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Sexual Life after Spinal Cord Injury, pp. 133-166 $100.00
Authors:  Tatjana Sramkova and Radmila Fajtova
Abstract:
Sexual dysfunctions are a common consequence of spinal cord injury (SCI). Benes
(1987) found that with time patients experience sexual dysfunctions as much worse than
loss of mobility. Sexual disorders demonstrably lower quality of life (QoL). Results of
QoL questionnaire SQUALA show that men with SCI have a significantly lower profile
of QoL in the areas “sexual life” and “having children” than the control group.
Therefore, rehabilitation of sexual functions forms an important part of complex care for
people with SCI. Along with counseling we provide educational DVDs, which leads to
full knowledge of sexuological problems and their treatment. Sexuologists are most often
consulted about erectile dysfunction (ED) and anejaculation. While incidence of ED (up
to 75%) predominantly depends on the location of transversal spinal cord lesion,
incidence of anejaculation is independent of location. Men with SCI often achieve
reflexive erection, which tends to be insufficient for satisfying sexual intercourse. The
first step in treatment of ED is per-oral medication, PDE5 inhibitors (sildenafil, tadalafil,
vardenafil). Treatment effect is 70-80%. In men with SCI, we reported (2008) use of
tadalafil, with effect 69%. When per-oral treatment is not successful, we recommend
intracavernous injection treatment of prostaglandin E1 (PG E1). It is highly effective and
safe in educated men. In 1998 we compared the effect of injection treatment in
paraplegic and diabetic patients. The treatment was successful in 94% paraplegics
(neurogenic etilology), whereas in 85% in diabetics (combined neurogenic and vascular
ED). Infertility of men with SCI is caused by two factors: inability to ejaculate and poor
sperm quality. In 97 – 99% men with SCI the ejaculation process is impaired due to
denervation. In order for these men to become biological fathers, it is necessary to obtain
sperm through artificial ejaculation (electroejaculation, vibrostimulation) or surgically
through TESE (Testicular Sperm Extraction). Electroejaculation is the most widely used
method in men with SCI. We perform a series of electroejaculations with the intention of
cryoconservation of sperm. Spermiologic results of men with SCI usually show good sperm concentration, but impaired motility and morphology. With regard to
pathospermia, the method of choice to achieve conception is ICSI (Intracytoplasmic
Sperm Injection), which is the least dependent on sperm quality and enables men with
very poor sperm quality to have their own biological children. The goal of sexuological
care is to enable people with SCI to lead a satisfying sexual life and have their own
biological children. 


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Sexual Life after Spinal Cord Injury, pp. 133-166