Spinal cord injury and Sexual health

  • V. Giannopapas
  • S.G. Pneumaticos
  • I. Vlamis
Keywords: Spinal cord injury, Sexual function, Sexual satisfaction, Sexual Health, Sexual dysfunction


The estimated global incidence of spinal cord injuries is 10.5 cases per 100.000 people. Apart from the motor and sensory damage, spinal cord injuries affect the patients’ sexual function and sexual activities. Arousal, erectile function, orgasm and fertility are the main somatic factors that are affected by the spinal cord injury. In addition, spinal cord injury patients show a higher rate of body image issues as well as psychological issues (anxiety, depression, post-traumatic stress disorders) which interfere with their sexual activities and lower their sexual satisfaction. Since there is no cure for spinal cord injury, therapeutic approaches related to the rehabilitation of sexual function mainly focuses on restoration of “normal” function. Pharmacological treatments and intracavernous injections for erectile dysfunction, body-exploration, assistive devices and sexual aids are some of the methods that healthcare professionals and patients can explore in order to improve sexual function and sexual satisfaction post-injury.


Download data is not yet available.

Author Biographies

S.G. Pneumaticos

3rd Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, KAT Hospital.

I. Vlamis

3rd Department of Orthopaedic Surgery, National and Kapodistrian University of Athens, KAT Hospital


1. Kumar R, Lim J, Mekary RA, et al. Traumatic Spinal Injury: Global Epidemiology and Worldwide Volume. World Neurosurg. 2018;113:e345-63.
2. Kirshblum SC, Waring W, Biering-Sorensen F et al. Reference for the 2011 revision of the International Standards for Neurological Classification of Spinal Cord Injury. J Spinal Cord Med. 2011;34(6):547-54.
3. Hou S., & Rabchevsky, A. G. Autonomic Consequences of Spinal Cord Injury. Comprehensive Physiology 2014;1419–53.
4. Alexander MS, Aisen CM, Alexander SM et al. Sexual concerns after Spinal Cord Injury: An update on management. NeuroRehabilitation. 2017;41(2):343-57..
5. McMahon CG, Abdo C, Incrocci L, et al. Disorders of orgasm and ejaculation in men. J Sex Med. 2004;1(1):58-65.
6. Meston CM, Hull E, Levin RJ, et al. Disorders of orgasm in women. J Sex Med. 2004;1(1):66-68.
7. Sexual health and its linkages to reproductive health: an operational approach. Geneva: World Health Organization; 2017. Licence: CC BY-NC-SA 3.0 IGO.
8. Alavinia SM, Hitzig SL, Farahani F, et al. Prioritization of rehabilitation Domains for establishing spinal cord injury high performance indicators using a modification of the Hanlon method: SCI-High Project. J Spinal Cord Med. 2019;42(sup1):43-50.
9. Taylan S, Gözüyeşil E, Manav Aİ, et al. An evaluation of the factors that affect the sexual satisfaction of people with spinal cord injuries. J Spinal Cord Med. 2019:1-8.
10. Dimitriadis F, Karakitsios K, Tsounapi P, et al. Erectile function and male reproduction in men with spinal cord injury: a review. Andrologia. 2010;42(3):139-65.
11. Bedbrook GM. The care and management of spinal cord injuries. Springer Science & Business Media, 2013.
12. Courtois FJ, Charvier KF, Leriche A, et al. Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury. BJU Int. 2008;101(3):331-37.
13. Soler JM, Previnaire JG, Plante P, et al. Midodrine improves orgasm in spinal cord-injured men: the effects of autonomic stimulation. J Sex Med. 2008;5(12):2935-41.
14. Hajiaghababaei M, Javidan AN, Saberi H,et al. Female sexual dysfunction in patients with spinal cord injury: a study from Iran. Spinal Cord. 2014;52(8):646-49.
15. Forsythe, E., Horsewell, J. Sexual rehabilitation of women with a spinal cord injury. Spinal Cord 2006;44:234–41
16. Ferreiro-Velasco ME, Barca-Buyo A, de la Barrera SS, et al. Sexual issues in a sample of women with spinal cord injury. Spinal Cord. 2005;43(1):51-55. doi: 10.1038/sj.sc.3101657.
17. Kreuter M, Taft C, Siösteen A, et al. Women’s sexual functioning and sex life after spinal cord injury. Spinal Cord. 2011;49(1):154-60.
18. Courtois F, Rodrigue X, Côté I, et al. Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat? Spinal Cord. 2012;50(12):869-77.
19. Post MW, van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal Cord. 2012;50(5):382-89. doi: 10.1038/sc.2011.182. Epub 2012 Jan 24.
20. Lombardi G, Del Popolo G, Macchiarella A et al. Sexual rehabilitation in women with spinal cord injury: a critical review of the literature. Spinal Cord. 2010;48(12):842-49.
21. Bailey KA, Gammage KL, van Ingen C, et al. Managing the stigma: Exploring body image experiences and self-presentation among people with spinal cord injury. Health Psychol Open. 2016;3(1):2055102916650094..
22. Sale P, Mazzarella F, Pagliacci M.C, et al. Predictors of Changes in Sentimental and Sexual Life After Traumatic Spinal Cord Injury. Archives of Physical Medicine and Rehabilitation 2012l;93(11):1944-49.
23. New PW, Seddon M, Redpath C, et al. Recommendations for spinal rehabilitation professionals regarding sexual education needs and preferences of people with spinal cord dysfunction: a mixed-methods study. Spinal Cord. 2016;54(12):1203-09.
24. Alexander M, Courtois F, Elliott S, et al. Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom. Top Spinal Cord Inj Rehabil. 2017;23(1):57-70.
25. Soler JM, Previnaire JG, Denys P, et al. Phosphodiesterase inhibitors in the treatment of erectile dysfunction in spinal cord-injured men. Spinal Cord. 2007;45(2):169-73.
26. Shridharani AN, Brant WO. The treatment of erectile dysfunction in patients with neurogenic disease. Transl Androl Urol. 2016;5(1):88-101.
27. Alexander, M., Rosen, R., Steinberg, S. et al. Sildenafil in women with sexual arousal disorder following spinal cord injury. Spinal Cord 2011;49:273-79
28. Chochina L, Naudet F, Chéhensse C, et al. Intracavernous Injections in Spinal Cord Injured Men With Erectile Dysfunction, a Systematic Review and Meta-Analysis. Sex Med Rev. 2016;4(3):257-69.
29. Rivas DA, Chancelor MB. Management of erectile dysfunction. In: Sipski ML, Alexander CJ, eds. Sexual Function in people with disability and chronic illness. Gaithersburg, Md: Aspen Publishers;1997, pp 429-464
30. Calabrò RS, Naro A, Pullia M, et al. Improving Sexual Function by Using Focal Vibrations in Men with Spinal Cord Injury: Encouraging Findings from a Feasibility Study. J Clin Med. 2019;8(5):658.
31. Brackett NL, Ibrahim E, Iremashvili V, et al. Treatment for ejaculatory dysfunction in men with spinal cord injury: an 18-year single center experience. J Urol. 2010;183(6):2304-08.
32. Kabalin JN, Kessler R. Infectious complications of penile prosthesis surgery. J Urol. 1988;139(5):953-55.
33. Lombardi G, Mondaini N, Giubilei G, et al. Sacral neuromodulation for lower urinary tract dysfunction and impact on erectile function. J Sex Med. 2008;5(9):2135-40.
34. Overgoor ML, de Jong TP, Cohen-Kettenis PT, et al. Increased sexual health after restored genital sensation in male patients with spina bifida or a spinal cord injury: the TOMAX procedure. J Urol. 2013;189(2):626-32.
35. Courtois F, Alexander M, McLain ABJ. Women’s Sexual Health and Reproductive Function After SCI. Top Spinal Cord Inj Rehabil. 2017;23(1):20-30.
36. Alexander M, Bashir K, Alexander C, et al. Randomized Trial of Clitoral Vacuum Suction Versus Vibratory Stimulation in Neurogenic Female Orgasmic Dysfunction. Arch Phys Med Rehabil. 2018;99(2):299-305.
37. Zimmerman LL, Rice IC, Berger MB, et al. Tibial Nerve Stimulation to Drive Genital Sexual Arousal in an Anesthetized Female Rat. J Sex Med. 2018;15(3):296-303.
38. Krassioukov A,MacHattie E, Naphtali K, et al. Pleasurable: Sexual device manual for persons with disabilities. Funded Project: Disabilities Health Research Network, Vancouver 2009