Sexual function in spinal cord injury men. I. Assessing sexual capability.

Precise diagnoses are seldom made upon complaints of sexual dysfunction by spinal cord injured men. The dysfunction is inevitably attributed to the neurological condition and available treatments are offered with little knowledge of the individual residual capacity or other contributing factors. Current practice emphasizes these treatment approaches, but the high rejection rate associated with the most widely used technique of intracavernous injections suggests that remaining sexual function should also be investigated. This study explores remaining function using physiological recording techniques and classifying the subjects according to the innervation of the reproductive system. The results show that, with objective measurements and proper classification of the subjects, 100% of individuals with high lesions maintain penile responses to reflexogenic stimulation and up to 90% of those with lower lesions maintain penile responses to psychogenic stimulation. These latter subjects also show naturally occurring emissions in 100% of the cases when they suffer from lesions to the conus terminalis and when they use psychogenic stimulation as a means of inducing erection and emission. Results from subjective reports reveal that spinal cord injured men underestimate their sexual capacity, while diagnoses based on clinical findings are better predictors.