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Fertility and sexuality in the spinal cord injury patient

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Abstract

Background

After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime.

Purpose

The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population.

Methods

As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury (SCI), a workgroup and comprehensive literature search of English language manuscripts regarding fertility and sexuality in the spinal cord injury patient were formed. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs).

Results

Genital arousal, ejaculation, and orgasm are significantly impacted after spinal cord injury in both male and female SCI patients. This may have a more significant impact on potential for fertility in male spinal cord injury patients, particularly regarding ability of generate erection, semen quantity and quality. Female patients should be consulted that pregnancy is still possible after injury and a woman should expect resumption of normal reproductive function. As a result, sexual health teaching should be continued in women despite injury. Pregnancy in a SCI may cause complications such as autonomic dysreflexia, so this group should be carefully followed during pregnancy.

Conclusions

By understanding physiologic changes after injury, patients and care teams can work together to achieve goals and maximize sexual quality of life after the injury.

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References

  1. Alexander MS, Brackett NL, Bodner D, Elliott S, Jackson A, Sonksen J et al (2009) Measurement of sexual functioning after spinal cord injury: preferred instruments. J Spinal Cord Med 32(3):226–236

    Article  PubMed  PubMed Central  Google Scholar 

  2. Davidson RA, Carlson M, Fallah N, Noonan VK, Elliott SL, Joseph J et al (2017) Inter-rater reliability of the international standards to document remaining autonomic function after spinal cord injury. J Neurotrauma 34(3):552–558

    Article  PubMed  Google Scholar 

  3. Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL (2007) Long-term effects of spinal cord injury on sexual function in men: implications for neuroplasticity. Spinal Cord 45(5):338–348

    Article  CAS  PubMed  Google Scholar 

  4. Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL (2007) Spinal cord injury influences psychogenic as well as physical components of female sexual ability. Spinal Cord. 45(5):349–359

    Article  CAS  PubMed  Google Scholar 

  5. Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL (2007) The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord 45(5):328–337

    Article  CAS  PubMed  Google Scholar 

  6. Elliott S (ed) (2009) Sexuality after spinal cord injury. FA Davis, Philadelphia

    Google Scholar 

  7. Ibrahim E, Brackett NL, Lynne CM (2016) Advances in the management of infertility in men with spinal cord injury. Asian J Androl 18(3):382–390

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Alexander M, Rosen RC (2008) Spinal cord injuries and orgasm: a review. J Sex Marital Ther 34(4):308–324

    Article  PubMed  Google Scholar 

  9. Chehensse C, Bahrami S, Denys P, Clement P, Bernabe J, Giuliano F (2013) The spinal control of ejaculation revisited: a systematic review and meta-analysis of anejaculation in spinal cord injured patients. Hum Reprod Update 19(5):507–526

    Article  CAS  PubMed  Google Scholar 

  10. Courtois F, Charvier K, Vezina JG, Journel NM, Carrier S, Jacquemin G et al (2011) Assessing and conceptualizing orgasm after a spinal cord injury. BJU Int 108(10):1624–1633

    Article  PubMed  Google Scholar 

  11. Soler JM, Previnaire JG, Plante P, Denys P, Chartier-Kastler E (2008) Midodrine improves orgasm in spinal cord-injured men: the effects of autonomic stimulation. J Sex Med 5(12):2935–2941

    Article  PubMed  Google Scholar 

  12. Karlsson AK (1999) Autonomic dysreflexia. Spinal Cord 37(6):383–391

    Article  CAS  PubMed  Google Scholar 

  13. Courtois F, Charvier K, Leriche A, Vezina JG, Cote I, Raymond D et al (2008) Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men. J Sex Med 5(10):2419–2430

    Article  PubMed  Google Scholar 

  14. Kreuter M, Taft C, Siosteen A, Biering-Sorensen F (2011) Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord 49(1):154–160

    Article  CAS  PubMed  Google Scholar 

  15. Mah K, Binik YM (2002) Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context. J Sex Res 39(2):104–113

    Article  PubMed  Google Scholar 

  16. Ortigue S, Grafton ST, Bianchi-Demicheli F (2007) Correlation between insula activation and self-reported quality of orgasm in women. Neuroimage 37(2):551–560

    Article  PubMed  Google Scholar 

  17. Komisaruk BR, Whipple B (2005) Functional MRI of the brain during orgasm in women. Annu Rev Sex Res 16:62–86

    PubMed  Google Scholar 

  18. Durga A, Sepahpanah F, Regozzi M, Hastings J, Crane DA (2011) Prevalence of testosterone deficiency after spinal cord injury. PM R 3(10):929–932

    Article  PubMed  Google Scholar 

  19. Barbonetti A, Vassallo MR, Felzani G, Francavilla S, Francavilla F (2016) Association between 25(OH)-vitamin D and testosterone levels: evidence from men with chronic spinal cord injury. J Spinal Cord Med 39(3):246–252

    Article  PubMed  PubMed Central  Google Scholar 

  20. Barassi A, Pezzilli R, Colpi GM, Corsi Romanelli MM, Melzi d’Eril GV (2014) Vitamin D and erectile dysfunction. J Sex Med 11(11):2792–2800

    Article  CAS  PubMed  Google Scholar 

  21. Sang JH, Kim TH, Kim SA (2016) Flibanserin for treating hypoactive sexual desire disorder. J Menopausal Med 22(1):9–13

    Article  PubMed  PubMed Central  Google Scholar 

  22. Courtois FJMC, Charbier KF, Leduc B (2001) Sexual rehabilitation for men with spinal cord injury: preliminary report on a behavioral strategy. Sex Disabil 19(2):149–157

    Article  Google Scholar 

  23. Bodner DR, Haas CA, Krueger B, Seftel AD (1999) Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology 53(1):199–202

    Article  CAS  PubMed  Google Scholar 

  24. Elliott S (2010) Case study: erectile dysfunction following spinal cord injury. J Sex Med 7(12):3808–3814

    Article  PubMed  Google Scholar 

  25. Tepper MS, Whipple B, Richards E, Komisaruk BR (2001) Women with complete spinal cord injury: a phenomenological study of sexual experiences. J Sex Marital Ther 27(5):615–623

    Article  CAS  PubMed  Google Scholar 

  26. Borisoff JF, Elliott SL, Hocaloski S, Birch GE (2010) The development of a sensory substitution system for the sexual rehabilitation of men with chronic spinal cord injury. J Sex Med 7(11):3647–3658

    Article  PubMed  Google Scholar 

  27. Fode M, Ohl DA, Sonksen J (2015) A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat Rev Urol 12(11):607–616

    Article  PubMed  Google Scholar 

  28. Soler JM, Previnaire JG, Mieusset R (2016) Evidence of a new pattern of ejaculation in men with spinal cord injury: ejaculation dyssynergia and implications for fertility. Spinal Cord 54(12):1210–1214

    Article  PubMed  Google Scholar 

  29. Qiu Y, Wang LG, Zhang LH, Zhang AD, Wang ZY (2012) Quality of sperm obtained by penile vibratory stimulation and percutaneous vasal sperm aspiration in men with spinal cord injury. J Androl 33(5):1036–1046

    Article  CAS  PubMed  Google Scholar 

  30. Basu S, Aballa TC, Ferrell SM, Lynne CM, Brackett NL (2004) Inflammatory cytokine concentrations are elevated in seminal plasma of men with spinal cord injuries. J Androl 25(2):250–254

    Article  CAS  PubMed  Google Scholar 

  31. Brackett NL, Cohen DR, Ibrahim E, Aballa TC, Lynne CM (2007) Neutralization of cytokine activity at the receptor level improves sperm motility in men with spinal cord injuries. J Androl 28(5):717–721

    Article  CAS  PubMed  Google Scholar 

  32. Brindley GS (1981) Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia 19(5):299–302

    CAS  PubMed  Google Scholar 

  33. Sonksen J, Ohl DA (2002) Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int J Androl 25(6):324–332

    Article  PubMed  Google Scholar 

  34. Sonksen J, Fode M, Lochner-Ernst D, Ohl DA (2012) Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 50(1):63–66

    Article  CAS  PubMed  Google Scholar 

  35. Soler JM, Previnaire JG (2011) Ejaculatory dysfunction in spinal cord injury men is suggestive of dyssynergic ejaculation. Eur J Phys Rehabil Med 47(4):677–681

    CAS  PubMed  Google Scholar 

  36. Linsenmeyer TA (2000) Sexual function and infertility following spinal cord injury. Phys Med Rehabil Clin N Am 11(1):141–156

    Article  CAS  PubMed  Google Scholar 

  37. Jackson AB, Wadley V (1999) A multicenter study of women’s self-reported reproductive health after spinal cord injury. Arch Phys Med Rehabil 80(11):1420–1428

    Article  CAS  PubMed  Google Scholar 

  38. Charlifue SW, Gerhart KA, Menter RR, Whiteneck GG, Manley MS (1992) Sexual issues of women with spinal cord injuries. Paraplegia 30(3):192–199

    CAS  PubMed  Google Scholar 

  39. Kiekens C (2015) Pregnancy in spinal cord injury. In: Corcos J, Ginsberg D, Karsenty G (eds) Textbook of the neurogenic bladder, 3rd edn. CRC Press, Boca Raton

  40. Consortium for Spinal Cord M (2010) Sexuality and reproductive health in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 33(3):281–336

    Article  Google Scholar 

  41. Welner SL (1998) Screening issues in gynecologic malignancies for women with disabilities: critical considerations. J Womens Health 7(3):281–285

    Article  CAS  PubMed  Google Scholar 

  42. Cross LL, Meythaler JM, Tuel SM, Cross AL (1992) Pregnancy, labor and delivery post spinal cord injury. Paraplegia 30(12):890–902

    CAS  PubMed  Google Scholar 

  43. Ghidini A, Healey A, Andreani M, Simonson MR (2008) Pregnancy and women with spinal cord injuries. Acta Obstet Gynecol Scand 87(10):1006–1010

    Article  PubMed  Google Scholar 

  44. Westgren N, Levi R (1994) Motherhood after traumatic spinal cord injury. Paraplegia 32(8):517–523

    CAS  PubMed  Google Scholar 

  45. Sipski ML, Alexander CJ (1997) Spinal cord injury and sexual function: an educational model. In: Sipski ML, Alexander CJ (eds) Sexual function in people with disability and chronic illness: a health professional's guide. Aspen Publishers, Gaithersburg, Md

  46. Pannek J, Bertschy S (2011) Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review. Spinal Cord 49(10):1028–1032

    Article  CAS  PubMed  Google Scholar 

  47. Salomon J, Schnitzler A, Ville Y, Laffont I, Perronne C, Denys P et al (2009) Prevention of urinary tract infection in six spinal cord-injured pregnant women who gave birth to seven children under a weekly oral cyclic antibiotic program. Int J Infect Dis 13(3):399–402

    Article  PubMed  Google Scholar 

  48. Pereira L (2003) Obstetric management of the patient with spinal cord injury. Obstet Gynecol Surv 58(10):678–687

    Article  PubMed  Google Scholar 

  49. Iezzoni LI, Chen Y, McLain AB (2015) Current pregnancy among women with spinal cord injury: findings from the US national spinal cord injury database. Spinal Cord 53(11):821–826

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Chisholm CA, Bray MJ, Karns LB (2001) Successful pregnancy in a woman with Bloom syndrome. Am J Med Genet 102(2):136–138

    Article  CAS  PubMed  Google Scholar 

  51. Tebbet M, Kennedy P (2012) The experience of childbirth for women with spinal cord injuries: an interpretative phenomenology analysis study. Disabil Rehabil 34(9):762–769

    Article  PubMed  Google Scholar 

  52. Skowronski E, Hartman K (2008) Obstetric management following traumatic tetraplegia: case series and literature review. Aust NZ J Obstet Gynaecol 48(5):485–491

    Article  Google Scholar 

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Author information

Authors and Affiliations

Authors

Contributions

John T Stoffel—Protocol/project development, manuscript writing/editing. Frank Van Der Aa—manuscript writing/editing. Daniela Wittman—Manuscript writing/editing. Shirish Yande—Manuscript writing/editing. Stacy Elliott—Project development, Manuscript writing/editing

Corresponding author

Correspondence to J. T. Stoffel.

Ethics declarations

Human and animal rights statement

This research did not involve human subjects or animals

Informed consent

No informed consent was needed for this research

Conflict of interest

J Stoffel—no conflict regarding this project, Frank Van Der Aa—no conflict, Daniela Wittman—no conflict, Shirish Yande—no conflict, Stacy Elliott—no conflict.

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Stoffel, J.T., Van der Aa, F., Wittmann, D. et al. Fertility and sexuality in the spinal cord injury patient. World J Urol 36, 1577–1585 (2018). https://doi.org/10.1007/s00345-018-2347-y

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  • DOI: https://doi.org/10.1007/s00345-018-2347-y

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