Erectile and ejaculatory dysfunction in SCI

1. How do reflexogenic erections occur?
2. What are methods used to induce erections in SCI?
3. What sort of SCI provides the best chance of having the ability to ejaculate?
4. What are methods used to induce ejaculation?
5. What percentage of patients have return of sexual function within 1 year?

Answers:
1. Manual stimulation of the genital region, mediated by sacral roots S2-4
2. Medications (sildenafil), intracavernosal injection therapy, penile vacuum device, transurethral devices (alprostadil), and penile implants.
3. Incomplete LMN lesion.
4. Intrathecal neostigmine, SQ physiostigmine, direct aspiration of sperm from vas deferens, vibratory stimulation, electroejaculation (very painful if sensation intact), direct stimulation of hypogastric nerve (surgical, very painful if sensation intact).
5. 80%.