F- CLINICAL ASPECTS OF SPINAL CORD INJURIES
461
where imaginative speculation and deduction on scanty grounds rather than on well-
founded evidence have prevailed.
3 A variety of types and degrees of reproductive deficiency can be distinguished through
the intrathecal prostigmin test.
4 Future research on the chemistry of the seminal fluid may give clues as to the cause or
causes of abnormalities of the morphology and function of spermatozoa. In this respect,
the deleterious effect of bladder infection on the various stations of the reproductive
system needs particular consideration.
5
The intrathecal prostigmin test can be utilized for artificial insemination. It is,
however, essential that the female partner undergo a thorough gynaecological examina
tion, including assessment of pH estimation of vaginal and cervix secretion and deter
mination of the most suitable time for assisted insemination.
6 Blood pressure and pulse should be examined at regular intervals during the prostig-
mine test from the start, especially in cervical lesions, to counteract excessive autonomic
hyperreflexia by appropriate measures (Ansolysen, etc.).
7 Patients, especially those with high cord lesions should be warned about undesirable
effects of prostigmin.
B. IN THE FEMALE
The main aspects to be considered are the effects of cord or cauda equina on menstrua
tion, pregnancy and labour. Studies on these problems have been published by Gerts-
mann (1926), Bors
et al.
(1950, 1960, 1963), Cooper & Hoen (1952), Talbot (1955),
Guttmann (1956,1963, 1964), Jung & Schmidt (1962), Robertson (1963), Comarr (1966),
Goller & Paeslack (1970).
In this connection it is worth while remembering that van Wagenen (1933) found,
following transection of the cord in the female primate, normal menstrual period present
5 to 6 days after the transection and thereafter normal periods at the usual intervals.
Moreover, Goltz & Ewald (1896) succeeded in inpregnating spinal bitches which delivered
normal litters of puppies.
Menstruation
In the great majority of our patients with complete or incomplete lesions at any level,
there was either no or only temporary cessation of menstruation, the return of periods
occurring from one to three months after injury. Only occasionally will the return of
periods be delayed longer. Menstrual irregularities have been reported after spinal cord
lesions, but the contrary may also occur—namely those patients with irregular periods
before the lesion may become regular afterwards (Comarr, 1966).
Organism
Orgasm during intercourse following penetration of the penis is absent in complete cord
lesions and those incomplete ones with bilateral section of the spino-thalamic tracts, but
