Understanding Erectile Dysfunction

Most male patients will have varying degrees of erectile dysfunction following spinal cord injury. The degree to which a patient is affected is dependent on the level, severity, nature and time elapsed since the injury. The erectile dysfunction occurs as a direct consequence of the resultant neurological fallout. There are a number of effective drugs, and appliances, readily available to restore erectile function in most patients. 

Psychogenic erections occur due to visual or auditory stimuli passing down from the brain to the sacral area and represent an intact neurological pathway. Most patients with incomplete lesions of the lower spinal cord will have preservation of this form of erection. Patients with complete lesions, and those with incomplete lesions of the upper spinal cord, are less likely to have preservation of this form of erection.

Reflexogenic erections are mediated by a reflex arc between the genital area and the cord. Typically, they may occur as a result of both unintentional and intentional stimulation of the genital area. The vast majority of men with both complete and incomplete injuries of the upper spinal cord will be able to have reflexogenic erections. This means that men who are spastic paraplegics have a better chance of achieving and maintaining an erection than those with flaccid paraplegia.

Drugs encourage erections by increasing the blood flow to the penis, promoting a more durable and sustained erection with stimulation. They can be used to enhance psychogenic and reflexogenic erectile function. The first group of drugs, taken by mouth, are the phosphodiesterase inhibitors which principally increase blood flow to the penis. They are safe to use in most patients except for those with uncontrolled angina using sublingual nitrates. They include Levitra, Viagra and Cialis - and are available on prescription.

An added, and often overlooked, advantage seen with the use of Levitra is the re-establishment of ejaculation in some patients and the consequential enhancement of fertility. Some patients may need to use a prostaglandin injection - directly into the penis - prior to intercourse. Patients using the injection are counselled about the rare complication of priapism - a prolonged erection (lasting more than four hours) without direct stimulation.

The use of a vacuum device is preferred by some patients to achieve an erection. Patients are instucted to remove the constriction band from the penis following intercourse as they have absent or diminished sensation. 

As a last resort the use of rigid and inflatable penile prosthesis may be inserted surgically to achieve erections. In patients without a spinal cord injury erectile dysfunction is usually a marker of cardiovascular disease. This usually prompts your doctor to exclude diabetes, hypertension, abnormally elevated blood lipids and a low testosterone. All of these conditions have the potential to damage the lining of your blood vessels - referred to as the endothelium. As a consequence of the paraplegia this marker may be of limited value except when individuals experience a decrease in the strength of their erections. Therefore you need to be pro-active and request that these diseases are screened for at your annual medical examination.

A healthy sex life is a basic human right. Safe and effective treatment is readily available to the well informed patient. The benefits of treatment extend to promoting intimacy with your partner and overall quality of the relationship.


Columnist Photos