Male infertility and erectile dysfunction in spinal cord injury: A review

Objective: To review the pathophysiology, evaluation, and management of ere ctile dysfunction and infertility in spinal cord injury (SCI). Study Selections: Studies that covered various treatment options and their contraindications, complications, or side effects, including sildenafil (Vi agra(R)), intracavernosal injection therapy, topical medications and a uret hral delivery system, a vacuum erection device, and penile prostheses. Othe r studies covered the effects of SCI on reproduction: spermatogenesis and t esticular function, and seminal constitutents. In addition, assisted reprod uctive techniques were compared: external vibratory stimulation, electroeja culation, testicular sperm aspiration, and intracytoplasmic sperm injection . Conclusion: Coal-directed therapy is the mainstay of treatment of erectile dysfunction in men with or without SCI. The choice of therapy is often defi ned more by the needs of the patient's sexual relationship than by his erec tile dysfunction. The majority of men with SCI are infertile because of a c ombination of ejaculatory dysfunction, impaired spermatogenesis, and poor s emen quality. Although many technological advances have evolved to overcome ejaculatory dysfunction, the sperm density, motility, and function remain poor. Until these parameters are improved, men with SCT will have to pursue more financially and emotionally taxing procedures. Further studies to elu cidate the cellular and molecular mechanisms of diminished sperm quality ar e needed. Addressing the issues of erectile dysfunction and male infertilit y may help to preserve the relationship between the patient and his partner . (C) 1999 by the American Congress of Rehabilitation Medicine and the Amer ican Academy of Physical Medicine and Rehabilitation.