| 709 Room 517-D | Sexuality and Health Wednesday, July 13, 2005 Time: 8:30 AM-10:30 AM |
Male Sexuality Following Spinal Cord Injury. A Systematic Review.
DeForge , Daniel *,1, 2, Blackmer, Jeff1, 2, 1 The Rehabilitation Centre of The Ottawa Hospital, Ottawa, Ontario, Canada2 The University of Ottawa, Ottawa, Ontario, Canada
ABSTRACT- ABSTRACT (282 words) Objective: To review sexuality in persons with spinal cord injuries, and to report the effectiveness of erectile interventions. Methods: Reports from 6 databases (1996 to 2003), annual proceedings from ten groups (1997 to 2002) and information from manufacturers were screened against eligibility criteria (report characteristics, study design, population, and participant dropouts and withdrawals reporting). Included reports were abstracted and data were statistically pooled from case series reports regarding intracavernous injections and sildenafil. Results: 2,128 unique reports were evaluated for eligibility, of which 56 were included. Seven reports examined physical reflex and cognitive pathways of sexual response in SCI females. Male sexual dysfunction was addressed in 49 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 also 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 in males remain to be studied. Rigorous study design and reporting, using common outcome measures, will facilitate higher quality and less biased future research. This will positively impact patient care. Sponsorship: This study was commissioned by the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services 2101 East Jefferson Street, Rockville, MD 20852 U.S.A
Key words: spinal cord injury, sexual health, male sexual function, systematic review