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Gowinnage SS, Wicramabahu Senarath Paranayapa P, Arambepola C. Sexual and Reproductive Health Experiences, Knowledge and Associations: A Neglected Issue Among Adults with Spinal Cord Injury in Sri Lanka. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09758-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Hough S, Cordes CC, Goetz LL, Kuemmel A, Lieberman JA, Mona LR, Tepper MS, Varghese JG. A Primary Care Provider's Guide to Sexual Health for Individuals With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:144-151. [PMID: 33192040 DOI: 10.46292/sci2603-144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting. This article provides guidance for practitioners in primary care settings who are caring for persons with spinal cord injury. Clinicians should seize the opportunity during the encounter to reframe the experience of disability as a social construct status, moving away from the narrow view of medical condition and "find it, fix it" to a broader understanding that provides increased access to care for sexual health and sexual pleasure.
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Affiliation(s)
- Sigmund Hough
- Spinal Cord Injury Service, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | | | - Lance L Goetz
- Spinal Cord Injury and Disorders Service, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Angela Kuemmel
- Psychology Service, Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Jesse A Lieberman
- Physical Medicine and Rehabilitation/Spinal Cord Medicine, Carolinas Rehabilitation, and Carolinas Medical Center, Charlotte, North Carolina
| | - Linda R Mona
- VA Long Beach Healthcare System, Long Beach, California
| | | | - Jithin G Varghese
- Centre for Family Medicine-Family Health Team, Kitchener, Ontario, Canada
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Abstract
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.
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Affiliation(s)
- Hao Zhang
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bing Li
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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de Almeida Kiguti LR, Pacheco TL, Antunes E, Kempinas WDG. Lorcaserin Administration has Pro-Ejaculatory Effects in Rats via 5-HT 2C Receptors Activation: A Putative Pharmacologic Strategy to Delayed Ejaculation? J Sex Med 2020; 17:1060-1071. [PMID: 32234370 DOI: 10.1016/j.jsxm.2020.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Lorcaserin is an anti-obesity drug whose weight loss effect results from 5-hydroxytryptamin (5-HT)2C receptors activation. The 5-HT2C receptor was shown to participate in the physiological control of ejaculation, but no data addressing a putative effect of lorcaserin on ejaculation exist. AIM To investigate the effects of lorcaserin in different in vitro and in vivo experimental models of ejaculation in rats. METHODS Contractile responses to lorcaserin in rat seminal emission organs in vitro (prostatic and epididymal vas deferens, cauda epididymis, and seminal vesicles), analysis of male rat copulatory behavior, and electromyographic recording of bulbospongiosus muscle in anesthetized animals were studied. MAIN OUTCOME MEASURES The main outcome measures included in vitro contraction of seminal emission organs and evaluation of the male rat copulatory behavior. The male rat sexual behavior in terms of copulation latency, ejaculation latency, mount and intromission frequency, and ejaculation frequency of sexually experienced adult male rats with a receptive female were also recorded. RESULTS Lorcaserin (1.0 nM to 1.0 mM) had no significant effects on the in vitro contractility of seminal emission organs smooth muscle (cauda epididymis, vas deferens, and seminal vesicles). On the other hand, lorcaserin administration (0.3-1.0 mg/kg, intravenous) induced ejaculation in anesthetized rats, which was prevented by the 5-HT2C-selective antagonist SB 242084 (0.1 and 0.3 mg/kg, intravenous). Single-dose treatment of non-anesthetized male rats with lorcaserin (1.0, 4.0, or 10 mg/kg, per os) induced non-copulating ejaculations in sexually naïve rats. Lorcaserin also had pro-ejaculation effects by decreasing the ejaculation threshold of copulating rats by half. The pro-ejaculatory effects of lorcaserin were reversible as the ejaculation threshold of treated rats recovered after a 1-week washout period. CLINICAL IMPLICATIONS Due to its reported clinical safety, repurposing lorcaserin for the treatment of delayed ejaculation may be suggested. STRENGTHS & LIMITATIONS The pro-ejaculatory effect of lorcaserin administration and the role of 5-HT2C were demonstrated in different experimental models of ejaculation in rats. The lack of studies in putative experimental models of delayed ejaculation is a limitation of this study. CONCLUSION Our results demonstrate that the clinically approved 5-HT2C agonist lorcaserin is a strong facilitator of ejaculation in rats. de Almeida Kiguti LR, Pacheco TL, Antunes E, et al. Lorcaserin Administration has Pro-Ejaculatory Effects in Rats via 5-HT2C Receptors Activation: A Putative Pharmacologic Strategy to Delayed Ejaculation? J Sex Med 2020;17:1060-1071.
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Affiliation(s)
| | - Tainá Louise Pacheco
- Laboratory of Reproductive and Developmental Biology and Toxicology (ReproTox), Department of Morphology, State University of São Paulo (UNESP), Botucatu, Brazil
| | - Edson Antunes
- Department of Pharmacology, University of Campinas (UNICAMP), Campinas, Brazil.
| | - Wilma de Grava Kempinas
- Laboratory of Reproductive and Developmental Biology and Toxicology (ReproTox), Department of Morphology, State University of São Paulo (UNESP), Botucatu, Brazil
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Double-blinded, placebo-controlled crossover trial to determine the effects of midodrine on blood pressure during cognitive testing in persons with SCI. Spinal Cord 2020; 58:959-969. [PMID: 32203065 PMCID: PMC7483245 DOI: 10.1038/s41393-020-0448-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/19/2022]
Abstract
Study Design: Clinical trial. Objectives: Individuals with spinal cord injury (SCI) above T6 experience impaired descending cortical control of the autonomic nervous system which predisposes them to hypotension. However, treatment of hypotension is uncommon in the SCI population because there are few safe and effective pharmacological options available. The primary aim of this investigation was to test the efficacy of a single dose of midodrine (10 mg), compared to placebo, to increase and normalize systolic blood pressure (SBP) between 110–120 mmHg during cognitive testing in hypotensive individuals with SCI. Secondary aims were to determine the effects of midodrine on cerebral blood flow velocity (CBFv) and global cognitive function. Setting: United States clinical research laboratory. Methods: Forty-one healthy hypotensive individuals with chronic (≥ 1-year post-injury) SCI participated in this 2-day study. Seated SBP, CBFv, cognitive performance were monitored before and after administration of identical encapsulated tablets, containing either midodrine or placebo. Results: Compared to placebo, midodrine increased SBP (4±13 vs. 18±24 mmHg, respectively; p<0.05); however, responses varied widely with midodrine (−15.7 to +68.6 mmHg). Further, the proportion of SBP recordings within the normotensive range did not improve during cognitive testing with midodrine compared to placebo. Although higher SBP was associated with higher CBFv (p=0.02), global cognitive function was not improved with midodrine. Conclusions: The findings indicate that midodrine increases SBP and may be beneficial in some hypotensive patients with SCI; however, large heterogeneity of responses to midodrine suggest careful monitoring of patients following administration.
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Steuer I, Guertin PA. Central pattern generators in the brainstem and spinal cord: an overview of basic principles, similarities and differences. Rev Neurosci 2019; 30:107-164. [PMID: 30543520 DOI: 10.1515/revneuro-2017-0102] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 03/30/2018] [Indexed: 12/11/2022]
Abstract
Central pattern generators (CPGs) are generally defined as networks of neurons capable of enabling the production of central commands, specifically controlling stereotyped, rhythmic motor behaviors. Several CPGs localized in brainstem and spinal cord areas have been shown to underlie the expression of complex behaviors such as deglutition, mastication, respiration, defecation, micturition, ejaculation, and locomotion. Their pivotal roles have clearly been demonstrated although their organization and cellular properties remain incompletely characterized. In recent years, insightful findings about CPGs have been made mainly because (1) several complementary animal models were developed; (2) these models enabled a wide variety of techniques to be used and, hence, a plethora of characteristics to be discovered; and (3) organizations, functions, and cell properties across all models and species studied thus far were generally found to be well-preserved phylogenetically. This article aims at providing an overview for non-experts of the most important findings made on CPGs in in vivo animal models, in vitro preparations from invertebrate and vertebrate species as well as in primates. Data about CPG functions, adaptation, organization, and cellular properties will be summarized with a special attention paid to the network for locomotion given its advanced level of characterization compared with some of the other CPGs. Similarities and differences between these networks will also be highlighted.
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Affiliation(s)
- Inge Steuer
- Neuroscience Unit, Laval University Medical Center (CHUL - CHU de Québec), 2705 Laurier Blvd, Quebec City, Quebec G1V 4G2, Canada
| | - Pierre A Guertin
- Neuroscience Unit, Laval University Medical Center (CHUL - CHU de Québec), 2705 Laurier Blvd, Quebec City, Quebec G1V 4G2, Canada
- Faculty of Medicine, Department of Psychiatry and Neurosciences, Laval University, Quebec City, Quebec G1V 0A6, Canada
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Groh AM, Moore CW, El-Warrak A, Seager SW, Power NE, Allman BL, Beveridge TS. Electroejaculation functions primarily by direct activation of pelvic musculature: Perspectives from a porcine model. TRANSLATIONAL RESEARCH IN ANATOMY 2018. [DOI: 10.1016/j.tria.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Alexander M, Marson L. Orgasm and SCI: what do we know? Spinal Cord 2017; 56:538-547. [PMID: 29259346 DOI: 10.1038/s41393-017-0020-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN narrative review OBJECTIVES: To determine the percentage of persons with SCI able to achieve orgasm and ejaculation, the associations between ejaculation and orgasm and the subjective and autonomic findings during these events, and the potential benefits with regards to spasticity. SETTING Two American medical centers METHODS: Data bases were searched for the terms orgasm and SCI and ejaculation and SCI. Search criteria were human studies published in English from 1990 to 12/2/2016. RESULTS Approximately 50% of sexually active men and women report orgasmic ability after SCI. There is a relative inability of persons with complete lower motor neuron injuries affecting the sacral segments to achieve orgasm. Time to orgasm is longer in persons with SCIs than able-bodied (AB) persons. With orgasm, elevated blood pressure (BP) occurs after SCI in a similar fashion to AB persons. With penile vibratory stimulation and electroejaculation, BP elevation is common and prophylaxis is recommended in persons with injuries at T6 and above. Dry orgasm occurs approximately 13% of times in males. Midodrine, vibratory stimulation, clitoral vacuum suction, and 4-aminopyridine may improve orgasmic potential. CONCLUSIONS Depending on level and severity of injury, persons with SCIs can achieve orgasm. Sympathetically mediated changes occur during sexual response with culmination at orgasm. Future research should address benefits of orgasm. Additionally, inherent biases associated with studying orgasm must be considered.
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Affiliation(s)
- Marcalee Alexander
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA. .,Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, MA, USA. .,Birmingham VA Medical Center, Birmingham, AL, USA.
| | - Lesley Marson
- Dignify Therapeutics, Research Triangle Park, NC, USA.,Department of Urology, School of Medicine, and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
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Dance DL, Chopra A, Campbell K, Ditor DS, Hassouna M, Craven BC. Exploring daily blood pressure fluctuations and cardiovascular risk among individuals with motor complete spinal cord injury: a pilot study. J Spinal Cord Med 2017; 40:405-414. [PMID: 27813450 PMCID: PMC5537957 DOI: 10.1080/10790268.2016.1236161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Clinically silent autonomic dysfunction with bowel and bladder care, are postulated to contribute to cardiovascular disease after chronic spinal cord injury (SCI). OBJECTIVE We describe the frequency and severity of dysreflexic episodes, termed transient blood pressure elevations (T-BPE) over 48 hours in adults with cervical or high-thoracic motor-complete SCI. SETTING Tertiary SCI Rehabilitation Centre in Toronto, Canada. PARTICIPANTS Individuals with chronic SCI, C1-T3 AIS A or B, >1 year post-injury, living in the community (n=19). OUTCOME MEASURES Data were obtained via 48-hour ambulatory blood pressure (BP) and heart rate (HR) monitoring, with data captured at 10-minute intervals and a concurrent diary describing activities of daily living, and bladder/bowel routines. T-BPE were defined as a ≥ 40 mmHg elevation in systolic blood pressure (SBP) above the participant's supine baseline. Severe (≥ 60-79 mmHg) and Extreme ≥80 mmHg elevations in SBP were described. RESULTS Thirteen participants experienced T-BPE within the assessment period, with 7/13 experiencing "severe", and 3/13 experiencing "extreme" SBP elevations. The median number of T-BPE was 8 (IQR = 3), and the mean ± SD SBP during T-BPE was 150 ± 16 mmHg, These T-BPE were verified as dysreflexic events using a conservative definition of a >40 mmHg increase in SBP, with a concurrent 10 bpm decrease in HR, above the 48-hour average SBP, yielding 12/19 participants with T-BPE. CONCLUSIONS T-BPE were frequent, often with severe or extreme elevations in SBP, despite few reported symptoms. Recognition and management of these dysreflexic events associated with T-BPE are needed, which may ameliorate cardiovascular disease risk.
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Affiliation(s)
- Derry L. Dance
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Amit Chopra
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Institute of Medical Science, University of Toronto, Toronto, ON, Canada
| | - Kent Campbell
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - David S. Ditor
- Department of Physical Education and Kinesiology, Brock University, St. Catharines, ON, Canada
| | - Magdy Hassouna
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - B. Catharine Craven
- Department of Medicine, University of Toronto, Toronto, ON, Canada,Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Correspondence to: B. Catharine Craven, Lyndhurst Centre, Toronto Rehabilitation Institute-UHN 520 Sutherland Drive, Toronto, ON, M4G 3V9, Canada.
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Dubray S, Gérard M, Beaulieu-Prévost D, Courtois F. Validation of a Self-Report Questionnaire Assessing the Bodily and Physiological Sensations of Orgasm. J Sex Med 2017; 14:255-263. [PMID: 28161081 DOI: 10.1016/j.jsxm.2016.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 11/24/2016] [Accepted: 12/08/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Despite a plethora of research on sexual functioning during the past decades, the field is still lacking standardized measurements specifically characterizing orgasm. Although several validated tools are available to assess sexual function in healthy and clinical populations, items on orgasm are limited to frequency or dichotomous responses. A neurophysiologic model of orgasm developed from previous research in able-bodied and spinally injured populations offers a promising framework for the construction of a new questionnaire. AIM To develop and validate a brief self-report measurement of orgasm by the assessment of bodily and physiologic sensations perceived during climax by able-bodied individuals. Although the currently available tool focuses on the phenomenological sensations associated with climax, the goal of this questionnaire was to capture the more specific genital and extragenital sensations associated with orgasm. MAIN OUTCOME MEASURES The current Bodily Sensations of Orgasm questionnaire and the Orgasm Rating Scale. METHODS Data from previous research conducted on individuals with spinal cord injury and the available empirical literature provided a pool of 45 items organized into four categories, which were reviewed by an expert panel. Upon review, a 28-item questionnaire was created and administered to a community sample of 227 participants, including men and women, 18 to 73 years old. RESULTS Exploratory factor analyses supported the four-factor model, in which orgasm is comprised of extragenital sensations, genital sensations and spasms, nociceptive sensations, and sweating responses. Overall, a high degree of internal consistency was found for the final 22-item questionnaire (Cronbach α = 0.87), with individual reliability coefficients showing moderate to high internal consistency (r = 0.65-0.79) for each dimension. Overall temporal stability of the measurement was acceptable (r = 0.74). Using the Orgasm Rating Scale, satisfying convergent validity was confirmed, thereby indicating that the two measurements are complementary. CONCLUSION The Bodily Sensations of Orgasm questionnaire allows for a brief evaluation of the physical and physiologic sensations associated with orgasm. Findings also suggest perceptual differences between men and women with regard to climax, with women reporting a larger repertoire of climactic sensations during orgasm.
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Affiliation(s)
- Samantha Dubray
- Department of Psychology Université du Québec à Montréal, Montreal, Canada
| | - Marina Gérard
- Department of Psychology Université du Québec à Montréal, Montreal, Canada
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Alexander M, Courtois F. Blood Pressure during Sexual Activity after Spinal Cord Injury Inaccurately Portrayed. J Neurotrauma 2017; 34:1289-1290. [PMID: 27796188 DOI: 10.1089/neu.2016.4810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Marcalee Alexander
- 1 Department of Rehabilitative Medicine, Birmingham VA Medical Center , Birmingham, Alabama.,2 Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham School of Medicine , Birmingham, Alabama.,3 Department of Physical Medicine and Rehabilitation, Harvard University School of Medicine , Boston, Massachusetts
| | - Frédérique Courtois
- 4 Departments of Sexology, and Psychology, University du Québec à Montréal , Faculté des sciences humaines, Montréal, Québec, Canada
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Davidson R, Phillips A. Cardiovascular Physiology and Responses to Sexual Activity in Individuals Living with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2017; 23:11-19. [PMID: 29339873 PMCID: PMC5340505 DOI: 10.1310/sci2301-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: Spinal cord injury (SCI) may profoundly impact autonomic function producing a variable degree of dysfunction in cardiovascular, bronchopulmonary, sweating, bladder, bowel, and sexual function. The cardiovascular system is crucially important for sexual function, as it is responsible for blood flow shifts to cavernous and musculoskeletal tissue during sexual activity. This system is prone to 3 main abnormalities after SCI including low resting blood pressure (LRBP), orthostatic hypotension (OH), and autonomic dysreflexia (AD), all of which have important effects on sexual function. Methods: We review the current etiological mechanisms and manifestations of cardiovascular dysfunction after SCI and discuss how this is documented to impact sexual function in individuals living with SCI. Conclusions: All individuals with SCI at or above the T6 neurologic level have an increased risk of AD during sexual stimulation, with increasing risk associated with higher levels of injury and greater completeness of injury. AD can be silent, and individuals living with SCI should be aware of blood pressure values at baseline and during sexual activity. Clinicians performing vibrostimulation fertility procedures need to be aware of the risk of AD and consider pretreatment if needed. Researchers studying the cardiovascular response to sexual stimulation should consider continuous monitoring of blood pressure, as intermittent monitoring may underestimate true blood pressure values.
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Affiliation(s)
- Ross Davidson
- International Collaboration On Repair Discoveries, Vancouver, BC, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, British Columbia, Canada
| | - Aaron Phillips
- International Collaboration On Repair Discoveries, Vancouver, BC, Canada
- Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia, British Columbia, Canada
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Alexander M, Courtois F, Elliott S, Tepper M. Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom. Top Spinal Cord Inj Rehabil 2017; 23:57-70. [PMID: 29339878 PMCID: PMC5340510 DOI: 10.1310/sci2301-57] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre- and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.
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Affiliation(s)
- Marcalee Alexander
- Department of Rehabilitative Medicine, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, Massachusetts
- Department of Physical Medicine and Rehabilitation University of Alabama at Birmingham
| | - Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Montreal, Canada
- Institut de réadaptation Gingras Lindsay de Montréal, Montreal, Canada
| | - Stacy Elliott
- Departments of Psychiatry and Urologic Sciences, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- International Collaboration On Repair Discoveries (ICORD), Vancouver, Canada
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Courtois F, Alexander M, McLain AB(J. Women's Sexual Health and Reproductive Function After SCI. Top Spinal Cord Inj Rehabil 2017; 23:20-30. [PMID: 29339874 PMCID: PMC5340506 DOI: 10.1310/sci2301-20] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Sexual function and to a lesser extent reproduction are often disrupted in women with spinal cord injuries (SCI), who must be educated to better understand their sexual and reproductive health. Women with SCI are sexually active; they can use psychogenic or reflexogenic stimulation to obtain sexual pleasure and orgasm. Treatment should consider a holistic approach using autonomic standards to describe remaining sexual function and to assess both genital function and psychosocial factors. Assessment of genital function should include thoracolumbar dermatomes, vulvar sensitivity (touch, pressure, vibration), and sacral reflexes. Self-exploration should include not only clitoral stimulation, but also stimulation of the vagina (G spot), cervix, and nipples conveyed by different innervation sources. Treatments may consider PDE5 inhibitors and flibanserin on an individual basis, and secondary consequences of SCI should address concerns with spasticity, pain, incontinence, and side effects of medications. Psychosocial issues must be addressed as possible contributors to sexual dysfunctions (eg, lower self-esteem, past sexual history, depression, dating habits). Pregnancy is possible for women with SCI; younger age at the time of injury and at the time of pregnancy being significant predictors of successful pregnancy, along with marital status, motor score, mobility, and occupational scores. Pregnancy may decrease the level of functioning (eg, self-care, ambulation, upper-extremity tasks), may involve complications (eg, decubitus ulcers, weight gain, urological complications), and must be monitored for postural hypotension and autonomic dysreflexia. Taking into consideration the physical and psychosocial determinants of sexuality and childbearing allows women with SCI to achieve positive sexual and reproductive health.
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Affiliation(s)
- Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Montreal, Canada
- Institut de réadaptation Gingras Lindsay de Montréal, Montreal, Canada
| | - Marcalee Alexander
- Department of Rehabilitative Medicine, Birmingham VA Medical Center, Birmingham, Alabama
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham
- Department of Physical Medicine and Rehabilitation, Harvard School of Medicine, Boston, Massachusetts
| | - Amie B. (Jackson) McLain
- Department of Physical Medicine and Rehabilitation, University of Alabama School of Medicine, Birmingham, Alabama
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Abstract
Delayed ejaculation (DE) is an uncommon and a challenging disorder to treat. It is often quite concerning to patients and it can affect psychosocial well-being. Here we reviewed how DE is treated pharmacologically .We also highlighted specific settings where drugs could be introduced to medical practice. Electronic databases were searched from 1966 to February 2016, including PubMed MEDLINE, EMBASE, EBCSO Academic Search Complete, Cochrane Systematic Reviews Database, and Google Scholar using key words; delayed ejaculation, retarded ejaculation, inhibited ejaculation, drugs, treatment, or pharmacology. To achieve the maximum sensitivity of the search strategy and to identify all studies, we combined “delayed ejaculation” as Medical Subject Headings (MeSH) terms or keywords with each of “testosterone” or “cabergoline” or “bupropion” or “amantadine” or “cyproheptadine” or “midodrine” or “imipramine” or “ephedrine” or “pseudoephedrine” or “yohimbine” or “buspirone” or “oxytocin” or “bethanechol” as MeSH terms or keywords. There are a number of drugs to treat patients with DE including: testosterone, cabergoline, bupropion, amantadine, cyproheptadine, midodrine, imipramine, ephedrine, pseudoephedrine, yohimbine, buspirone, oxytocin, and bethanechol. Although there are many pharmacological treatment options, the evidence is still limited to small trials, case series or case reports. Review of literature showed that evidence level 1 (Double blind randomized clinical trial) studies were performed with testosterone, oxytocin, buspirone or bethanechol treatment. It is concluded that successful drug treatment of DE is still in its infancy. The clinicians need to be aware of the pathogenesis of DE and the pharmacological basis underlying the use of different drugs to extend better care for these patients. Various drugs are available to address such problem, however their evidence of efficacy is still limited and their choice needs to be individualized to each specific case.
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Affiliation(s)
| | | | - Taymour Mostafa
- Department of Andrology & Sexology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
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Davidson R, Elliott S, Krassioukov A. Cardiovascular Responses to Sexual Activity in Able-Bodied Individuals and Those Living with Spinal Cord Injury. J Neurotrauma 2016; 33:2161-2174. [PMID: 27243099 DOI: 10.1089/neu.2015.4143] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Sexuality is an integral part of the human experience and persists in health and disability. The cardiovascular system is crucial to sexual function and can be affected profoundly by spinal cord injury (SCI). The effects of sexual activity on the cardiovascular system in SCI have not been summarized and compared with sexual activity in able-bodied individuals. A keyword search of Embase, PubMed, and Medline was conducted. From 471 retrieved studies for able-bodied individuals, 11 were included that met the strict criteria of medically uncomplicated participants. In the SCI literature, 117 studies were screened, with 18 meeting criteria. In able-bodied persons, sexual activity resulted in modest increases in systolic blood pressure peaking at orgasm (males of 163 mm Hg and females of 142 mm Hg) and returning to baseline shortly afterward. In persons with SCI, results varied from minimal changes to significant elevations in systolic blood pressure because of episodes of autonomic dysreflexia, especially in those with high thoracic and cervical lesions. Peak systolic blood pressure in these individuals was measured to be as high as 325 mm Hg. In the SCI population, more intense stimuli (including penile vibrostimulation and electroejaculation) tended to result in a greater increase in systolic blood pressure compared with self-stimulation. Studies that used continuous versus intermittent monitoring were more likely to report greater changes in systolic blood pressure. In able-bodied persons, sexual activity results in modest increases in blood pressure. In those with SCI, intense stimulation and higher injury levels result in a higher likelihood of autonomic dysreflexia and elevated blood pressure. Because of rapid changes in blood pressure, continuous monitoring is more advantageous than intermittent measurement, because the latter may miss peak values.
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Affiliation(s)
- Ross Davidson
- 1 Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,2 International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Stacy Elliott
- 1 Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,3 Faculty of Medicine, Department of Psychiatry, University of British Columbia , Vancouver, British Columbia, Canada .,4 Vancouver Coastal Health , GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
| | - Andrei Krassioukov
- 1 Faculty of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,2 International Collaboration on Repair Discoveries (ICORD), Department of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,4 Vancouver Coastal Health , GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada
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Fode M, Ohl DA, Sønksen J. A step-wise approach to sperm retrieval in men with neurogenic anejaculation. Nat Rev Urol 2015; 12:607-16. [PMID: 26481575 DOI: 10.1038/nrurol.2015.241] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Normal fertility is dependent on intravaginal delivery of semen through ejaculation. This process is highly dependent on an intact ejaculatory reflex arc, which can be disrupted through any type of trauma or disease causing damage to the CNS and/or peripheral nerves. Neurogenic anejaculation is most commonly associated with spinal cord injury. This aetiology is especially relevant because most men with spinal cord injuries are injured at reproductive age. Assisted ejaculation in the form of penile vibratory stimulation is the first choice for sperm retrieval in such patients because it is noninvasive and inexpensive. In patients in whom vibratory stimulation fails, electroejaculation is almost always successful. When both methods of assisted ejaculation are unsuccessful, sperm retrieval by aspiration from either the vas deferens or the epididymis, or by testicular biopsy or surgery are reasonable options. In such cases the most inexpensive and least invasive methods should be considered first. The obtained semen can be used for intravaginal or intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Roskilde Hospital, Koegevej 7-13, DK-4000 Roskilde, Denmark
| | - Dana A Ohl
- Department of Urology, University of Michigan, 1500 East Medical Center Drive, Box 0330, Ann Arbor, MI 48108, USA
| | - Jens Sønksen
- Department of Urology, Herlev Hospital, University of Copenhagen, Herlev Ringvej 75, DK-2730 Herlev, Denmark
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Abstract
Many aspects of fertility rely on intact neurologic function and thus neurologic diseases can result in infertility. While research into general female fertility and alterations in male semen quality is limited, we have an abundance of knowledge regarding ejaculatory dysfunction following nerve injury. Normal ejaculation is the result of coordinated reflex activity involving both the sympathetic and somatic nervous systems. Nerve injury can result in retrograde ejaculation, and anejaculation. With retrograde ejaculation, the ejaculate is propelled into the bladder instead of out through the urethra. In mild cases this condition can be reversed by sympathomimetic medications and, in more severe cases, sperm cells can be extracted from the bladder following ejaculation. With anejaculation, the ejaculatory reflex is not activated by normal sexual stimulation. In such cases, the first choice of treatment is assisted ejaculation, preferably by penile vibratory stimulation. If vibratory stimulation is unsuccessful, then ejaculation can almost always be induced by electroejaculation. In cases where assisted ejaculation fails, sperm can be retrieved surgically from either the epididymis or from the testis. Once viable sperm cells have been obtained, these are used in assisted reproductive techniques, including intravaginal insemination, intrauterine insemination, and in vitro fertilization/intracytoplasmic sperm injection.
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Abstract
Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.
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Affiliation(s)
- Shaoping Hou
- Spinal Cord Research Center, Department of Neurobiology & Anatomy, Drexel University College of Medicine, Philadelphia, Pennsylvania
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Leduc BE, Fournier C, Jacquemin G, Lepage Y, Vinet B, Hétu PO, Chagnon M. Midodrine in patients with spinal cord injury and anejaculation: A double-blind randomized placebo-controlled pilot study. J Spinal Cord Med 2015; 38:57-62. [PMID: 24969635 PMCID: PMC4293534 DOI: 10.1179/2045772314y.0000000225] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE The objective of this study is to evaluate the efficacy of midodrine in the treatment of anejaculation in men with spinal cord injury (SCI). STUDY DESIGN Prospective, double-blind, randomized, placebo-controlled pilot study. METHOD Men with anejaculation associated with SCI (level of injury above T10) of more than 1 year in duration were approached. Those with no ejaculatory response to one penile vibratory stimulation (PVS) trial were assigned in a double-blind manner to one of the two following interventions once a week for a maximum of 3 weeks or until ejaculation occurred: oral administration of flexible midodrine (7.5-22.5 mg max) followed by PVS (group M), or oral administration of flexible sham-midodrine (placebo) followed by PVS (group P). Sociodemographic data, medical characteristics, and plasma desglymidodrine concentration were collected for all participants. OUTCOME MEASURE Ejaculation success rate in each group. RESULTS Among the 78 men approached, 23 participants (level of SCI: C4-T9) were randomized. Three participants abandoned the study and 20 completed the study; 10 were assigned to group M, 10 to group P. Ejaculation was reached for one participant of group M and for two participants of group P. Autonomic dysreflexia associated to PVS occurred in three patients. CONCLUSION In this small sample study, treatment of anejaculation after SCI with midodrine and PVS did not result in a better rate of antegrade ejaculation in 10 men than in 10 men treated with a placebo and PVS.
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Affiliation(s)
- Bernard E. Leduc
- Department of Rehabilitation Medicine, Institut de réadaptation Gingras-Lindsay-de Montréal, Montréal, Canada,Correspondence to: Bernard E. Leduc, Department of Rehabilitation Medicine, Institut de réadaptation Gingras-Lindsay-de Montréal, 6300 Darlington Avenue, Montreal, QC, Canada H3S 2J4.
| | - Christine Fournier
- Department of Rehabilitation Medicine, Institut de réadaptation Gingras-Lindsay-de Montréal, Montréal, Canada
| | - Géraldine Jacquemin
- Department of Rehabilitation Medicine, Institut de réadaptation Gingras-Lindsay-de Montréal, Montréal, Canada
| | - Yves Lepage
- Department of Mathematics and Statistics, Université de Montréal, Montréal, Canada
| | - Bernard Vinet
- Department of Biochemistry, Hôpital Notre-Dame du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Pierre-Olivier Hétu
- Department of Biochemistry, Hôpital Notre-Dame du Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Miguel Chagnon
- Department of Mathematics and Statistics, Université de Montréal, Montréal, Canada
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Courtois F, Charvier K. Sexual dysfunction in patients with spinal cord lesions. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:225-45. [PMID: 26003247 DOI: 10.1016/b978-0-444-63247-0.00013-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Many aspects of sexuality can be disrupted following a spinal cord lesion (SCL). It can alter an individual's self-esteem and body image, interfere with positioning and mobility, introduce unexpected problems with incontinence and spasticity, decrease pleasure, and delay orgasm. Sexual concerns in men can involve erectile function, essential for intercourse, ejaculation function, necessary for fertility, and the ability to reach orgasm. In women they can involve concerns with vaginal lubrication, genital congestion, and vaginal infections, which can all go unnoticed, and orgasm, which may be lost. All of these concerns must be addressed during rehabilitation as individuals with SCL continue to live an active sexual life, and consider sexuality among their top priority for quality of life. This chapter describes the impact of SCL on various phases of men's and women's sexual responses and on various aspects of sexuality. Treatments are described in terms of what is currently available and what is specific to the SCL population. New approaches in particular for women are described, along with tips from sexual counseling which consider an overall approach, taking into account the primary, secondary, and tertiary consequences of the SCL on the individual's sexuality. Throughout the chapter, attempts are made to integrate neurophysiologic knowledge, findings from the literature on SCL, and clinical experience in sexual rehabilitation.
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Affiliation(s)
- Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, Quebec, Canada.
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Guertin PA. Preclinical evidence supporting the clinical development of central pattern generator-modulating therapies for chronic spinal cord-injured patients. Front Hum Neurosci 2014; 8:272. [PMID: 24910602 PMCID: PMC4038974 DOI: 10.3389/fnhum.2014.00272] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/11/2014] [Indexed: 12/14/2022] Open
Abstract
Ambulation or walking is one of the main gaits of locomotion. In terrestrial animals, it may be defined as a series of rhythmic and bilaterally coordinated movement of the limbs which creates a forward movement of the body. This applies regardless of the number of limbs-from arthropods with six or more limbs to bipedal primates. These fundamental similarities among species may explain why comparable neural systems and cellular properties have been found, thus far, to control in similar ways locomotor rhythm generation in most animal models. The aim of this article is to provide a comprehensive review of the known structural and functional features associated with central nervous system (CNS) networks that are involved in the control of ambulation and other stereotyped motor patterns-specifically Central Pattern Generators (CPGs) that produce basic rhythmic patterned outputs for locomotion, micturition, ejaculation, and defecation. Although there is compelling evidence of their existence in humans, CPGs have been most studied in reduced models including in vitro isolated preparations, genetically-engineered mice and spinal cord-transected animals. Compared with other structures of the CNS, the spinal cord is generally considered as being well-preserved phylogenetically. As such, most animal models of spinal cord-injured (SCI) should be considered as valuable tools for the development of novel pharmacological strategies aimed at modulating spinal activity and restoring corresponding functions in chronic SCI patients.
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Affiliation(s)
- Pierre A. Guertin
- Department of Psychiatry and Neurosciences, Laval UniversityQuebec City, QC, Canada
- Spinal Cord Injury and Functional Recovery Laboratory, Laval University Medical Center (CHU de Quebec)Quebec City, QC, Canada
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Cramp J, Courtois F, Connolly M, Cosby J, Ditor D. The Impact of Urinary Incontinence on Sexual Function and Sexual Satisfaction in Women with Spinal Cord Injury. SEXUALITY AND DISABILITY 2014. [DOI: 10.1007/s11195-014-9354-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Anatomie et physiologie de la sexualité. Prog Urol 2013; 23:547-61. [DOI: 10.1016/j.purol.2012.11.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/16/2012] [Indexed: 01/08/2023]
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Courtois F, Rodrigue X, Côté I, Boulet M, Vézina JG, Charvier K, Dahan V. Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat? Spinal Cord 2012; 50:869-77. [PMID: 22869221 DOI: 10.1038/sc.2012.83] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES Review the literature on the acute or prophylactic treatment of autonomic dysreflexia in the context of sexual activities. SETTING International. METHODS Medline search using AD and spinal cord injury and all years of publication. RESULTS Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. CONCLUSION Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.
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Affiliation(s)
- F Courtois
- Outpatient Clinic, Institut de Réadaptation en Déficience Physique de Québec, Quebec, Quebec, Canada.
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Abstract
Ejaculatory dysfunction is a highly prevalent clinical condition that may be classified along a continuum that ranges from premature ejaculation (PE), through retarded or delayed ejaculation (DE), to complete anejaculation (AE). Retrograde ejaculation (RE) represents a distinct entity in which ejaculate is expelled either partially or completely into the bladder. While DE and PE are significant sources of sexual dissatisfaction among men and their partners, patients with these disorders retain normal fertility in most cases. Conversely, men with AE and RE are unable to deliver sperm into the female genital tract and are therefore rendered subfertile. Therefore, in reviewing ejaculatory disorders as they relate to fertility, this paper will primarily focus on the diagnosis and management of AE and RE. Physiology, diagnostic strategies, pharmacological treatments, and procedural interventions relevant to AE and RE are discussed.
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Fode M, Krogh-Jespersen S, Brackett NL, Ohl DA, Lynne CM, Sønksen J. Male sexual dysfunction and infertility associated with neurological disorders. Asian J Androl 2011; 14:61-8. [PMID: 22138899 DOI: 10.1038/aja.2011.70] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.
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Affiliation(s)
- Mikkel Fode
- Department of Urology, Herlev Hospital, University of Copenhagen, Denmark
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Caremel R, Courtois F, Charvier K, Ruffion A, Journel NM. Side effects of intradetrusor botulinum toxin injections on ejaculation and fertility in men with spinal cord injury: preliminary findings. BJU Int 2011; 109:1698-702. [DOI: 10.1111/j.1464-410x.2011.10639.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Courtois F, Charvier K, Vézina JG, Morel Journel N, Carrier S, Jacquemin G, Côté I. Assessing and conceptualizing orgasm after a spinal cord injury. BJU Int 2011; 108:1624-33. [DOI: 10.1111/j.1464-410x.2011.10168.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Wecht JM, Rosado-Rivera D, Handrakis JP, Radulovic M, Bauman WA. Effects of Midodrine Hydrochloride on Blood Pressure and Cerebral Blood Flow During Orthostasis in Persons With Chronic Tetraplegia. Arch Phys Med Rehabil 2010; 91:1429-35. [DOI: 10.1016/j.apmr.2010.06.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 06/15/2010] [Accepted: 06/23/2010] [Indexed: 12/01/2022]
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Guertin PA, Steuer I. Key central pattern generators of the spinal cord. J Neurosci Res 2009; 87:2399-405. [DOI: 10.1002/jnr.22067] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Safarinejad MR. Midodrine for the treatment of organic anejaculation but not spinal cord injury: a prospective randomized placebo-controlled double-blind clinical study. Int J Impot Res 2009; 21:213-20. [PMID: 19474795 DOI: 10.1038/ijir.2009.19] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 04/28/2009] [Accepted: 04/30/2009] [Indexed: 11/09/2022]
Abstract
Anejaculation is a rare cause of infertility and adversely affects the general sense of well-being and perception of sexual life satisfaction. Evidence to support effective and noninvasive treatment for this ejaculatory disorder is lacking. This study aimed to evaluate the efficacy and safety of midodrine (alpha(1)-adrenergic receptor agonist) for the treatment of organic anejaculation but not spinal cord injury (SCI). A total of 128 patients were randomly assigned to oral midodrine 7.5-15 mg per day in a stepwise approach (group 1, n=64), or a similar regimen of placebo (group 2, n=64). They underwent a complete physical examination, echocardiography, 12-lead electrocardiogram, transrectal ultrasonography, complete blood count and blood chemistry. Hormonal assays included serum levels of luteinizing hormone, follicle-stimulating hormone, prolactin and testosterone. To rule out other sexual dysfunction, patients also completed the International Index of Erectile Function questionnaire. Psychiatric disorders were excluded by appropriate tests. Outcome measure was reversal of the anejaculation. None of the patients in the placebo group achieved antegrade or retrograde ejaculation. At the end of study, antegrade, retrograde and antegrade+retrograde ejaculation occurred in 18 (29.5%), 8 (13.1%) and 9 (14.8%) patients in midodrine group, respectively (all P=0.01). The most and least favorable responses were among patients with multiple sclerosis and bilateral sympathectomy, respectively. Midodrine improved ejaculation function in a dose-dependent manner. Four participants (6.3%) in midodrine group discontinued this study for reasons of adverse events. In patients with organic anejaculation but without SCI midodrine can reverse anejaculation in more than 50% of patients. Further studies are needed, however, for the evaluation of different treatment regimens in anejaculation therapy.
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Affiliation(s)
- M R Safarinejad
- Department of Urology, Urology and Nephrology Research Center, Shahid Beheshti University (MC), Tehran, Iran.
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Courtois F, Charvier K, Leriche A, Vézina JG, Jacquemin G. Réactions sexuelles et orgasme chez le patient traumatisé médullaire : un modèle de rééducation/réadaptation. SEXOLOGIES 2009. [DOI: 10.1016/j.sexol.2009.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Courtois F, Charvier K, Leriche A, Vézina JG, Jacquemin G. Sexual and climactic responses in men with traumatic spinal injury: A model for rehabilitation. SEXOLOGIES 2009. [DOI: 10.1016/j.sexol.2009.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Soler JM, Previnaire JG, Plante P, Denys P, Chartier‐Kastler E. Midodrine Improves Orgasm in Spinal Cord‐Injured Men: The Effects of Autonomic Stimulation. J Sex Med 2008; 5:2935-41. [DOI: 10.1111/j.1743-6109.2008.00844.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Guertin PA. A technological platform to optimize combinatorial treatment design and discovery for chronic spinal cord injury. J Neurosci Res 2008; 86:3039-51. [DOI: 10.1002/jnr.21761] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Sensations éjaculatoires chez l’homme paraplégique et tétraplégique durant la stimulation par vibromassage avec et sans Gutron®. ACTA ACUST UNITED AC 2008. [DOI: 10.1007/s11608-008-0192-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Inskip JA, Ramer LM, Ramer MS, Krassioukov AV. Autonomic assessment of animals with spinal cord injury: tools, techniques and translation. Spinal Cord 2008; 47:2-35. [DOI: 10.1038/sc.2008.61] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Courtois F, Charvier K, Leriche A, Vézina JG, Côté I, Raymond D, Jacquemin G, Fournier C, Bélanger M. Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men. J Sex Med 2008; 5:2419-30. [PMID: 18466272 DOI: 10.1111/j.1743-6109.2008.00857.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION With the advances in penile vibrator stimulation (PVS), most spinal cord injured (SCI) men can self-ejaculate. Oral midodrine may further increase ejaculation success, while maintaining autonomy. Since most SCI men attempt ejaculation for sexual rather than reproductive purposes, self-ejaculation should be emphasized and sensations explored. AIMS Explore (i) self-ejaculation success rate in SCI men; (ii) vascular parameters indicative of autonomic dysreflexia (AD) during sexual stimulation and ejaculation; and (iii) sensations associated with ejaculation. METHODS Ejaculation was assessed on 81 SCI men with complete ASIA A (49%) and incomplete B to D lesions (51%), subdivided into tetraplegics (C2-T2), paraplegics sensitive to AD (T3-T6), paraplegics not sensitive to AD (T7-T10), paraplegics with lesions to the emission pathway (T11-L2), and paraplegics with lesions interrupting the emission-ejaculation pathways (L3-below). Natural stimulation was attempted first followed, if negative, by PVS followed, if again negative, by PVS combined with oral midodrine (5-25 mg). MAIN OUTCOME MEASURES Ejaculation success, systolic and diastolic blood pressure, and perceived physiological and orgasmic sensations. RESULTS Overall 91% reached ejaculation, 30% with natural stimulation, 49% with PVS and 12% with midodrine plus PVS. Midodrine salvaged up to 27% depending upon the lesion. Physiological and orgasmic sensations were perceived significantly more at ejaculation than sexual stimulation. Tetraplegics did not differ from paraplegics sensitive to AD on perceived cardiovascular and muscular sensations, but perceived significantly more autonomic sensations, and generally more physiological sensations than lower lesions unsensitive to AD. CONCLUSION Most SCI men can self-ejaculate and perceive physiological and orgasmic sensations. The climactic experience of ejaculation seems related to AD, few sensations being reported when AD is not reached, pleasurable climactic sensations being reported when mild to moderate AD is reached, and unpleasant or painful sensations reported with severe AD. Sexual rehabilitation should emphasize self-ejaculation and self-exploration and consider cognitive reframing to maximize sexual perceptions.
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Affiliation(s)
- Frédérique Courtois
- Departement of Sexology, Université du Québec à Montréal, Québec, Montreal, Quebec, Canada.
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