For many years, there had been a widespread and inaccurate belief that men who have suffered a spinal cord injury (SCI) were permanently and completely impotent and sterile. Ludwig Guttmann introduced the prostigmine test whereby it was injected intrathecally to produce erections and emissions and carried out systematic research to achieve fertility among male patients with an SCI. Despite his undoubted authority in the field, the test received widespread opposition at the time and eventually, because of the risks involved and the death of a patient, it was abandoned. Nevertheless, it served as a stimulus for the development of the modern approach towards sexual function in men with a spinal injury. The history of these controversies is of relevance to professionals treating patients with spinal injuries today.

In 1936, M. Kremer, H.E.S. Pearson and Wright carried out research in Samson Wrights’ Department of Physiology at the Middlesex Hospital Medical School where they studied the effect of intrathecal injections of 1–1.5 mg of prostigmine in 8 patients [1]. Prostigmine (generic name neostigmine) is a cholinesterase inhibitor. It is a parasympathomimetic agent that acts as a reversible acetylcholinesterase inhibitor. It does not cross the blood–brain barrier.

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