogenic erections; rigidity, evaluated by a visual analog scale; maximum duration of erection; possibility of ejaculation. Results: Libido and the ability to obtain psychogenic or reflexogenic erections were not modified. However, eight patients reported a decrease of erection rigidity and/or duration. Ejaculation was possible in three cases before implantation. It disappeared in two patients, and was more difficult to obtain in the last one. It reappeared after treatment withdrawal. No differences were found between multiple sclerosis and spinal cord injured patients. Conclusion: Intrathecal baclofen may compromise erection and ejaculation. This effect is reversible. Patients should be informed of this effect.