03/28/2013 // Concord, CA, USA // LifeCare123 // Greg A. Vigna M.D., J.D. // (press release)
Medical Perspective:
Following spinal cord injury to a male patient sexual function is effected both mentally and physically, both of which have a significant impact on the individual’s quality of life. Sexual education of both the patient and the partner, psychologic counseling of the patient, and medical interventions can greatly improve a patient’s quality of life.
‘There are two types of erections a man can have, psychogenic and reflex. Ability to achieve erection will depend on both the level of spinal cord injury and is the injury is complete or incomplete. Psychogenic erections occur with sexual thoughts or dreams and require an intact neurologic connection between the brain and spinal levels T11-L2 and the genitals. Reflex erections occur when there is physical contact to the penis or other areas such as the ears and will require intact neurologic connection between genitals and sacral segments (S2-S4). Successful ejaculation will also be effected by the level of injury and if the injury is complete or incomplete.
In spinal cord patients above T11, less than 10% of compete spinal cord patients and 50% of incomplete spinal cord patients will be able to achieve psychogenic erections. Ninety percent of patients with complete and incomplete spinal cord injuries above T11 will be able to achieve reflex erections with nearly half of patients achieving sustained erections to have successful intercourse. Only 5-10% of complete patients at these levels will be able to have ejaculation, while nearly a third of patients with incomplete injuries swill have ejaculation.’
In spinal injuries that effect sacral segments S2 to S4 psychogenic erections are preserved. Three fourths of incomplete injuries at these levels, and 12% of complete injuries will be able to achieve reflex erections. Incomplete injuries will have improved ejaculation function with three fourths of those patients achieving ejaculation.
It is this author’s opinion that an acutely injured spinal who is in spinal shock will often not have either psychogenic or reflex erections and will be in great despair regarding physical loss, potential social loss, and vocational loss that these statistics can be discussed with the patient that there is hope for successful sexual function with or without medical interventions.
It is this author’s opinion that sexual education of the patient and his partner should begin as the patient progresses out of spinal shock. Issues such strict adherence to a bowel and bladder program to prevent accidents during intercourse and adequate padding to prevent skin problems such as shear injuries or decubitus ulcers.
Medical interventions have proven successful in treating male sexual dysfunction. Viagra has been shown to be successful intervention if taken an hour prior to sexual activity with 10 to 20 percent of patients having some symptoms of low blood pressures. More invasive treatments such as injections, intraurethral medications (putting medicine in tip of penis, and external vacuum pumps have been effective when utilized by a knowledgeable physician with strict patient education. Implantable devices are not recommended because of the high risk of erosions and other complications.
It is this author’s opinion that sexual counseling and marital counseling are important both during the acute rehabilitation period and in the future. Men often will have feelings of despair, shame, and feelings of inadequacy if they are not able to have sex. For a patient without a partner there may be anxiety and depression that without sex or with sexual aids the patient will not be able to attract a partner. There may be long standing feelings of inadequacy that effects a marriage or other relationship going forward into the future that will require counseling.
It is this author’s opinion that if sexual dysfunction following spinal cord injury is addressed early with education, medical intervention, and potentially counseling depression, despair, and social isolation will be alleviated.
Life Care Planner’s Perspective:
All future medical needs that are necessary and appropriate caused by a catastrophic injury should be included to prevent complications, improve outcomes, and improve quality of life. A detailed history of sexual function and patient desires is necessary. Urologic evaluation and routine follow ups will be necessary to follow medications and devices. Medication cost, equipment cost, and equipment replacement schedules are necessary to understand future cost. Sexual counseling, individual counseling, and marital counseling will need to be considered.
Lawyer’s Perspective:
A serious injury lawyer must provide a medical foundation for future cost related to a catastrophic injury for a patient to receive a full judgment for their damages. Failure to take into account cost related to sexual dysfunction will lead to inadequate compensation. Sexual dysfunction will also provide evidence of pain and suffering that can be separately awarded at the jury’s discretion. Pain and suffering is defined as “physical pain/mental suffering/loss of enjoyment of life/disfigurement/physical impairment/inconvenience/grief/anxiety/humiliation/emotional distress”.
Sexual dysfunction will also be a basis for a loss of consortium claim by the uninjured spouse against the negligent party, whereby the spouse is suing for the ‘deprivation of the benefits of a family relationship’ which would include sexual relationships. Loss of consortium is defined as “1. The loss of love, companionship, comfort, care, assistance, protection, affection, society, and moral support; and 2. The loss of the enjoyment of sexual relations [or the ability to have children].”
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