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"Sexual and Fertility Rehabilitation Following SCI" - Stacy Elliott, MD

Sexual function is a huge priority for persons with SCI, ranked either first or second in terms of importance in quality of life after SCI. This relatively neglected area of rehabilitation has been highlighted with the advent of Viagra and rise of social media. For men, the use of PDE5i and penile injections has mainly resolved the issue of unreliable erectile function, but ejaculation and orgasm still remain elusive to more than 75% and 50% respectively. For women, there is no specific medication for arousal disorders or orgasmic dysfunction after SCI. Experience over time, having an intimate partner, and having an incomplete injury versus complete injury bode better for orgasmic release for both sexes. Some persons experience autonomic dysreflexia with sexual practices (particularly with ejaculation and orgasm) which may require prophylactic medications, while others experience mild to moderate dysreflexia which over time can be morphed into more erotic feelings. Ejaculation has been utilized not only for sexual and fertility purposes, but anecdotally has improved bladder and bowel control. While not formally studied, improved walking skills with Exoskeleton and pelvic floor strengthening, may enhance sexual function in some.  Fertility is most affected in men after SCI with the ejaculatory difficulties, of which sperm retrieval methodology exists. However, semen quality is invariably affected by the cytokines found in seminal fluid, significantly altering sperm quality. Women’s fertility is not affected after SCI, but contraception may need to be modified. Women with SCI can safely carry a pregnancy and most deliver vaginally. A multidisciplinary team must be in place for women to assist with pregnancy, labour, delivery and postpartum issues (including breastfeeding). A positive outlook and interest toward sexual and fertility rehabilitation is finally here!

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