Sexual Dysfunction

  • Hyun-Yoon Ko


As life expectancy after spinal cord injury increases, the importance in rehabilitation has gradually shifted to improving quality of life. To achieve this goal, the rehabilitation team must address issues related to sexuality during the acute and chronic phases of spinal cord injuries. Sexuality in spinal cord injuries, as well as the medical and neurogenic problems of the sexual organs, is associated with many components, including body control, trunks stability, and the presence of spasticity. The recovery of sexual function is extremely important and constitutes an area of unmet need for people with spinal cord injuries. It would be the highest priority for people with paraplegia and the second highest priority in people with tetraplegia after recovering arm and hand function.


  1. Alexander MS, Aisen CM, Alexander SM, et al. Sexual concerns after spinal cord injury: an update on management. NeuroRehabilitation. 2017;41(2):343–57.CrossRefGoogle Scholar
  2. American Spinal Injury Association. International standards to document remaining autonomic function after spinal cord injury (ISAFSCI). Atlanta, GA: American Spinal Injury Association; 2012.Google Scholar
  3. Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–283.CrossRefGoogle Scholar
  4. Anderson KD, Borisoff JF, Johnson RD, et al. Spinal cord injury influences psychogenic as well as physical components of female sexual ability. Spinal Cord. 2007;45:349–59.CrossRefGoogle Scholar
  5. Baker ER, Cardenas DD. Pregnancy in spinal cord injured women. Arch Phys Med Rehab. 1996;7:501–7.CrossRefGoogle Scholar
  6. Biering-Sorensen F, Sonksen J. Sexual function in spinal cord lesioned men. Spinal Cord. 2001 Sep;39(9):455–70.CrossRefGoogle Scholar
  7. Bird VG, Brackett NL, Lynne CM, et al. Reflexes and somatic responses as predictors of ejaculation by penile vibratory stimulation in men with spinal cord injury. Spinal Cord. 2001;39:514–9.CrossRefGoogle Scholar
  8. Bodner DR, Haas CA, Krueger B, et al. Intraurethral alprostadil for treatment of erectile dysfunction in patients with spinal cord injury. Urology. 1999;53(1):199–202.CrossRefGoogle Scholar
  9. Brackett NL, Lynne CM, Weizman MS, et al. Scrotal and oral temperatures are not related to sperm quality of serum gonadotropin levels in spinal cord-injured men. J Androl. 1994;15:614–9.PubMedGoogle Scholar
  10. Brackett NL, Lynne CM, Ibrahim E, et al. Treatment of infertility in men with spinal cord injury. Nat Rev Urol. 2010;7:162–72.CrossRefGoogle Scholar
  11. Brindley GS. Deep scrotal temperature and the effect on it of clothing, air temperature, activity, posture and paraplegia. Br J Urol. 1982;54:49–55.CrossRefGoogle Scholar
  12. Brown DJ, Hill ST, Baker HW. Male fertility and sexual function after spinal cord injury. Prog Brain Res. 2006;152:427–39.CrossRefGoogle Scholar
  13. Camune BD. Challenges in the management of the pregnant woman with spinal cord injury. J Perinat Neonatal Nurs. 2013;27(3):225–31.CrossRefGoogle Scholar
  14. Chapelle PA, Durand J, Lacert P. Penile erection following complete spinal cord injury in man. Br J Urol. 1980;52(3):216–9.CrossRefGoogle Scholar
  15. Colpi G, Weidner W, Jungwirth A, et al. EAU guidelines on ejaculatory dysfunction. Eur Urol. 2004;46:555–8.CrossRefGoogle Scholar
  16. Consortium for Spinal Cord Medicine. Sexuality and reproductive health in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2010;33:281–336.Google Scholar
  17. Courtois FJ, Goulet MC, Charvier KF, et al. Posttraumatic erectile potential of spinal cord injured men: how physiologic recordings supplement subjective reports. Arch Phys Med Rehabil. 1999;80(10):1268–72.CrossRefGoogle Scholar
  18. Craig DI. Spinal cord injury and pregnancy: the stories of two women. Sci Nurs. 1994;11:100–4.PubMedGoogle Scholar
  19. Das S, Soni BM, Sharma SD, et al. A case of rapid deterioration in sperm quality following spinal cord injury. Spinal Cord. 2006;44:56–8.CrossRefGoogle Scholar
  20. Deforge D, Blackmer J, Garritty C, et al. Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord. 2006;44(8):465–73.CrossRefGoogle Scholar
  21. Del Popolo G, Marzi VL, Mondaini N, et al. Time/duration effectiveness of sildenafil versus tadalafil in the treatment of erectile dysfunction in male spinal cord injured patient. Spinal Cord. 2004;42:644–8.CrossRefGoogle Scholar
  22. Denil J, Ohl DA, Smythe C. Vacuum erection device in spinal cord injured men: patient and partner satisfaction. Arch Phys Med Rehabil. 1996;77:750–3.CrossRefGoogle Scholar
  23. Derry F, Hultling C, Seftel AD, et al. Efficacy and safety of sildenafil citrate (Viagra) in men with erectile dysfunction and spinal cord injury: a review. Urology. 2002;60(2 Suppl 2):49–57.CrossRefGoogle Scholar
  24. Dimitriadis F, Karakitsios K, Tsounapi P, et al. Erectile function and male reproduction in men with spinal cord injury: a review. Andrologia. 2010;42:139–65.CrossRefGoogle Scholar
  25. Elliott SL. Problems of sexual function after spinal cord injury. Prog Brain Res. 2006;152:387–99.CrossRefGoogle Scholar
  26. Everaert K, de Waard WI, Van Hoof T, et al. Neuroanatomy and neurophysiology related to sexual dysfunction in male neurogenic patients with lesions to the spinal cord or peripheral nerves. Spinal Cord. 2010;48:182–91.CrossRefGoogle Scholar
  27. Ghidini A, Simonson M. Pregnancy after spinal cord injury: a review of the literature. Top Spinal Cord Inj Rehabil. 2011;16:93–103.CrossRefGoogle Scholar
  28. Giuliano F, Sanchez-Ramos A, Löchner-Ernst D, et al. Efficacy and safety of tadalafil in men with erectile dysfunction following spinal cord injury. Arch Neurol. 2007;64(11):1584–92.CrossRefGoogle Scholar
  29. Greer IA. Thrombosis in pregnancy: maternal and fetal issues. Lancet. 1999;353:1258–65.CrossRefGoogle Scholar
  30. Hughes SJ, Short DJ, Usherwood M, et al. Management of pregnant women with spinal cord injuries. Br J Obstet Gynecol. 1991;98:513–8.CrossRefGoogle Scholar
  31. Ibrahim E, Lynne CM, Brackett NL. Male fertility following spinal cord injury: an update. Andrology. 2016;4(1):13–26.CrossRefGoogle Scholar
  32. Jones ML, Leslie DP, Bilsky G, et al. Effects of intrathecal baclofen on perceived sexual functioning in men with spinal cord injury. J Spinal Cord Med. 2008;31:97–102.CrossRefGoogle Scholar
  33. Kafetsoulis A, Brackett NL, Ibrahim E, et al. Current trends in the treatment of infertility in men with spinal cord injury. Fertil Steril. 2006;86:781–9.CrossRefGoogle Scholar
  34. Kennedy P, Lude P, Taylor N. Quality of life, social participation, appraisals and coping post pinal cord injury: a review of four community samples. Spinal Cord. 2006;44:95–105.CrossRefGoogle Scholar
  35. Komisaruk BR, Whipple B, Crawford A, et al. Brain activation during vaginocervical self-stimulation and orgasm in women with complete spinal cord injury: fMRI evidence of mediation by the vagus nerves. Brain Res. 2004;1024:77–88.CrossRefGoogle Scholar
  36. Konstantinidis C. Chapter 7. Erectile dysfunction in paraplegic males. In: Nunes K, editor. Erectile dysfunction-disease-associated mechanisms and novel insights into therapy. London: InTechOpen; 2012. p. 127–43. Scholar
  37. Kreuter M, Taft C, Siösteen A, et al. Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord. 2011;49:154–60.CrossRefGoogle Scholar
  38. McGregor JA, Meeuwsen J. Autonomic hyperreflexia: a mortal danger for spinal cord injured women in labor. Am Obstet Gynecol. 1985;151:330–3.CrossRefGoogle Scholar
  39. Mitra M, Clements KM, Zhang J, et al. Maternal characteristics, pregnancy complications, and adverse birth outcomes among women with disabilities. Med Care. 2015;53:1027–32.CrossRefGoogle Scholar
  40. Monga M, Bernie J, Rajasekaran M. Male infertility and erectile dysfunction in spinal cord injury: a review. Arch Phys Med Rehabil. 1999;80:1331–9.CrossRefGoogle Scholar
  41. Nygaard I, Bartscht KD, Cole S. Sexuality and reproduction in spinal cord injured women. Obstet Gynecol Surg. 1990;45:727–32.CrossRefGoogle Scholar
  42. Patki P, Woodhouse J, Hamid R, et al. Effects of spinal cord injury on semen parameters. J Spinal Cord Med. 2008;31:27–32.CrossRefGoogle Scholar
  43. Pereira L. Obstetric management of the patient with spinal cord injury. Obstet Gynecol Surv. 2003;58:678–87.CrossRefGoogle Scholar
  44. Ramos AS, Samso JV. Specific aspects of erectile dysfunction in spinal cord injury. Int J Impot Res. 2004;16(Suppl 2):S42–5.CrossRefGoogle Scholar
  45. Reame NE. A prospective study of the menstrual cycle and spinal cord injury. Am J Phys Med Rehabil. 1982;71:15–21.CrossRefGoogle Scholar
  46. Rizio N, Tran C, Sorenson M. Efficacy and satisfaction rates of oral PDE5 is in the treatment of erectile dysfunction secondary to spinal cord injury: a review of literature. J Spinal Cord Med. 2012;35(4):219–28.CrossRefGoogle Scholar
  47. Saenz de Tejada I, Angulo J, et al. Pathophysiology of erectile dysfunction. J Sex Med. 2005;2(1):26–39.CrossRefGoogle Scholar
  48. Sipski ML. Spinal cord injury: what is the effect on sexual response? J Am Paraplegia Soc. 1991;14:40–3.CrossRefGoogle Scholar
  49. Sipski ML, Alexander CJ, Rosen RC. Physiologic parameters associated with psychogenic sexual arousal in women with complete spinal cord injuries. Arch Phys Med Rehabil. 1995a;76:811–8.CrossRefGoogle Scholar
  50. Sipski M, Alexander C, Rosen R. Orgasm in women with spinal cord injuries: a laboratory assessment. Arch Phys Med Rehabil. 1995b;76:1097–102.CrossRefGoogle Scholar
  51. Sipski ML, Alexander CJ, Rosen RC. Physiologic parameters associated with sexual arousal in women with incomplete spinal cord injuries. Arch Phys Med Rehabil. 1997;78:305–13.CrossRefGoogle Scholar
  52. Sipski ML, Alexander CJ, Rosen R. Sexual arousal and orgasm in women: effects of spinal cord injury. Ann Neurol. 2001;49:35–44.CrossRefGoogle Scholar
  53. Smeltzer SC. Pregnancy in women with physical disabilities. J Obstet Gynecol Neonatal Nurs. 2007;36:88–96.CrossRefGoogle Scholar
  54. Smith EM, Bodner DR. Sexual dysfunction after spinal cord injury. Urol Clin North Am. 1993;20(3):535–42.PubMedGoogle Scholar
  55. Soler JM, Previnaire JG, Amarenco G. Dartos reflex as autonomic assessment in persons with spinal cord injury. Spinal Cord Ser Cases. 2017;3(1):17097.CrossRefGoogle Scholar
  56. Sonksen J, Ohl DA. Penile vibratory stimulation and electroejaculations in the treatment of ejaculatory dysfunctions. Int J Androl. 2002;25:324–32.CrossRefGoogle Scholar
  57. Suh DD, Yang CC, Clowers DE. Nocturnal penile tumescence and effects of complete spinal cord injury: possible physiologic mechanisms. Urology. 2003;61(1):184–9.CrossRefGoogle Scholar
  58. Vodusek DB. Bulbocavernosus reflex revisited. Neurourol Urodyn. 2003;22(7):681–2.CrossRefGoogle Scholar
  59. Wespes E, Amar E, Hatzichristou D, et al. EAU guidelines on erectile dysfunction: an update. Eur Urol. 2006;49:806–15.CrossRefGoogle Scholar
  60. Whipple B, Komisaruk BR. Sexuality and women with complete spinal cord injury. Spinal Cord. 1997;35:136–8.CrossRefGoogle Scholar
  61. Yilmaz U, Yang CC, Berger RE. Dartos reflex: a sympathetically mediated scrotal reflex. Muscle Nerve. 2006;33(3):363–8.CrossRefGoogle Scholar

Suggested Reading

  1. Cardenas DD, Hooton TM, editors. Medical complications in physical medicine and rehabilitation. New York: Demos Medical Publishing, LLC; 2015.Google Scholar
  2. Chhabra HS, editor. ISCoS textbook on comprehensive management of spinal cord injuries. New Delhi: Wolters Kluwer; 2015.Google Scholar
  3. Green D, Olson DA, editors. Medical management of long-term disability. 2nd ed. Boston, MA: Butterworth-Heinemann; 1996.Google Scholar
  4. Guttmann L. Spinal cord injuries. Comprehensive management and research. Oxford: Blackwell Scientific Publications; 1976.Google Scholar
  5. Illis LS, editor. Spinal cord dysfunction: assessment. Oxford: Oxford University Press; 1988.Google Scholar
  6. Kennedy P, editor. The Oxford handbook of rehabilitation psychology. Oxford: Oxford University Press; 2012.Google Scholar
  7. Kirshblum S, Campagnolo DI, editors. Spinal cord medicine. 2nd ed. Philadelphia, PA: Wolters Kluwer, Lippincott, Williams & Wilkins; 2011.Google Scholar
  8. Mtuid E, Gruener G, Dockery P. Fitzgerald’s clinical neuroanatomy and neuroscience. 7th ed. Philadelphia: Elsevier; 2016.Google Scholar
  9. Neuburger M. The historical development of experimental brain and spinal cord physiology before Flourens. Baltimore, MD: The Johns Hopkins University Press; 1981.Google Scholar
  10. Noback CR, Strominger NL, Demarest RJ, Ruggiero DA. The human nervous system: structure and function. 6th ed. Totowa, NJ: Humana Press; 2005.Google Scholar
  11. Robertson D, Bigaaioni I, Burnstock G, et al. Primer on the autonomic nervous system. 3rd ed. London: Elsevier; 2011.Google Scholar
  12. Russel C, Matta B. Tracheostomy a multiprofessional handbook. Cambridge: Cambridge University Press; 2004.Google Scholar
  13. Sabharwal S. Essentials of spinal cord medicine. New York: Demos Medical; 2014.Google Scholar
  14. Simonds AK, editor. Non-invasive respiratory support. A practical handbook. 3rd ed. London: CRC Press; 2012.Google Scholar
  15. Snell RS. Clinical neuroanatomy. 7th ed. Philadelphia, PA: Wolters Kluwer; 2010.Google Scholar
  16. Somers MF. Spinal cord injury. Functional rehabilitation. 3rd ed. New York: Pearson; 2010.Google Scholar
  17. Sykes K, Yong JD. Respiratory support in intensive care. London: BMJ Books; 1999.Google Scholar
  18. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part I. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976.Google Scholar
  19. Vinken PJ, Bruyn GW, editors. Injuries of the spine and spinal cord. Part II. Handbook of clinical neurology, vol. 25. Oxford: North-Holland Publishing Company; 1976.Google Scholar
  20. Vodusek DB, Boller F. Neurology of sexual and bladder disorders. In: Aminoff MJ, Boller F, Swaab DF, editors. Handbook of clinical neurology, 3rd series, vol. 130. London: Elsevier; 2015.Google Scholar
  21. Vogel LC, Zebracki K, Betz RR, Mulcahey MJ, editors. Spinal cord injury in the child and young adult. London: Mac Keith Press; 2014.Google Scholar
  22. Watson C, Paxinos G, Kayalioglu G, editors. The spinal cord. A Christopher and Dana Foundation text and atlas. New York: Elsevier; 2009.Google Scholar
  23. Weaver LC, Polosa C, editors. Autonomic dysfunction after spinal cord injury, Progress in brain research, vol. 152. New York: Elsevier; 2006.Google Scholar
  24. Weidner N, Rupp R, Taney KE, editors. Neurological aspects of spinal cord injury. Cham: Springer; 2017.Google Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hyun-Yoon Ko
    • 1
  1. 1.Department of Rehabilitation MedicineRehabilitation Hospital, Pusan National University Yangsan Hospital, Pusan National University School of MedicineYangsanSouth Korea

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