Sexual dysfunctions and their associations with neurological level in spinal cord injured patients [Spinal kord yaralanmali hastalarda cinsel fonksiyon bozukluklari ve nörolojik düzey ile ilişkileri]

Objective: To determine sexual dysfunction and its association with neurological examination findings in spinal cord injured patients. Materials and Methods: Forty-three patients (30 men, 13 women) who were out of the spinal shock period were enrolled to the study. Information about the post-injury sexual functions was obtained via questionnaires. Erectile function was evaluated by International Index of Erectile Function-5 (IIEF-5), women sexual function was evaluated with Female Sexual Function Index (FSFI). Neurological level was determined according to American Spinal Injury Association (ASIA) impairment scale. These levels were classified into 4 groups, namely, T10 and above, T11-L2, conus, and cauda according to the alignment of the spinal cord centers responsible of sexual function. The relations between the data about erection, ejaculation, lubrication and orgasm, and neurological level were investigated. Results: Mean IIEF-5 score in men was 7±6.69. It was found that at levels of T10 and above; reflex erections were preserved with a 100% ratio. At conus-cauda lesions; while psychogenic erections were preserved with a 100% ratio, reflex erections were absent. In all patients with neurologic levels at or below T12, psychogenic erections were present. Ejaculation was present in 43.3% of men. Ejaculation rate was lower in T10 and above levels when compared with that in conus-cauda levels. Orgasm was present in 83.3% of the patients with conus-cauda lesions, and 54.5% of the patients with lesions above this level. Mean FSFI score in women was 2.35±0.94. Despite the lack of sufficient data in women, it was determined that in 83.3% of the patients with conus-cauda lesions, psychogenic lubrication was preserved while reflex lubrication was not. Orgasmic disorder was noteworthy in this limited sample of female patients. Conclusion: This study has demonstrated there is impairment in sexual dysfunction in both sex after spinal cord injury and that the classification of neurological level according to the spinal centers regulating sexual function in spinal cord injured patients has an imperative place in the estimation of the remaining sexual function