1
|
Zizzo J, Gater DR, Hough S, Ibrahim E. Sexuality, Intimacy, and Reproductive Health after Spinal Cord Injury. J Pers Med 2022; 12:jpm12121985. [PMID: 36556205 PMCID: PMC9781084 DOI: 10.3390/jpm12121985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/04/2022] Open
Abstract
Spinal cord injury (SCI) is a life-altering event often accompanied by a host of anxiety-provoking questions and concerns in the minds of affected individuals. Questions regarding the ability to resume sexual activity, partner's satisfaction as well as the ability to have biological children are just a few of the unknowns facing patients following the devastating reality that is SCI. As a result of advances in SCI research over the last few decades, providers now have the knowledge and tools to address many of these concerns in an evidence-based and patient-centered approach. SCI can impair multiple components involved in sexual function, including libido, achieving and maintaining an erection, ejaculation, and orgasm. Many safe and effective fertility treatments are available to couples affected by SCI. Finally, learning to redefine one's self-image, reinforce confidence and self-esteem, and feel comfortable communicating are equally as important as understanding functionality in regaining quality of life after SCI. Thus, this review aims to highlight the current state of SCI research relating to sexual function, reproductive health, and the search for meaning.
Collapse
Affiliation(s)
- John Zizzo
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine & Rehabilitation, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Sigmund Hough
- Department of Psychiatry, Harvard Medical School, Harvard University, Boston, MA 02215, USA
- Department of Psychiatry, Boston University School of Medicine, Boston University, Boston, MA 02118, USA
| | - Emad Ibrahim
- Desai Sethi Urology Institute, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Correspondence:
| |
Collapse
|
2
|
Pathophysiology, Classification and Comorbidities after Traumatic Spinal Cord Injury. J Pers Med 2022; 12:jpm12071126. [PMID: 35887623 PMCID: PMC9323191 DOI: 10.3390/jpm12071126] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/25/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a spinal cord injury (SCI), supraspinal influences on the spinal segmental control system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, pain and dysesthesia, sympathetic blunting and parasympathetic dominance resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of traumatic SCI, current and emerging methods of classification, and its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue.
Collapse
|
3
|
Balik V, Šulla I. Autonomic Dysreflexia following Spinal Cord Injury. Asian J Neurosurg 2022; 17:165-172. [PMID: 36120615 PMCID: PMC9473833 DOI: 10.1055/s-0042-1751080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
AbstractAutonomic dysreflexia (AD) is a potentially life-threatening condition of the autonomic nervous system following spinal cord injury at or above T6. One of the most common symptoms is a sudden increase in blood pressure induced by afferent sensory stimulation owing to unmodulated reflex sympathetic hyperactivity. Such episodes of high blood pressure might be associated with a high risk of cerebral or retinal hemorrhage, seizures, heart failure, or pulmonary edema. In-depth knowledge is, therefore, crucial for the proper management of the AD, especially for spine surgeons, who encounter these patients quite often in their clinical practice. Systematical review of the literature dealing with strategies to prevent and manage this challenging condition was done by two independent reviewers. Studies that failed to assess primary (prevention, treatment strategies and management) and secondary outcomes (clinical symptomatology, presentation) were excluded. A bibliographical search revealed 85 eligible studies that provide a variety of preventive and treatment measures for the subjects affected by AD. As these measures are predominantly based on noncontrolled trials, long-term prospectively controlled multicenter studies are warranted to validate these preventive and therapeutic proposals.
Collapse
Affiliation(s)
- Vladimír Balik
- Department of Neurosurgery, Svet Zdravia Hospital, Michalovce, Slovakia
| | - Igor Šulla
- Department of Anatomy, University of Veterinary Medicine and Pharmacy, Histology and Physiology, Košice, Slovakia
| |
Collapse
|
4
|
Male Sexual Dysfunction and Infertility in Spinal Cord Injury Patients: State-of-the-Art and Future Perspectives. J Pers Med 2022; 12:jpm12060873. [PMID: 35743658 PMCID: PMC9225464 DOI: 10.3390/jpm12060873] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/16/2022] [Accepted: 05/24/2022] [Indexed: 01/27/2023] Open
Abstract
Spinal cord injury (SCI) is a relevant medical and social problem. According to the World Health Organization, the commonly estimated worldwide annual incidence of SCI is 40 to 80 cases per million population. After the SCI experience, most men present with sexual dysfunction (erectile dysfunction (ED) and ejaculatory dysfunction), fertility problems (such as impaired spermatogenesis, abnormalities in sperm viability, motility, and morphology), and systemic disorders such as genitourinary infection and endocrine imbalances. The best options available for managing the ejaculatory disorders in patients suffering from SCI are penile vibratory stimulation (PVS) and electroejaculation (EEJ). Furthermore, the treatment of ED in SCI patients consists of medical therapies including phosphodiesterase 5 inhibitors (PDE5i), intracavernosal injections (ICI), vacuum erection devices (VEDs), and surgical as penile prosthesis (PP). This review provides a snapshot of the current evidence for the mechanisms of sexual dysfunction and infertility in SCI patients, discusses the best management strategies for these conditions, and offers our perspective on the direction of future research.
Collapse
|
5
|
Abed M, Raeisi Z, Rezaei-Jamalouei H, Ansari Shahidi M. Promoting sexual self-efficacy of men with spinal cord injury using PLISSIT model. PSYCHOLOGY & SEXUALITY 2022. [DOI: 10.1080/19419899.2020.1789893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Mohammadreza Abed
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | - Zohreh Raeisi
- Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran
| | | | | |
Collapse
|
6
|
Ibrahim E, Brackett NL, Lynne CM. Penile Vibratory Stimulation for Semen Retrieval in Men with Spinal Cord Injury: Patient Perspectives. Res Rep Urol 2022; 14:149-157. [PMID: 35480782 PMCID: PMC9037179 DOI: 10.2147/rru.s278797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022] Open
Abstract
Spinal cord injury (SCI) is a catastrophic event with sequelae that are not often apparent. For the spinal cord injured man, the inability to become a biologic father because of reproductive dysfunction becomes a major negative factor in his self-esteem and a hindrance to his social rehabilitation. Approximately, 90% of men with SCI develop ejaculatory dysfunction and only 10% can ejaculate by masturbation or during sexual activity. It is only over the last 40 years that it has been possible to properly study and understand the various factors contributing to the problem. Advances have been made in governmental and societal attitudes that have led to improvements in the treatment and rehabilitation of persons with SCI and other disabilities. It is now possible to retrieve sperm reliably and safely from men with SCI. Although their semen quality is often impaired, there is a very reasonable chance for achieving biologic fatherhood using assisted reproductive techniques. Penile vibratory stimulation (PVS) is a safe, reliable, efficient, and cost-effective, method of sperm retrieval that will produce an ejaculate in up to 86% of the patients with a level of injury T10 or rostral, which accounts for approximately 80% of the SCI population. Some motile sperm will be present in 90% of these ejaculates. In approximately 75% of the ejaculates, there will be greater than 5 million motile sperm, allowing a couple to explore all the options available to a couple seeking help in conceiving a child. The Male Fertility Program of the Miami Project to Cure Paralysis is at the leading edge of basic and clinical research contributing to the management of infertility in men with SCI. This review will outline “how we got there” enabling us to recommend PVS as the first choice in assisting men with SCI to become biologic parents.
Collapse
Affiliation(s)
- Emad Ibrahim
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
- Correspondence: Emad Ibrahim, The Desai Sethi Urology Institute/The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, 1611 NW 12th Ave, 2nd floor, Rm 2.147, Miami, FL33136, USA, Tel +1 305 243 9083, Fax +1 305 243 3913, Email
| | - Nancy L Brackett
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Charles M Lynne
- The Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
7
|
Alisseril S, Prakash NB, Chandy BR, Tharion G. Clinical Predictors of Vibrator-Assisted Ejaculation following Spinal Cord Injury: A Prospective Observational Study. J Neurosci Rural Pract 2021; 12:758-763. [PMID: 34737512 PMCID: PMC8558968 DOI: 10.1055/s-0041-1735819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Introduction Infertility in men with spinal cord injury (SCI) occurs due to combination of factors like erectile dysfunction, ejaculatory failure, and semen abnormalities. Penile vibratory stimulation (PVS) is a known method of treatment for anejaculation. Predicting successful outcome of PVS depends on several clinical factors, which assess the intactness of the neural arc pertaining to the spinal ejaculation pattern generator. This study reports the clinical predictors for successful candidacy for a PVS trial in males with SCI. Methods Twenty-three males with SCI, satisfying the inclusion criteria, were recruited in this prospective observational study. Participants underwent two trials of PVS with single high-amplitude vibrator. The clinical predictors recorded were neurological level, superficial abdominal reflex, cremasteric reflex, bulbocavernosus reflex, plantar reflex, ankle jerk, knee jerk, lower abdominal sensation, and hip flexor response. In addition, somatic responses during PVS were recorded and corelated. Participants who had successful ejaculation were "responders" and the others were termed as "nonresponders." Binary logistic regression analysis of the clinical parameters was done to compare responders against nonresponders. Results Of the twenty-three males (mean age 33.2 ± 6.8 years) with paraplegia, all four persons with neurological level above T9 had successful ejaculation with PVS. Among all the clinical parameters in the study, presence of somatic responses showed statistical significance in predicting successful ejaculation ( p -value = 0.02). Conclusion This study reports that in men with SCI, along with the level of injury, somatic responses and other clinical reflexes, should be considered concurrently to predict the outcome of vibrator assisted ejaculation.
Collapse
Affiliation(s)
- Sivaram Alisseril
- Department of Physical Medicine and Rehabilitation, TD Medical College, Alappuzha, Kerala, India
| | - Navin B Prakash
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurological Sciences, Bengaluru, Karnataka, India
| | - Bobeena Rachel Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| |
Collapse
|
8
|
Krassioukov A, Linsenmeyer TA, Beck LA, Elliott S, Gorman P, Kirshblum S, Vogel L, Wecht J, Clay S. [Formula: see text] [Formula: see text] [Formula: see text] [Formula: see text]Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows. J Spinal Cord Med 2021; 44:631-683. [PMID: 34270391 PMCID: PMC8288133 DOI: 10.1080/10790268.2021.1925058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Affiliation(s)
- Andrei Krassioukov
- University of British Columbia, Vancouver, British Columbia, BC
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, BC, Canada
| | - Todd A Linsenmeyer
- Kessler Institute for Rehabilitation, West Orange, NJ
- Rutgers University Medical School, Newark, NJ
| | | | - Stacy Elliott
- University of British Columbia, Vancouver, British Columbia, BC
| | | | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, NJ
- Rutgers University Medical School, Newark, NJ
| | | | - Jill Wecht
- Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sarah Clay
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| |
Collapse
|
9
|
Wiggins JW, Sledd JE, Coolen LM. Spinal Cord Injury Causes Reduction of Galanin and Gastrin Releasing Peptide mRNA Expression in the Spinal Ejaculation Generator of Male Rats. Front Neurol 2021; 12:670536. [PMID: 34239493 PMCID: PMC8258150 DOI: 10.3389/fneur.2021.670536] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 05/21/2021] [Indexed: 01/23/2023] Open
Abstract
Spinal cord injury (SCI) in men is commonly associated with sexual dysfunction, including anejaculation, and chronic mid-thoracic contusion injury in male rats also impairs ejaculatory reflexes. Ejaculation is controlled by a spinal ejaculation generator consisting of a population of lumbar spinothalamic (LSt) neurons that control ejaculation through release of four neuropeptides including galanin and gastrin releasing peptide (GRP) onto lumbar and sacral autonomic and motor nuclei. It was recently demonstrated that spinal contusion injury in male rats caused reduction of GRP-immunoreactivity, but not galanin-immunoreactivity in LSt cells, indicative of reduced GRP peptide levels, but inconclusive results for galanin. The current study further tests the hypothesis that contusion injury causes a disruption of GRP and galanin mRNA in LSt cells. Male rats received mid-thoracic contusion injury and galanin and GRP mRNA were visualized 8 weeks later in the lumbar spinal cord using fluorescent in situ hybridization. Spinal cord injury significantly reduced GRP and galanin mRNA in LSt cells. Galanin expression was higher in LSt cells compared to GRP. However, expression of the two transcripts were positively correlated in LSt cells in both sham and SCI animals, suggesting that expression for the two neuropeptides may be co-regulated. Immunofluorescent visualization of galanin and GRP peptides demonstrated a significant reduction in GRP-immunoreactivity, but not galanin in LSt cells, confirming the previous observations. In conclusion, SCI reduced GRP and galanin expression in LSt cells with an apparent greater impact on GRP peptide levels. GRP and galanin are both essential for triggering ejaculation and thus such reduction may contribute to ejaculatory dysfunction following SCI in rats.
Collapse
Affiliation(s)
- James W Wiggins
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States.,Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jonathan E Sledd
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lique M Coolen
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, MS, United States.,Department of Biological Sciences, Kent State University, Kent, OH, United States
| |
Collapse
|
10
|
Dewitte M, Reisman Y. Clinical use and implications of sexual devices and sexually explicit media. Nat Rev Urol 2021; 18:359-377. [PMID: 33948009 DOI: 10.1038/s41585-021-00456-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2021] [Indexed: 12/14/2022]
Abstract
Given that sexual pleasure is a core component of sexual health, devices that are designed to enhance and diversify sexual pleasure are particularly useful in clinical practice. Despite their growing popularity and widespread use in various biopsychosocial circumstances, many taboos still seem to exist, as indicated by the paucity of scientific literature on the prevalence, application and effectiveness of sexual devices for therapeutic use. However, sex toys and sexual devices are commonly used and have a variety of indications to expand individual and partnered sexuality and to treat sexual difficulties. Different devices are associated with specific advantages and potential risks, opportunities, barriers and ethical challenges when used in a clinical context. Increased knowledge about the aim and functional possibilities of sexual devices might help health-care professionals overcome potential embarrassment, preconceptions and other barriers, learn which patients might benefit from which products, consider their use in treatment programmes, educate about correct use and safety issues, and facilitate open communication about sexual pleasure with their patients.
Collapse
Affiliation(s)
- Marieke Dewitte
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands.
| | | |
Collapse
|
11
|
Krassioukov A, Linsenmeyer TA, Beck LA, Elliott S, Gorman P, Kirshblum S, Vogel L, Wecht J, Clay S. Evaluation and Management of Autonomic Dysreflexia and Other Autonomic Dysfunctions: Preventing the Highs and Lows: Management of Blood Pressure, Sweating, and Temperature Dysfunction. Top Spinal Cord Inj Rehabil 2021; 27:225-290. [PMID: 34108837 PMCID: PMC8152175 DOI: 10.46292/sci2702-225] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | | | | | - Stacy Elliott
- University of British Columbia, Vancouver, British Columbia, CA
| | | | | | | | - Jill Wecht
- Icahn School of Medicine at Mt Sinai, New York, NY
| | - Sarah Clay
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| |
Collapse
|
12
|
Sexual Health in the Neurogenic Patient. CURRENT BLADDER DYSFUNCTION REPORTS 2020. [DOI: 10.1007/s11884-020-00605-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
13
|
Ali A, Ibrahim E. Sexual Dysfunction After Spinal Cord Injury. CURRENT SEXUAL HEALTH REPORTS 2020. [DOI: 10.1007/s11930-020-00296-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Keren D, Kelly M. Successful conception using home intravaginal insemination following spinal cord injury in a man. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:665-668. [PMID: 32933980 PMCID: PMC7491664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Daniela Keren
- Family medicine resident in the Schulich School of Medicine & Dentistry at Western University in London, Ont.
| | - Martina Kelly
- Associate Professor in the Department of Family Medicine in the Cumming School of Medicine at the University of Calgary in Alberta
| |
Collapse
|
15
|
Ibrahim E, Jensen CFS, Sunara I, Khodamoradi K, Aballa TC, Elliott S, Sonksen J, Ohl DA, Hultling C, Lynne CM, Seager SWJ, Brackett NL. Evaluation of a re-engineered device for penile vibratory stimulation in men with spinal cord injury. Spinal Cord 2020; 59:151-158. [PMID: 32665708 DOI: 10.1038/s41393-020-0515-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Cohort study OBJECTIVES: The purpose of this study was to evaluate the performance of a re-engineered device (Ferticare 2.0), which is replacing the previous standard (Ferticare 1.0) for penile vibratory stimulation in men with spinal cord injury. Most men with spinal cord injury are anejaculatory, requiring medical assistance to obtain their semen. Penile vibratory stimulation is generally recognized as the standard of care for semen retrieval in these anejaculatory men. SETTING Major Research University in Miami, Florida, USA. METHODS The Ferticare 2.0 device was applied to 15 men with spinal cord injury in a three-step protocol simulating normal use. Step 1: one device (2.5 mm amplitude, 100 Hz) was applied to the glans penis for 2 min. Step 2: If no ejaculation occurred, the amplitude was increased to 4.0 mm (100 Hz) and the device similarly applied. Step 3: If no ejaculation occurred, two devices, each 2.5 mm and 100 Hz were applied to the dorsum and frenulum of the glans penis. Participants at risk for autonomic dysreflexia were pretreated with sublingual nifedipine (20 mg), 15 min prior to stimulation. Blood pressure and other symptoms of autonomic dysreflexia were monitored. Participants answered a questionnaire about their experience with the device. RESULTS Thirteen of 15 participants ejaculated with the device. No adverse events occurred. All participants commented they would recommend the device to other men with spinal cord injury. CONCLUSIONS A re-engineered device, the Ferticare 2.0, is safe and effective for inducing ejaculation in men with spinal cord injury.
Collapse
Affiliation(s)
- Emad Ibrahim
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA.
| | - Christian F S Jensen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Ivan Sunara
- Department of Neurobiology, Care Science and Society, Spinalis Spinal Cord Injury Unit, Karolinska Institute, Stockholm, Sweden
| | - Kajal Khodamoradi
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Teodoro C Aballa
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Stacy Elliott
- Departments of Psychiatry and Urological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Jens Sonksen
- Department of Urology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Dana A Ohl
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Claes Hultling
- Department of Neurobiology, Care Science and Society, Spinalis Spinal Cord Injury Unit, Karolinska Institute, Stockholm, Sweden
| | - Charles M Lynne
- Department of Urology, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | - Nancy L Brackett
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| |
Collapse
|
16
|
A therapeutic effect for males with spinal cord injury using abdominal functional electrical stimulation for sexual functioning. Spinal Cord Ser Cases 2020; 6:24. [PMID: 32317626 DOI: 10.1038/s41394-020-0273-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/16/2020] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Sexual functioning is a high priority for people with a spinal cord injury (SCI) yet this area has received little attention. Two SCI case reports are presented which suggests there may be greater potential for the recovery of sexual functioning than previously recognised. CASE PRESENTATION A 74-year-old SCI male (AIS D, C5/C6) and a 36-year-old SCI male (AIS A, T4/T5) were treated for neurogenic bowel using 6 weeks of abdominal FES (ABFES) (40 Hz, 300 µ pulse width (current typically 30-60 MA) simultaneously delivered (8 s contraction with 2 s ramps and 3 s off period) from both channels). The 74-year-old AIS D, C5/C6 participant reported improved strength and duration of erectile function after using ABFES for 3 weeks. The 36-year-old AIS A, T4/T5 participant reported improvements in ejaculatory function and urine flow. Both reported a reduction in time required for bowel management. DISCUSSION The findings could be attributed to an improved vascularisation of the abdominal area, an improved body image and self-esteem, direct innervation of nerves involved in parasympathetic pathways or innervation of the T11/T1 area implicated in the alternative psychogenic pathway. Both participants reported they had not used ABFES during sexual activity suggesting a therapeutic effect from the treatment.
Collapse
|
17
|
Rodger S. Evaluating sexual function education for patients after a spinal cord injury. ACTA ACUST UNITED AC 2019; 28:1374-1378. [PMID: 31778344 DOI: 10.12968/bjon.2019.28.21.1374] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM this article shares findings from a service evaluation exploring the views of patients relating to the specialist sexual function education and information provided following a spinal cord injury. BACKGROUND education optimises patients' involvement in their own decision-making and care processes, with the aim of promoting adherence to agreed plans, reducing the risks of post-injury complications, promoting independence and improving quality of life. Sexual function is a well-known quality-of-life indicator and it has been widely documented that it is not well addressed following spinal cord injury. A previous service evaluation exploring education provided to patients with spinal cord injury identified the need for improved provision of sexual function education/information. As a result, weekly 1-hour sessions focused on sexual function for up to three patients of the same sex were held, facilitated by a clinical nurse specialist. The sessions had an open forum structure. They were initially designed to discuss thoughts and feelings around intimacy and sex after a spinal cord injury, but focused on group members' requests. In addition, patients were offered a one-to-one session where the 'mechanics' of sex could be discussed in further detail. DESIGN AND METHODS a service evaluation used a questionnaire survey to collect data from a purposive convenience sample of spinal cord injury patients. Data were collected between July and September 2018. Participants completed a locally designed paper questionnaire, which included Likert-style questions and space to add free text comments. Descriptive analysis of the data was used. RESULTS survey results suggest that the newly formed sexual function education session is positively evaluated in terms of usefulness and all attendees to date would recommend this session to other patients. CONCLUSIONS AND RECOMMENDATIONS following completion of data analysis, findings will inform the further development of sexual function education, with a particular focus on tailoring it to the patient and reducing the stigma around talking about sex.
Collapse
Affiliation(s)
- Sian Rodger
- Clinical Nurse Specialist, London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, London
| |
Collapse
|
18
|
Latella D, Maggio MG, Manuli A, Militi D, Calabrò RS. Sexual dysfunction in male individuals with spinal cord iniury: What do we know so far? J Clin Neurosci 2019; 68:20-27. [DOI: 10.1016/j.jocn.2019.07.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/06/2019] [Indexed: 12/31/2022]
|
19
|
Wiggins JW, Kozyrev N, Sledd JE, Wilson GG, Coolen LM. Chronic Spinal Cord Injury Reduces Gastrin-Releasing Peptide in the Spinal Ejaculation Generator in Male Rats. J Neurotrauma 2019; 36:3378-3393. [PMID: 31111794 DOI: 10.1089/neu.2019.6509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Spinal cord injury (SCI) causes sexual dysfunction, including anejaculation in men. Likewise, chronic mid-thoracic contusion injury impairs ejaculatory reflexes in male rats. Ejaculation is controlled by a spinal ejaculation generator (SEG) comprised of a population of lumbar spinothalamic (LSt) neurons. LSt neurons co-express four neuropeptides, including gastrin-releasing peptide (GRP) and galanin and control ejaculation via release of these peptides in lumbar and sacral autonomic and motor nuclei. Here, we tested the hypothesis that contusion injury causes a disruption of the neuropeptides that are expressed in LSt cell bodies and axon terminals, thereby causing ejaculatory dysfunction. Male Sprague Dawley rats received contusion or sham surgery at spinal levels T6-7. Five to six weeks later, animals were perfused and spinal cords were immunoprocessed for galanin and GRP. Results showed that numbers of cells immunoreactive for galanin were not altered by SCI, suggesting that LSt cells are not ablated by SCI. In contrast, GRP immunoreactivity was decreased in LSt cells following SCI, evidenced by fewer GRP and galanin/GRP dual labeled cells. However, SCI did not affect efferent connections of LSt, cells as axon terminals containing galanin or GRP in contact with autonomic cells were not reduced following SCI. Finally, no changes in testosterone plasma levels or androgen receptor expression were noted after SCI. In conclusion, chronic contusion injury decreased immunoreactivity for GRP in LSt cell soma, but did not affect LSt neurons per se or LSt connections within the SEG. Since GRP is essential for triggering ejaculation, such loss may contribute to ejaculatory dysfunction following SCI.
Collapse
Affiliation(s)
- J Walker Wiggins
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi.,Graduate Program in Neuroscience, University of Mississippi Medical Center, Jackson, Mississippi
| | - Natalie Kozyrev
- Robarts Institute, Western University, London, Ontario, Canada
| | - Jonathan E Sledd
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - George G Wilson
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Lique M Coolen
- Department of Neurobiology and Anatomical Sciences, University of Mississippi Medical Center, Jackson, Mississippi.,Department of Biological Sciences, Kent State University, Kent, Ohio
| |
Collapse
|
20
|
Restoration of fertility in a young patient with spinal cord injury: is there a place for noninvasive neurostimulation? Neurol Sci 2018; 39:2207-2208. [DOI: 10.1007/s10072-018-3523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 08/03/2018] [Indexed: 11/26/2022]
|
21
|
Aikman K, Oliffe JL, Kelly MT, McCuaig F. Sexual Health in Men With Traumatic Spinal Cord Injuries: A Review and Recommendations for Primary Health-Care Providers. Am J Mens Health 2018; 12:2044-2054. [PMID: 30043673 PMCID: PMC6199421 DOI: 10.1177/1557988318790883] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Sexual health has been well established as a salient priority for men following traumatic spinal cord injury; yet, it continues to be under-addressed by health-care providers in both inpatient and community settings. Given that most men with traumatic spinal cord injuries will be followed by community-based primary health-care providers, including family physicians and nurse practitioners, for their long-term health-care needs, these clinicians are well positioned to address ongoing sexual health issues with this population. A scoping review of literature published between 2007 and 2017 inclusive was undertaken to identify what is known about the sexual health of men with spinal cord injuries. Twenty articles met the inclusion criteria. The findings are presented in four themes: (a) patterns and diversity of sexual health concerns; (b) sexual health recovery as an ongoing priority; (c) clinical barriers to addressing sexual health concerns, and (d) recommended interventions and strategies for primary health-care providers. The findings indicate that physiological changes as well as psychological and social factors influence men’s sexual function following spinal cord injury, and that sexual health recovery is an enduring rehabilitation priority. Several barriers including lack of sexual rehabilitation services and consensus around clinician roles, and societal stigmas related to disability and sexuality impede treatment. Attention to sexual health recovery has mainly focused on formal rehabilitation settings; however, many evidence-based clinical strategies and resources are relevant to and adaptable for primary care providers caring for these men in the community.
Collapse
Affiliation(s)
- Kirsten Aikman
- 1 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - John L Oliffe
- 1 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Mary T Kelly
- 1 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Fairleth McCuaig
- 1 School of Nursing, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
22
|
Anderson R, Moses R, Lenherr S, Hotaling JM, Myers J. Spinal cord injury and male infertility-a review of current literature, knowledge gaps, and future research. Transl Androl Urol 2018; 7:S373-S382. [PMID: 30159244 PMCID: PMC6087847 DOI: 10.21037/tau.2018.04.12] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 04/04/2018] [Indexed: 12/15/2022] Open
Abstract
Spinal cord injury (SCI) affects nearly half a million new patients worldwide, with 17,700 in the US each year, and disproportionately impacts young males of reproductive age. Almost every aspect of male reproduction is affected by SCI, resulting in: erectile, endocrine and sexual dysfunction, decreased sperm motility despite an often-normal count, and abnormal semen emission and ejaculation. The aim of this review is to focus on how SCI impacts testicular spermatogenesis, sperm function, semen quality, and overall fecundity while discussing what is not known, and future avenues for research.
Collapse
Affiliation(s)
- Ross Anderson
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Moses
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Sara Lenherr
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - James M Hotaling
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| | - Jeremy Myers
- Department of Surgery, Division of Urology, University of Utah, Salt Lake City, Utah, USA
| |
Collapse
|