Predictive Factors of Male Sexual Dysfunction After Traumatic Spinal Cord Injury

Josepha Karinne de Oliveira Ferro, MD; Andrea Lemos, PhD; Caroline Palácio da Silva, BS; Claudia Regina Oliveira de Paiva Lima, PhD; Maria Cristina Falcão Raposo, PhD; Geraldo de Aguiar Cavalcanti, PhD; Daniella Araújo de Oliveira, PhD


Spine. 2019;44(17):1228-1237. 

In This Article

Abstract and Introduction


Study Design: Observational study (Ethics Committee Number 973.648).

Objective: Evaluating the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction.

Summary of Background Data: Besides the motor and sensory loss, sexual function changes after spinal cord injury, ranging from decreased sexual desire to erectile disorders, orgasm, and ejaculation.

Methods: Performed with 45 men, with traumatic spinal cord injury and sexually active. Sexual function was assessed by the International Index of Erectile Function and the level and degree of injury were determined following guidelines of International Standards for Neurological and Functional Examination Classification of Spinal Cord Injury. Bi and multivariate analysis was applied, with a 0.05 significance level.

Results: Forty-five subjects with mean injury time of 7.5 years (CI 5.2–9.9) were evaluated. Having a fixed partner is a protective factor (OR: 0.25; 95% CI: 0.07–0.92) of erectile dysfunction. Sexual desire is associated with the fixed partner (OR: 0.12; 95% CI: 0.02–0.66), masturbation (OR: 0.13; 95% CI: 0.02–0.62), and sexual intercourse in the last month (OR: 0.13; 95% IC: 0.01–0.92). Ejaculation (OR: 0.01; 95% CI: 0.00–0.15) and erectile dysfunction (OR: 15.7; 95% CI: 1.38–178.58) are associated with orgasm. Psychogenic erection (OR: 0.07; 95% CI: 0.01–0.69), monthly frequency of sexual intercourse (OR: 11.3; 95% CI: 2.0–62.8), and orgasmic dysfunction (OR: 7.1; 95% CI: 1.1–44.8) are associated with satisfaction.

Conclusion: Fixed partner, ejaculation, masturbation are protective factors for sexual dysfunction. Erectile dysfunction, orgasmic, and infrequent sex dysfunction are predictors of sexual dysfunction.

Level of Evidence: 3


The loss of sexual performance, when compared with loss of autonomy, may appear to be a minor consequence of spinal cord injury.[1] However, sexual function is an important health component, with evidence that its reduction results in poorer quality of life[2,3] becoming a negative factor in motivation and well-being.[4–7]

The impact of the traumatic injury involves young adults in their productive and reproductive phase.[8] In addition to motor and sensory losses, visceral and sexual functions are also affected after spinal cord injury and their severity will depend on the level and complexity of the injury.[1,9,10] Thus, the impact of the traumatic injury is evident in cases of physically active men who unexpectedly need to learn to deal with loss of physical independence, bladder dysfunction, and limitations, considered to be visible reducers of self-image and self-confidence.[11]

Functional and neuroanatomical studies make evident the relationship between the level of injury and the ejaculatory and erectile function of men with spinal cord injury caused by impairment of the descending, facilitative, and inhibitory pathways present in the spinal cord.[1,12–14] Sexual function, traditionally divided into desire, arousal, orgasm, and resolution, is associated with neurophysiological and psychosocial factors.[13,15]

On the other hand, the presence of genital sensation seems to be associated with arousal and self-quality of erection postspinal cord injury. Also, factors such as low level of injury, voluntary control of bladder and bowel, and spasticity during sexual intercourse are associated with the presence of ejaculation.[16] Sexual satisfaction after injury can be influenced by injury time, erection quality, and orgasmic sensation.[6,17]

Therefore, negatively altered physiological and psychological factors influence the sexual intercourse, also affecting the desire, frequency, and sexual satisfaction.[6,16,18–21] After injury, usually there is a decrease in the perception of masculinity, contributing to the loss, or reduction of the motivation to find a partner and readjust sexual function to the current condition.[21]

However, despite its relevance, sexual performance after spinal cord injury is still a poorly addressed and neglected theme during the rehabilitation process, and there are few studies that verify more detailed associations about erectile function and other components of sexual function. Thus, the objective of this study is to evaluate the social and clinical factors associated with sexual dysfunction in men with traumatic spinal cord injury, as well as predictive factors for sexual dysfunction.