F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
449
Sexual re-adjustment
The sexual re-adjustment of the paralysed is conditioned to a great deal by their desire,
experience and sexual habits in their pre-paraplegic life, whether this applies to love play
or actual methods of intercourse. It will also greatly depend on the co-operation and
helpfulness of the partner. Individuals, who had been indifferent to sexual activity before
their paraplegia, will hardly change. On the other hand, young married couples in parti
cular, will be very eager to adjust themselves in one way or another to the new situation.
Data published of the percentage of paraplegics and tetraplegics capable of intercourse
vary (Bors, 1963; Jackson, 1972). Jackson recently found in 20 male paraplegic and
tetraplegic athletes 85 per cent who had erections and 90 per cent who were able to carry
out intercourse but only 35 per cent who had ejaculations and orgasm. However, these
statistics do not classify these cases into complete and incomplete lesions.
It is much easier for a female paraplegic to satisfy her husband than for a male to
prevent frustration of his spouse, if he gets only short-lasting strong erections or semi-
erections or no erections at all. In those with short-lasting erection or semi-erection,
attempts could be made to maintain the erection by a constricting device such as appli
cation of a rubber ring at the base of the penis, as recommended by Reuben (quoted by
Jackson). However, many couples have found alternative methods of sexual intercourse
by manual or oral stimulation and even by artificial penile appliances of plastic material.
It is obvious that in the sexual re-adjustment of spinal paraplegics and tetraplegics
medical guidance must play a very important role. Once shyness and embarrassment on
the part of the patient as well as of the medical attendant is overcome, the patient and
his or her spouse will be only too pleased and grateful to discuss freely their sexual prob
lems. The medical attendant can be of tremendous help, especially in young couples
who had had no sexual experience before their paraplegia. The medical advice should
include the most suitable time for and the positioning during intercourse, which may
vary from case to case. Another important aspect in connection with intercourse is the
function of the bladder in the individual case to avoid urination during intercourse. All
this shows how important the proper assessment of potency and fertility is in these
patients, which will be discussed in the following chapter.
The assessment of potency and fertility
Investigators have employed various procedures to assess potency and fertility in para
plegics and tetraplegics, which can be divided into two main groups:
(i) Questionnaire and personal interview technique
The investigators have, of course, to rely entirely on the statements of the individual
by these techniques. Results obtained with these methods were reported by Bors in 1948
on 157 and in 1963 on 529 patients, Talbot in 1949 on 208 and in 1955 on 408 patients,
Zeitlin
et al.
in 1957 on 100 and Tsuji
et al.
in 1961 on 655 patients. The latter authors
stressed the difference between results obtained with the questionnaire technique and
