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Fertility, Sexuality and Reproduction After Spinal Cord Injury

Condition: Spinal cord injuries (SCI) affect sexuality and reproduction differently in different situations, depending on the injury and the individual.

Background: Sexual arousal occurs through either physical or mental stimulation, and the effects of SCI on these pathways depends on the location, type, and severity of injury. SCI can impair reproductive function by hindering sexual activity due to problems with achieving erection and ejaculation in men or achieving sexual arousal in women. Sperm quality may be affected in some cases following injury, but SCI typically does not affect the ability of a woman to become pregnant.

Risk Factors: Lower motor neuron injuries and complete SCI are more likely to result in impairments of erection and ejaculation in men and genital lubrication in women; however, more than 90% of patients with complete upper motor neuron injuries and 90% of incomplete lower motor neuron injuries regain the ability to achieve erections.

History and Symptoms: Patients will describe other medical problems, sexual health-related issues, mental health problems, current medications, sexual experiences before and after injury, and adjustment to SCI by the patient and partner.

Physical Exam: A physician will perform a physical exam to evaluate the patient’s vital signs, musculoskeletal system, the hip flexion reflex to predict the ability to ejaculate, and sensation below the injury. A functional assessment will determine dependence on caregiver for transfers, mobility and muscle contractions that might affect sexual positioning, function of the hands and arms, and management of bladder and bowels.

Diagnostic Process: Blood samples may be tested for hormone levels, infection, metabolic syndrome, and diabetes. Other assessments may include a patient-reported erection function scale.

Rehab Management: An interdisciplinary treatment team may include a physician, nurse, physical therapist, occupational therapist, psychologist, and recreation therapist. These team members can prescribe medications and devices to assist sexual function, address bladder and bowel control issues, provide equipment for positioning during sexual activity, offer help for activities relevant to sexual activity such as undressing, perform individual and/or couples counseling, and help the patient participate in the community and relationships to support a healthy lifestyle.

Other Resources for Patients and Families: Rehabilitation services should provide education regarding sexuality and reproduction after SCI. Counseling of patients and partners is recommended. Resources for patients include websites (www.pva.org, www.sexualhealth.com), moderated videos, and books.

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