Orgasm and SCI: what do we know?

Empowering Women's Health after Spinal Cord Injuries: A Timely and Practical Update

Women encompass about 20% of all the traumatic spinal cord injury (SCI) population and there is increased incidence and prevalence of women with SCIs. The most recent data estimate that approximately 40,000-45,000 women with SCI are living in the United States, increasing from previous years, with the most common cause still being motor vehicle collisions. Throughout their lifespan, women with SCI present with unique healthcare needs compare to the male population. Therefore we present a comprehensive summary to empower and equip all providers with awareness of these needs and recommendations of care.

Looking Beyond the Chair: Psycho-Perceptual Predictors of Sexual Distress and Sexual Satisfaction in Individuals with Spinal Cord Injury

Despite a large body of biomedical research, little is known about the psychological and perceptual predictors of sexual satisfaction (SS) and sexual distress (SD) post spinal cord injury (SCI). Guided by a bio-psycho-perceptual framework, this cross-sectional research aimed at assessing SS and SD in a large SCI sample using validated patient-reported outcome measures (PROM). Significant correlates and predictors of SS and SD were also identified. Ninety-one men and women with SCI completed PROMs of SS and SD, as well as psychological (mood, sexual and body esteem) and perceptual (interoceptive awareness, trait mindfulness, sexual mindfulness) factors. Neurological profiles were also assessed, along with experience of orgasm. Correlates of SS and SD were first identified using Pearson's correlations, then multiple hierarchical regression models were computed to isolate predictors. Orgasm experience and psychological factors emerged as moderate correlates of both SS and SD, while neurological factors did not. Interoceptive awareness and trait mindfulness showed weak associations with SD and none with SS. Among the tested predictors, experience of orgasm emerged as the strongest for SS (β = -.29, p < .01), followed by mood, which predicted SS and SD. Sexual and body esteem was predictive of SD only. In sexually active participants, sexual mindfulness predicted both SS (β = 0.55, p < .001) and SD (β = -0.56, p < .001) above and beyond all other variables. This study reveals unique aspects of SS and SD postinjury and supports further consideration of psychological and perceptual dimensions of SCI sexuality in rehabilitation research.

Clinical and Laboratorial Evaluation of Male Infertility. A Detailed Practical Approach

Infertility, defined as the inability to achieve pregnancy after one year of unprotected, frequent sexual intercourse, is a global burden that affects approximately 15% of couples, or 190-230 million people worldwide, who are trying to start a family. The male contributes significantly, directly accounting for 30-35% and up to 52% of total couple infertility, affecting approximately 7-8% of all men. This work aims to present, in a didactic and objective way, a standardization of the initial steps toward a thorough evaluation of subfertile and infertile men. We have focused on the evaluation of initial management, emphasizing the need for a comprehensive evaluation that includes a detailed history, physical examination, and semen analysis as the golden triple helix of basic evaluation of the infertile male. General and genital physical examinations are highly valuable due to the wealth of information they provide, from potential diagnoses to pregnancy prognoses. Comprehensive and quality-controlled semen analysis provides reliable information as a baseline test to evaluate the patency of the reproductive tract and to evaluate basic sperm parameters and fertility potential. However, it is not a fertility determinant and should preferentially be complemented with sperm functional tests. like biomarkers of oxidative stress, sperm immaturity and DNA fragmentation. Most cases of infertility require evaluation by a specialist in andrology, nonetheless the understanding and rationale of the initial assessment of the infertile male can be undertaken by non-specialists, thus improving the care and counseling of couples facing this troubling issue and avoiding unnecessary use of assisted reproductive technologies (ART) since most cases of male infertility can be treated and reversed by medical or surgical interventions, and the fertility status can be restored. The ultimate goal is to achieve natural pregnancy, the use of ART should not be the initial offered resource.

Remote spinal trauma resulting in dorsal column spinal pathway dysfunction and anejaculation

Spinal cord injury (SCI) as the cause of anejaculation is a rare entity. We present the case of a 65-year-old male with a five-year history of intractable anejaculation. Two years prior to onset of his anejaculation, the patient fell from height, causing minor spinal trauma, with sequelae of cervical myelopathy and eventual posterior spinal fusion of C1/C2. Biothesiometry and sensory evaluation revealed diminished somatic sensation of his glans penis in a frequency-dependent pattern. The patient's pudendal sensory loss and anejaculation correlate with his spinal trauma, as evidenced by the lack of peripheral nervous system findings upon neurological exam and imaging.

What Is the Trigger for Sexual Climax?

A model is proposed to consider sexual climax in men, women, and animals as a unitary phenomenon. Sexual climax is a stereotyped rhythmic pattern of spinally generated neural activity in the autonomic and somatic nerves innervating pelvic organs. A column of neurons in the spinal cord of the male rat is strongly activated by ejaculation (sexual climax in the male). These neurons project to the thalamus and are therefore called lumbar spinothalamic cells (LSt cells). Comprehensive studies have demonstrated that the LSt cells constitute a central pattern generator of ejaculation. These findings have been extended to female animals. Further studies identified LSt cells in the lumbar spinal cord of men and women. Strong evidence indicates that the LSt cells mediate ejaculation in men. The climax model generalizes and extends these studies. It postulates that LSt cells in the lumbar spinal cord of humans and animals of both sexes generate climax. The LSt cells generate the neural activity driving the pelvic contractions and other responses of climax. The activity is transmitted to supraspinal sites to activate orgasm. The LSt cells receive excitatory and inhibitory projections from supraspinal sites. The descending projections reflect subjective arousal and inhibitions. Spinal sensory neurons from the genitals provide excitatory and inhibitory innervation to the LSt cells. These represent pleasurable and noxious sensations. The supraspinal and spinal excitatory and inhibitory inputs are integrated by the LSt. When the sum of the excitatory inputs, minus the sum of the inhibitory inputs reaches a threshold, the LSt cells generate sexual climax.

Male genital sensation after spinal cord injury: a review

Genital sensation (GS) is an essential component of male sexual function. Genital sensory disturbance (GSD) caused by spinal cord injury (SCI) has a severe impact on the patients' sexual function but has garnered little research focus. Under normal conditions, GS encompasses the erection, ejaculation, sexual arousal, and orgasm courses associated with physiological and psychological responses in male sexual activity. However, in SCI patients, the deficiency of GS makes the tactile stimulation of the penis unable to cause sexual arousal, disturbs the normal processes of erection and ejaculation, and decreases sexual desire and satisfaction. To provide an overview of the contemporary conception and management of male GS after SCI, we review the innervation and sexual function of male GS in this article, discuss the effects of GSD following SCI, and summarize the current diagnosis and treatment of GSD in male SCI patients.

Assessing the ability of the Sacral Autonomic Standards to document bladder and bowel function based upon the Asia Impairment Scale

Study design

Retrospective review of data.

Objective

To determine if there is a relationship between the Asia Impairment Scale (AIS) and the bladder and bowel components of the International Standards to Document Remaining Autonomic Function after SCI (ISAFSCI).

Setting

University-Based Academic Rehabilitation Program.

Methods

Retrospective cross-sectional study assessing International Standards for Neurologic Classification After SCI (ISNCSCI) examination along with bladder and bowel components of the ISAFSCI.

Results

Subjects with AIS A injuries were statistically less likely to have history of bladder control and bowel control per investigator determination and bladder sensation via self-report versus patients categorized with AIS B injuries. Self-reported history of bowel sensation and control of voiding were more likely in subjects with C, D, or E injuries than with B injuries. Bowel and bladder control as determined by investigator and bladder and bowel sensation and control as self-reported were all statistically less likely in persons with AIS A injuries versus CDE.

Conclusions

This retrospective study provides initial data regarding components of the bladder and bowel sections of the sacral ISAFSCI and AIS. Further prospective research is needed to further characterize the relationship between retention of bladder and bowel sensation and function and the AIS. We suggest that incorporation of the sacral components of the ISAFSCI into the ISNCSCI may be beneficial to obtain further information about retention of sacral function with specific patterns of injury.