Cardiovascular Physiology and Responses to Sexual Activity in Individuals Living with Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2017 · DOI: 10.1310/sci2301-11 · Published: January 1, 2017

Simple Explanation

Spinal cord injury (SCI) can disrupt autonomic functions like cardiovascular, respiratory, and sexual function. The cardiovascular system is vital for sexual function, controlling blood flow during sexual activity. SCI can lead to abnormalities like low blood pressure, orthostatic hypotension, and autonomic dysreflexia, all affecting sexual function. Autonomic function, controlled by the autonomic nervous system, includes heart rate, blood pressure, sweating, pulmonary function, bladder/bowel control, and sexual function. This system has sympathetic and parasympathetic divisions that balance these functions. For individuals living with SCI, sexual function has been identified as a priority for recovery. Cardiovascular autonomic function has an important role in facilitating sexual activity.

Study Duration

Not specified

Participants

Individuals living with Spinal Cord Injury

Evidence Level

Review

Key Findings

1
Individuals with SCI at or above the T6 neurologic level are at increased risk of AD during sexual stimulation. This risk increases with higher and more complete injuries.
2
AD can be asymptomatic, so individuals with SCI should monitor their blood pressure at baseline and during sexual activity. Clinicians performing vibrostimulation should be aware of AD risk and consider pretreatment.
3
Continuous BP monitoring is recommended during procedures like vibrostimulation to accurately assess BP changes. Intermittent monitoring may underestimate true BP values.

Research Summary

Spinal cord injury can lead to alterations in cardiovascular autonomic function, resulting in low resting blood pressure, orthostatic hypotension, and autonomic dysreflexia. The mechanisms behind these abnormalities include sympathetic preganglionic plasticity and peripheral vascular hyperresponsiveness. Aberrant cardiovascular physiology can interfere with sexual function in individuals living with SCI, potentially triggering autonomic dysreflexia during self-stimulation, intercourse, and fertility procedures. Medical professionals involved in procedures like penile vibrostimulation or electroejaculation must closely monitor cardiovascular parameters, preferably using continuous blood pressure monitoring. Pretreatment with medications like prazosin or nifedipine may be necessary for individuals with severe autonomic dysreflexia.

Practical Implications

Monitoring Blood Pressure

Regularly monitor blood pressure, especially during sexual activity, for individuals with SCI above T6.

Clinical Awareness

Clinicians should be aware of AD risks during vibrostimulation or electroejaculation fertility procedures.

Continuous Monitoring

Employ continuous BP monitoring during PVS and EEP procedures to ensure accurate assessment and safety.

Study Limitations

1
Limited data on AD incidence during vibrostimulation with commercially available devices.
2
Few studies directly measure BP and HR changes during sexual intercourse in individuals with SCI.
3
Variability in reported peak SBP during PVS procedures.

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