Fertility and Sexuality in the Spinal Cord Injury Patient

Overview

Journal World J Urol

Specialty Urology

Date 2018 Jun 28

PMID 29948051

Citations 16

Authors

J T Stoffel

F Van der Aa

D Wittmann

S Yande

S Elliott

Affiliations

Soon will be listed here.

Abstract

Background: After a spinal cord injury, patients have different perceptions of sexuality, sexual function, and potential for fertility. These changes can greatly impact quality of life over a lifetime.

Purpose: The purpose of this workgroup was to identify common evidence based or expert opinion themes and recommendations regarding treatment of sexuality, sexual function and fertility in the spinal cord injury population.

Methods: As part of the SIU-ICUD joint consultation of Urologic Management of the Spinal Cord Injury (SCI), a workgroup and comprehensive literature search of English language manuscripts regarding fertility and sexuality in the spinal cord injury patient were formed. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for levels of evidence (LOEs) and grades of recommendation (GORs).

Results: Genital arousal, ejaculation, and orgasm are significantly impacted after spinal cord injury in both male and female SCI patients. This may have a more significant impact on potential for fertility in male spinal cord injury patients, particularly regarding ability of generate erection, semen quantity and quality. Female patients should be consulted that pregnancy is still possible after injury and a woman should expect resumption of normal reproductive function. As a result, sexual health teaching should be continued in women despite injury. Pregnancy in a SCI may cause complications such as autonomic dysreflexia, so this group should be carefully followed during pregnancy.

Conclusions: By understanding physiologic changes after injury, patients and care teams can work together to achieve goals and maximize sexual quality of life after the injury.

Citing Articles

Effect and prognosis of thoracolumbar fracture combined with incomplete spinal cord injury on male sexual function.

Gao S, Yuexin W, Daole H, Fang Z, Yun T, Yang L J Orthop Surg Res. 2025; 20(1):176.

PMID: 39972507 PMC: 11837624. DOI: 10.1186/s13018-025-05587-5.

Therapeutic effects of erythropoietin-alginate/chitosan hydrogel on impaired male rat fertility after spinal cord injury.

Rasekh M, Gilanpour H, Sadeghinezhad J, Mortazavi P, Akbari G Mol Biol Rep. 2025; 52(1):137.

PMID: 39826030 DOI: 10.1007/s11033-025-10224-9.

Considerations for Contraception Following Spinal Cord Injury: A Systematic Review.

Hall L, Nnoromele C, Lalla A, Hentschel C, Slocum C Top Spinal Cord Inj Rehabil. 2024; 30(2):1-8.

PMID: 38799610 PMC: 11123607. DOI: 10.46292/sci23-00081.

Quality of sexual life in Mexican men after spinal cord injury.

Acosta-Santillan P, Toro-Sashida M, Rosas-Mendoza A, Fuentes-Orozco C, Jasso-Garcia K, Garcia de Leon-Flores P J Rehabil Med. 2023; 55:jrm11641.

PMID: 38124428 PMC: 10802783. DOI: 10.2340/jrm.v55.11641.

Breaking the taboo: qualitative analysis of the sexuality in people with acquired motor disability.

Sologuren-Garcia G, Linares C, Flores J, Mendoza-Mamani K, Pilco R, Escobar-Bermejo G BMC Psychol. 2023; 11(1):380.

PMID: 37941069 PMC: 10633942. DOI: 10.1186/s40359-023-01423-9.

References

Anderson K, Borisoff J, Johnson R, Stiens S, Elliott S . Spinal cord injury influences psychogenic as well as physical components of female sexual ability. Spinal Cord. 2006; 45(5):349-59. DOI: 10.1038/sj.sc.3101979. View

Sonksen J, Ohl D . Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction. Int J Androl. 2002; 25(6):324-32. DOI: 10.1046/j.1365-2605.2002.00378.x. View

Barbonetti A, Vassallo M, Felzani G, Francavilla S, Francavilla F . Association between 25(OH)-vitamin D and testosterone levels: Evidence from men with chronic spinal cord injury. J Spinal Cord Med. 2015; 39(3):246-52. PMC: 5073757. DOI: 10.1179/2045772315Y.0000000050. View

Chisholm C, Bray M, Karns L . Successful pregnancy in a woman with Bloom syndrome. Am J Med Genet. 2001; 102(2):136-8. DOI: 10.1002/ajmg.1437. View

Ortigue S, Grafton S, Bianchi-Demicheli F . Correlation between insula activation and self-reported quality of orgasm in women. Neuroimage. 2007; 37(2):551-60. DOI: 10.1016/j.neuroimage.2007.05.026. View

Anderson K, Borisoff J, Johnson R, Stiens S, Elliott S . The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord. 2006; 45(5):328-37. DOI: 10.1038/sj.sc.3101977. View

Elliott S . Case study: Erectile dysfunction following spinal cord injury. J Sex Med. 2010; 7(12):3808-14. DOI: 10.1111/j.1743-6109.2010.02105.x. View

Alexander M, Rosen R . Spinal cord injuries and orgasm: a review. J Sex Marital Ther. 2008; 34(4):308-24. DOI: 10.1080/00926230802096341. View

Courtois F, Charvier K, Vezina J, Morel Journel N, Carrier S, Jacquemin G . Assessing and conceptualizing orgasm after a spinal cord injury. BJU Int. 2011; 108(10):1624-33. DOI: 10.1111/j.1464-410X.2011.10168.x. View

10.

Tepper M, Whipple B, Richards E, Komisaruk B . Women with complete spinal cord injury: a phenomenological study of sexual experiences. J Sex Marital Ther. 2001; 27(5):615-23. DOI: 10.1080/713846817. View

11.

Kreuter M, Taft C, Siosteen A, Biering-Sorensen F . Women's sexual functioning and sex life after spinal cord injury. Spinal Cord. 2010; 49(1):154-60. DOI: 10.1038/sc.2010.51. View

12.

Salomon J, Schnitzler A, Ville Y, Laffont I, Perronne C, Denys P . Prevention of urinary tract infection in six spinal cord-injured pregnant women who gave birth to seven children under a weekly oral cyclic antibiotic program. Int J Infect Dis. 2008; 13(3):399-402. DOI: 10.1016/j.ijid.2008.08.006. View

13.

Sang J, Kim T, Kim S . Flibanserin for Treating Hypoactive Sexual Desire Disorder. J Menopausal Med. 2016; 22(1):9-13. PMC: 4854663. DOI: 10.6118/jmm.2016.22.1.9. View

14.

Pannek J, Bertschy S . Mission impossible? Urological management of patients with spinal cord injury during pregnancy: a systematic review. Spinal Cord. 2011; 49(10):1028-32. DOI: 10.1038/sc.2011.66. View

15.

CROSS L, Meythaler J, Tuel S, Cross A . Pregnancy, labor and delivery post spinal cord injury. Paraplegia. 1992; 30(12):890-902. DOI: 10.1038/sc.1992.166. View

16.

Sonksen J, Fode M, Lochner-Ernst D, Ohl D . Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord. 2011; 50(1):63-6. DOI: 10.1038/sc.2011.101. View

17.

Mah K, Binik Y . Do all orgasms feel alike? Evaluating a two-dimensional model of the orgasm experience across gender and sexual context. J Sex Res. 2002; 39(2):104-13. DOI: 10.1080/00224490209552129. View

18.

Tebbet M, Kennedy P . The experience of childbirth for women with spinal cord injuries: an interpretative phenomenology analysis study. Disabil Rehabil. 2011; 34(9):762-9. DOI: 10.3109/09638288.2011.619619. View

19.

Borisoff J, Elliott S, Hocaloski S, Birch G . The development of a sensory substitution system for the sexual rehabilitation of men with chronic spinal cord injury. J Sex Med. 2010; 7(11):3647-58. DOI: 10.1111/j.1743-6109.2010.01997.x. View

20.

Brindley G . Reflex ejaculation under vibratory stimulation in paraplegic men. Paraplegia. 1981; 19(5):299-302. DOI: 10.1038/sc.1981.57. View