Abstract
Study design:
Systematic review.
Objective:
To review sexuality in persons with spinal cord injuries (SCIs), and to report the effectiveness of erectile interventions.
Methods:
Reports from six databases (1966–2003), selected annual proceedings (1997–2002) and manufacturer's information were screened against eligibility criteria. Included reports were abstracted and data pooled from case-series reports regarding intracavernous injections and sildenafil.
Results:
From 2127 unique reports evaluated, 49 were included. Male sexual dysfunction was addressed in these reports of several interventions (behavioural therapy, topical agents, intraurethral alprosatadil, intracavernous injections, vacuum tumescence devices, penile implants, sacral stimulators and oral medication). Penile injections resulted in successful erectile function in 90% (95% CI: 83%, 97%) of men. Sildenafil resulted in 79% (95% CI: 68%, 90%) success; the difference in efficacy was not statistically significant. Five case-series reports involving 363 participants with penile implants demonstrated a high satisfaction rate, but a 10% complication rate.
Conclusions:
A large body of evidence addressing sexuality in males focuses on erection. Penile injection, sildenafil and vacuum devices generally obviate the need for penile implants to address erectile dysfunction. Interventions may positively affect sexual activity in the short term. Long-term sexual adjustment and holistic approaches beyond erections remain to be studied. Rigorous study design and reporting, using common outcome measures, will facilitate higher quality research. This will positively impact patient care.
Sponsorship:
Agency for Healthcare Research and Quality, US Department of Health and Human Services, 2101 East Jefferson Street, Rockville, MD 20852, USA.
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Acknowledgements
This document was prepared by the University of Ottawa Evidence-based Practice Center, Ottawa, Canada. We gratefully acknowledge the following individuals who served on our Technical Expert Panel (acknowledgment does not reflect endorsement of this report): Drs David Chen, Stanley Ducharme, Stacy Elliott, Arthur Leader, Todd Linsenmeyer and Shawn Marshall. We also thank Dr Meg Sears who helped in the drafting and editing of this manuscript.
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Note: Sexuality and Reproductive Health Following Spinal Cord Injury. Evidence Report (AHRQ Publication No. 05-E003-2). The views expressed in this article are those of the authors and do not necessarily reflect those of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services. Appendices and Evidence tables cited in this report are available at http://www.ahrq.gov/downloads/pub/evidence/pdf/sexlspine/sexlspine.pdf
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DeForge, D., Blackmer, J., Garritty, C. et al. Male erectile dysfunction following spinal cord injury: a systematic review. Spinal Cord 44, 465–473 (2006). https://doi.org/10.1038/sj.sc.3101880
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DOI: https://doi.org/10.1038/sj.sc.3101880
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