Neural Control and Physiology of Sexual Function: Effect of Spinal Cord Injury

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

Simple Explanation

This review explains the normal anatomy and physiology of sexual function, how spinal cord injuries (SCI) affect these functions, and suggests ways to improve sexual satisfaction before using medical treatments. In both men and women, genital arousal depends on a balance between the parasympathetic (pro-erectile) and sympathetic (detumescence) nervous systems. SCI can disrupt this balance, affecting psychogenic, reflexogenic, and nocturnal arousal. Following SCI, individuals may experience changes in sexual desire, arousal, ejaculation, and orgasm. These changes are influenced by the level and severity of the injury, as well as psychological and social factors.

Study Duration

Not specified

Participants

Individuals with spinal cord injury

Evidence Level

Not specified

Key Findings

1
Peripheral nerves in the pelvis are regulated by cerebral control, and SCI can disrupt this control, impacting both psychological and reflex responses for genital arousal, ejaculation, and orgasm.
2
Nitric oxide is crucial for smooth muscle relaxation in erectile tissue during arousal in both sexes.
3
Ejaculation and orgasm are controlled separately and can be independently affected by SCI in men.

Research Summary

This article reviews the impact of spinal cord injury (SCI) on sexual function, covering the basic anatomy and physiology of sexual responses, the pathophysiology of sexual dysfunction following SCI, and potential strategies for improving sexual satisfaction. The review highlights the importance of understanding the neurological control of sexual responses, including the roles of the autonomic and somatic nervous systems, and how SCI can disrupt these pathways. It also discusses potential therapeutic avenues for altering sexual pathophysiology after SCI, such as mindfulness techniques, body mapping, and the use of medications to enhance sensation and vasocongestion.

Practical Implications

Neuroplasticity Techniques

Employ mindfulness, body mapping, and stimulation of sensate areas to encourage neuroplasticity and maximize sexual neurophysiology.

Biopsychosocial Context

Address the biopsychosocial sexual contexts within which persons with SCI live to maximize their sexual and fertility rehabilitation.

Medical Therapies

Consider medical therapies after maximizing neurological changes and sexual neurophysiology through techniques like mindfulness and body mapping.

Study Limitations

1
Definition and interpretation of orgasm remains neurophysiologically unclear.
2
Reliance on subject self-report for orgasm studies.
3
Lack of a clinically agreed upon SCI measurement tool for sexual health outcomes.

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