CHAPTER 28
THE SEXUAL PROBLEM
Sexual disturbances, which inevitably follow a severe injury of the spinal cord, regardless
of whether the lesion is complete or incomplete, constitute a complex problem in the
rehabilitation of paraplegics and even more in tetraplegics. It must be remembered that,
whatever the level and however severe the spinal cord injury may be, the urge to sexual
relationship, the libido, continues commensurate with the patient's age and his or her
pre-paraplegic sexual tendencies and activities. No mastery over physical disability
can completely dispel that yearning for affection which is just as common in most
severely disabled people as it is in the able-bodied. Therefore, the readjustment of the
paraplegic to his sexual dysfunction and the adequate supplementation of his sexual
drive is essential for his successful domestic and social resettlement.
A. IN THE MALE
We have to consider here, in particular, the problems of potency and fertility. Both
married and unmarried patients in the majority are naturally interested in their chances of
reproductive activity. This information was found to be sometimes particularly impor
tant to patients of the Catholic faith or those who were engaged to Catholic girls. For,
if their parents and, indeed, sometimes priests still adhered to the view, generally held
for a long time, that paraplegics and tetraplegics were impotent and infertile, the people
concerned met great opposition to marriage. Experience during the last 25 years has
shown that such generalized prejudice is no longer acceptable.
The pathophysiology of sexual function
Normal sexual function depends on a co-ordinated activity of cerebral, spinal and
peripheral components of the nervous system as well as on the condition of the anatomical
structures of the reproductive organs themselves. Following spinal cord transection,
one has, as with bladder and bowels, to distinguish three phases in the pathophysiology
of the sexual organs: spinal shock, reflex return and re-adjustment.
Stage of spinal shock
In the stage of spinal shock, voluntary control is eliminated, as descending messages from
the brain are blocked at the point of transection, as also are afferent impulses to the brain
from the reproductive organs via the spinal cord at the point of transection. The erec-
tional and ejaculatory functions are abolished. It is true that, in complete lesions, the
penis becomes enlarged and more or less semi-erected, which is often misinterpreted as
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