Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA.
Division of Pediatric Urology, Riley Hospital for Children at IU Health, Indianapolis, IN, USA.
J Pediatr Urol. 2023 Jun;19(3):308.e1-308.e9. doi: 10.1016/j.jpurol.2023.03.002. Epub 2023 Mar 6.
Data on sexual function of men with spina bifida (SB) is limited. We aimed to assess sexual activity and erectile dysfunction (ED) in a large international sample of men with SB.
Men with SB (≥18yo) were recruited in an international online survey via clinics and social media. We collected data on demographics, ambulation (Hoffer classification), penile rigidity (Erection Hardness Score), sexual activity and ED (International Index of Erectile Function). Non-parametric tests were used.
A total of 162 men (median age 35, 62% shunted, 38% community ambulators) reported sexual desire similar to the general population (p = 0.82), but 55% were dissatisfied with their sex life (Summary Table). Overall, 36% reported full penile rigidity with erections, more commonly with better ambulation (p = 0.01), 69% had ever experienced orgasm and 84% ejaculated. In 44 men (27%) attempting sexual intercourse in the last 4 weeks, 59% had ED (11% severe, 7% moderate, 14% mild-moderate, 27% mild). In this group, 91% of men reporting less than full penile rigidity had ED, compared to 30% with full penile rigidity (p = 0.001). Overall, partnered non-genital contact in the last 3 months was reported by 56%, solo masturbation: 62%, partnered intercourse: 48% (31% vaginal). Of 54 men who used phosphodiesterase type 5 inhibitors (PDE5I), 80% reported improved erections, 56% improved intercourse. Overall, 40% reported non-genital erogenous zones as most pleasurable, especially with poorer ambulation (p = 0.002, chest/nipples: 73%).
Strengths of this study include anonymous, voluntary, online participation maximizing participation of a heterogenous, international population. Whenever available, we compared findings to published values for the general population. Since romantic and sexual activity is a complex intersection of interest, opportunity and ability, a more comprehensive assessment was beyond the study's scope. Future work will focus on the interplay with issues like incontinence.
ED was frequent among men with SB, especially in men with poorer ambulation. PDE5 inhibitors may be beneficial. Partnered sexual activity was reported by half of the men, although it may not involve penetrative intercourse.
有关脊髓裂男性性功能的数据有限。我们旨在评估大量国际脊髓裂男性样本的性活动和勃起功能障碍（ED）。
通过诊所和社交媒体，在一项国际在线调查中招募了 18 岁及以上的脊髓裂男性。我们收集了人口统计学、步行能力（霍弗分类）、阴茎硬度（勃起硬度评分）、性活动和 ED（国际勃起功能指数）的数据。使用非参数检验。
共有 162 名男性（中位年龄 35 岁，62%分流，38%社区步行者）报告的性欲与一般人群相似（p=0.82），但 55%对性生活不满意（摘要表）。总体而言，36%的人报告完全阴茎硬度和勃起，更常见于步行能力更好的人（p=0.01），69%有过性高潮，84%射精。在过去 4 周内尝试过性交的 44 名男性中，59%有 ED（11%严重，7%中度，14%轻度-中度，27%轻度）。在这一组中，91%报告阴茎硬度不足的男性有 ED，而阴茎硬度完全的男性有 30%（p=0.001）。总体而言，过去 3 个月内有 56%的人报告有非生殖器接触，62%有单独手淫，48%有伴侣性交（31%阴道）。在 54 名使用磷酸二酯酶 5 抑制剂（PDE5I）的男性中，80%报告勃起改善，56%报告性交改善。总体而言，40%的人报告非生殖器性感区最愉悦，尤其是步行能力较差的人（p=0.002，胸部/乳头：73%）。
本研究的优势在于匿名、自愿、在线参与，最大限度地增加了异质、国际人群的参与。只要有可用数据，我们就将研究结果与一般人群的已发表数据进行比较。由于浪漫和性活动是一个复杂的兴趣、机会和能力的交集，因此更全面的评估超出了研究范围。未来的工作将侧重于研究与尿失禁等问题的相互作用。
脊髓裂男性中 ED 很常见，尤其是步行能力较差的男性。PDE5I 可能有益。尽管可能不涉及插入性交，但一半的男性报告有伴侣性行为。
