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Objectives

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OBJECTIVES

After reading this chapter, the reader will be able to:

  • Discuss causes of infertility in men with SCI

  • Discuss methods of treating erectile dysfunction in men with SCI

  • Discuss methods of treating ejaculatory dysfunction in men with SCI

  • Discuss semen quality in men with SCI

  • Discuss reproductive options in couples with SCI male partners

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Introduction

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Spinal cord injury (SCI) occurs most often to young men at the peak of their reproductive health. In the United States, 80% of new injuries occur to men between the ages of 16 and 45.1 Around the world, similar statistics are found.2,3,4,5,6 The most common causes of SCI are motor vehicle accidents, violence, sports-related injuries, and falls.1 It is assumed that more men than women are injured because men engage in more risk-taking behavior that leads to injury. The actual cause for the disproportionately high percentage of injured men, however, is unknown. Recent evidence suggests that sex hormones may play a role in this discrepancy; that is, estrogen may be neuroprotective and/or that testosterone may be neurotoxic after injury.7,8

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Following SCI, fertility is severely impaired in men, but not in women. For example, 90% of men with SCI cannot father a child via sexual intercourse.9 Women with SCI, however, can conceive and deliver children with nearly the same success rate as the general population.10 Reproductive function is of great importance to men with SCI.11,12 Regaining sexual function has been identified as the highest priority among individuals with paraplegia.11 Most men with SCI require medical assistance to father children due to impairments in erection, ejaculation, and semen quality13

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Given the fact that sexual function and fertility are of paramount importance to men with SCI, it is critical that these topics be included as part of any standard rehabilitation curriculum for clients. In addition, rehabilitation professionals should continually educate themselves with current and accurate information on these topics and be prepared to discuss these topics with their clients. Clients will request this information at different times during their recovery. Some clients wish to know this information immediately after injury, and other clients may not request this information for months or years. As with other questions regarding rehabilitation, clients typically first query a therapist or nurse, rather than a physician. It is therefore vital that rehabilitation professionals be ready to discuss these topics whenever they are brought up. Discussion of sexual and fertility issues may be uncomfortable for some caregivers as well as for some individuals with SCI. In those instances, the caregiver should at least be knowledgeable about professionals in their community who can act as a backup resource for additional education and/or management.

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Treatments for Erectile Dysfunction

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The same treatments used for treatment of erectile dysfunction ...

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