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JR, J. Castro
JR, J. Bessa
NEUROUROLOGY AND URODYNAMICS, v.32, n.6, p.678-678, 2013
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Hypothesis / aims of study Sexual function is tremendously affected by spinal cord injury (SCI).(1, 2) Sexuality is identified as a very important aspect of life, and restoration of sexual function may have a significant impact in the rehabilitation process and may improve quality of life. After spinal cord injury (SCI), sexuality may be affected by physiological, psychological and emotional consequences. Genitalorgans’ functions may be damaged depending on the level and completeness of the neurological injury. Furthermore, the impaired ability to maintain continence after SCI puts individuals at risk of presenting urinary leakage during typical daily activities, such as sexual intercourse, impairing the willingness to engage in sexual activity. In this study we sought to investigate sexual function and satisfaction in men with SCI, and the impact of urinary incontinence. Study design, materials and methods We prospectively evaluated 295 men with traumatic SCI (>12 months) with a mean age of 40.8 ± 14.4 years. Median time from SCI was 3.6 years [1.7-7.0]. The lesion level was cervical in 129 (43.7%), thoracic in 133 (45.1%), lumbar in 32 (10.8%) and sacral in 1 (0.3%) patient. The American Spinal Injury Association (ASIA) impairment scale was A in 192 (65.1%), B in 33 (11.2%), C in 27 (9.2%), D in 34 (11.4%) and E in 9 (1.1%). Urinary incontinence was defined as any complaint of involuntary leakage of urine during the past month. Two groups were created, comprising 138 (46.8%) continent and 157 (53.2%) incontinent patients, respectivelly. A structured questionnaire was applied to all subjects including a detailed sexual anamnesis regarding orgasmic and ejaculatory functions, as well as the subjective satisfaction with sexual life (SSL–scale varrying from 0=dissatisfied to 10=satisfied). Moreover, the International Index of Erectile Function-5 item (IIEF-5) was applied to all subjects. Results Table 1– Sexual parameters before and after SCI Before SCI (n=295) After SCI (n=295) p Sexually active 289 (97.9%) 159 (53.9%) <0.001 IIEF*-5 [0-16] IIEF*>17-63 (21.4%) Orgasm 286 (96.9%) 105 (35.6%) <0.001 Masturbation 116 (39.3%) 27 (9.1%) <0.001 Ejaculation 288 (97.6%) 61 (20.6%) <0.001 SSLº 9 [8-10] 4 [0-6] <0.001 *International Index of Erectile Function °Satisfaction with Sexual Life Table 2– Comparisons between continent and incontinent SCI men Continent (n=157) Incontinent (n=138) p Odds Ratio Sexually active 95 (60.1%) 64 (46.3%) 0.019 1.7[1.1-2.8] IIEF* 9 [0-17] 0 [0-13] 0.026 IIEF*>17 37 (23.5%) 26 (18.8%) 0.3931.3[0.7-2.3] Orgasm 61 (46.3%) 44 (38.8%) 0.2251.3[0.8-2.2] Ejaculation 43 (27.3%) 18 (13.1%) 0.002 2.5[1.3-4.6] SSSLº 5[0-6] 3[0-3] 0.036 *International Index of Erectile Function °Subjective Satisfaction with Sexual Life Interpretation of results Table 1 shows the tremendous negative impact of SCI in male sexual life, with significant reduction of sexually active men after SCI, as well as in the ability to achieve orgasm and ejaculation. Consequently, satisfaction with sexual life was markedly reduced after SCI. Table 2 compares sexual parameters between continent and incontinent men after SCI. Continent men had better results in a number of parameters including the prevalence of sexually active men, median IIEF-5 score, ability to achieve ejaculat ion and the overall satisfaction with sexual life. The ability to achieve orgasm was similarly low in the two groups. Concluding message Sexual dysfunction is highly prevalent in SCI men and has a tremendous negative impact in the satisfaction with sexua l life. Urinary incontinence is associated with worse sexual outcomes in SCI men, with inferior rates of sexually active men, decreased IIEF-5 scores, decreased ability to achieve ejaculation and overall satisfaction with sexual life.
  1. Sexual function in men and women with neurological disorders. Lancet. 2007 Feb 10;369(9560):512-25
  2. The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord. 2007 May;45(5):328-37. Epub 2006 Oct 10