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CHAPTER 28
Incomplete lesions
In incomplete cord lesions, various types of sexual dysfunction may occur depending
on the severity of lesion. There may be dissociations between strength and duration of
erection and power of ejaculation. Moreover, the associated closing reflex of the internal
sphincter complex of the bladder may be impaired, resulting in ejaculation of seminal
fluid into the bladder, or seminal urethral ejaculation is associated with discharge of
urine.
Orgastic sensations may or may not occur in incomplete lesions, depending on whether
or not there has been bilateral damage of the spino-thalamic tracts. In unilateral damage
of the spino-thalamic tract, orgastic sensation is, as a rule, present although more or less
diminished.
Excessive flexor—and especially adductor spasms—may be a great obstacle to penile
penetration, even in incomplete lesions with good erection and ejaculation. Resection
of the obturator nerve has proved, in our experience, to be most successful in removing
this obstacle and ensuring satisfactory intercourse.
Cauda equina lesion.
In cauda equina lesions, erection at will and reflexly is abolished only
if the sacral centre between 82-85 is destroyed, but seminal discharge may occur without
erection if the lumbar component of the centre has escaped damage. However, some
patients with incomplete or dissociated lesions of the cauda equina are able to get good
erections at will, but either have at first no orgastic sensations or, in fact, experience
discomfort and pain during ejaculation and are easily put off making further attempts.
However, by further trial, the pain usually disappears and is replaced first by a sensation
of warmth and later by some pleasurable sensation.
Sexual desire—dreams
There is a difference between the age groups as far as sexual desire is concerned. As one
would expect, sexual desire is certainly more pronounced in the younger age groups,
regardless of whether or not the individuals had been married or had had an active sexual
life before their paraplegia or tetraplegia. In the writer's experience no great differences
between males and females were observed in this respect, although in the manifestation
of her sexual desire the female will be more passive than the male. This is evidenced by
the greater interest of male paraplegics in sexual material, such as literature, pictures and
photographs. It is not uncommon to find photographs or calendars of nude girls in
various positions hanging on the wall of rooms occupied by male paraplegics living in
hostels and other institutions. In this respect, there is really no difference between the
paralysed and the able-bodied male.
An interesting point is the question of dreams, both day and night dreams, in para
plegics and tetraplegics. From personal interviews of both males and females it would
appear that erotic dreams occur, especially in those who had sexual experiences before
their spinal injury. In all the dreams reported, the individuals saw themselves as not
paralysed. However, more experience on this subject is necessary to come to definite
conclusions.
