Paralysis Resource Guide - (Page 120) HEALTH MANAGEMENT Sexual Health FOR MEN Paralysis affects a man’s sexuality both physically and psychologically. Men wonder, “Can I still do it?” Men worry that sexual pleasure is a thing of the past. They worry that they can no longer father children, that mates will find them unattractive, that partners will pack up and leave. It is true that, after disease or injury, men often face changes in their relationships and sexual activity. Emotional changes occur, of course, and these too can affect a person’s sexuality. Erections are the number-one issue after paralysis. Normally, men have two types of erections. Psychogenic erections result from sexual thoughts or seeing or hearing something stimulating. The brain sends these arousing messages through the nerves of the spinal cord that exit at the T10–L2 levels, then relays them to the penis, resulting in tumescence. The ability to have a psychogenic erection depends on the level and extent of paralysis. Generally, men with an incomplete injury at a low level are more likely to have psychogenic erections than men with high-level, incomplete injuries. Men with complete injuries are less likely to experience psychogenic erections. A reflex erection occurs when there is direct physical contact to the penis or other erotic areas such as the ears, nipples or neck. A reflex erection is involuntary and can occur without sexual or stimulating thoughts. The nerves that control a man’s ability to have a reflex erection are located in the sacral segments (S2–S4) of the spinal cord. Most paralyzed men are able to have a reflex erection with physical stimulation unless the S2–S4 pathway is damaged. Ejaculation is the number-two issue. Researchers report that ejaculation occurs in up to 70 percent of men with incomplete lower-level injuries and in as many as 17 percent of men with complete lower-level injuries. Ejaculation occurs in about 30 percent of men with incomplete upper-level injuries and almost never in men with complete upper-level injuries. While many men who are paralyzed can still “get it up,” the erection may not be hard enough or last long enough for sexual activity. This condition is called erectile dysfunction (ED). Numerous treatments and products (pills, pellets, shots and 120
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