Here is sexuality for men on the Christopher Reeve's website.
http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5917433/apps/s/content.asp?ct=5865547
http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.5917433/apps/s/content.asp?ct=6769155
Sexual function is a major concern of men with paralysis. Men wonder if they
can "do it" or whether 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 can affect a person’s sexuality.
It is important to note that healthy sexuality involves warmth, tenderness,
and love, not just genital contact. Still, erections and orgasms are the top
issues after paralysis.
Normally, men have two types of erections. Psychogenic erections result from
prurient sights or thoughts and depend on the level and extent of paralysis.
Men with complete parlaysis usually do not have psychogenic erections. A reflex
erection occurs involuntarily by direct contact with the penis or other
erogenous zones (ears, nipples, neck). Most paralyzed men are able to have a
reflex erection unless nerves in the sacral spinal cord (S2-S4) are damaged.
Orgasm after paralysis is possible for some men but it is often not the same as
it is usually defined. It can become less physical, less focused on the
genitals and more a state of mind. It is important to know that loss of
sensation does not rule out loss of sexuality.
While many men who are paralyzed can still "get it up," the erection may not be
hard enough or last long enough for intercourse. Numerous treatments (pills,
pellets, shots and implants) are available for treating erectile dysfunction
(ED). Be sure to see your doctor for accurate information on the various
options.
The best-known clinical treatment for ED, Viagra (sildenafil), improves the
quality of erections and sexual activity in many paraplegic men. There is some
clinical evidence that men with MS benefit from Viagra. Men with blood pressure
issues (high or low) or vascular disease should avoid this drug. Other newer
medications that purport to surpass the efficacy of Viagra include Cialis and
Levitra. They may have beneficial effects for paralyzed men but no clinical
data is available.
Another erection option involves injecting a drug (papavarine or alprostadil)
into the shaft of the penis. This produces a hard erection that can last for an
hour or more. Caution: these drugs can result in priapism, a prolonged erection
that can damage the penis. Injection erections can also cause bruising,
scarring or infection and may not be the best option for those with limited
hand function.
A medicated urethral suppository is another option. A drug pellet (containing
alprostadil) is placed into the urethra, causing blood vessels to relax and
fill the penis with blood. This might be an alternative for the 30-40 percent
of men who fail with Viagra.
Vacuum pumps are a non-invasive, non-drug way to produce an erection. The penis
is placed in a plastic cylinder; as air is pumped out, blood is drawn into the
penis. Hardness is maintained by placing an elastic band around the base of the
penis. This produces a bluish looking erection that may also be cold to the
touch. Be sure to remove the band after 30 minutes to avoid skin irritation.
Medicare and insurance companies often pay for these devices (you need a
prescription though), including a battery-operated model best for those with
limited hand function.
A penile prosthesis (a semi-rigid or bendable rod or inflatable device) is
another choice, but because it is permanent and requires surgery, it is carries
a higher risk for complications than other options. Surgery can cause bleeding,
infection, or allergic reaction to anesthesia. Following a routine outpatient
procedure, a four to eight week recovery period is necessary before the implant
can be used. The device itself, especially the more complex inflatable units,
can malfunction or become damaged.
Ejaculation and fertility are also major issues facing men with paralysis. Men
want to know, can I still father children? Ejaculation is not always possible
but there are ways to retrieve viable sperm. A vibrator is an inexpensive and
fairly reliable tool to produce an ejaculation at home or in a clinical
setting. Rectal probe electroejaculation is an option (albeit in a clinic with
several technicians around) if the vibratory method is not successful.
Borrowing from animal husbandry, electroejaculation places a probe in the
rectum; a measured electrical stimulation produces an ejaculation.
Once sperm are collected they can be used in various means of artificial
insemination, including in vitro techniques and micromanipulation. Sometimes
the retrieved sperm are healthy but not strong
