Erectile problems after a spinal cord injury (SCI) has been an issue for countless patients. To better understand this problem, there have been numerous studies addressing the problem from a variety of angles such as specific dysfunctions and the neurophysiology of erections.
If erectile dysfunction is a problem that you or someone you know is experiencing, then we hope the following clinical research will be of help.
The Wikipedia defines a penile erection as an “increased penile blood flow resulting from the relaxation of penile arteries and the smooth muscle of the corpus cavernosum. This response is mediated by the release of nitric oxide (NO) from nerve terminals and endothelial cells, which stimulates the synthesis of cGMP in smooth muscle cells. Cyclic GMP relaxes smooth muscle and increases blood flow to the corpus cavernosum.” The simplified version is that blood flows to the penis causing a rigid state also known as an “erection”.
The Journal of the American Paraplegia Society states that “the majority of spinal cord injured (SCI) men with upper motor neuron lesions have reflex erections. However, these erections are often not adequately sustained making it difficult if not impossible to have intercourse.” They go on to say that the majority of those with lower neuron lesions are unable to have erections at all.
There are a few different approaches to this problem. Penile implants are one possibility, and for some, work very well. The drawback to the implant is that it increases the risk for infection and there is the chance that it will erode through the skin. You can choose between two types – inflatable and semirigid and the procedure is done in just a couple of hours under either general or spinal anesthetic. Inflatable implants operated with a pump have the benefit of allowing the penis to fully relax while the semirigid, as its name implies, keeps the penis continuously in a partially “aroused” state and is the lesser used version. Implants are a good option if medication fails to work, as is often the case with those who have a SCI.
Vacuum devices create an erection by drawing blood into the penis. This cylindrical device is placed over the penis to pull blood into the tissue and a ring is put around the base to hold the blood in place. Also called a penis pump, this tool has been used successfully for many.
Intracavernous injections of papaverine and phentolamine are other options that can lead to prolonged erections. Papaverine is an opiate and has some side effects such as constipation, somnolence and vertigo. Phentolamine causes blood vessels to expand which increases blood flow to the needed area and has few side effects. Both of these drugs are administered through injection and the patient can be taught how to do it himself assuming he is physically able.
Medications such as sildenafil (Viagra), vardenafil (Levitra) and Tadalafil (Cialis) are orally administered drugs that have shown positive results in a variety of studies. The recommended dosage is once a day, though Cialis is known for having a longer lasting effect – up to 36 hours. All of these pills have the potential for some uncomfortable side effects. Back pain, muscle aches, headache, indigestion and a runny nose are the primary ones, though some patients have reported experiencing hearing loss.
If your main concern is being able to father a child, Mitch Tepper at Sexualhealth.com lists two methods for obtaining sperm if manual ejaculation fails – electroejaculation stimulation (EES) and penile vibratory stimulation (PVS). EES requires anesthesia as an electric probe is inserted into the rectum. This procedure stimulates the nerves that control ejaculation. PVS is a less invasive process where you apply a vibrator to the penis and it has the added benefits of being a home procedure and pleasurable. It is common to first try PVS and if that fails to produce results, then try EES.
This topic is seldom an easy one to discuss and many are hesitant to do so. Keep in mind that this problem is not only widespread among those with SCIs, but among the general male population. You are not alone and with so many options to try, there is a good chance of finding one that works well for you!
A.J. Gross, D.H. Sauerwein, J. Kutzenberger, R.-H. Ringert. Penile prostheses in paraplegic men. British Journal of Urology
Male Urology and Sexuality After Spinal Cord Injury (SCI) Through a Narrative Book. Lombardi G.M.D., Macchiarella A. M.D, Celso M. M.D, Del Popolo G. M.D. Department of Neuro-urology Spinal Unit of Florence, Italy