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Abstract

Volume 14, Issue 1 (January 2012) 14, 61–68; 10.1038/aja.2011.70

Male sexual dysfunction and infertility associated with neurological disorders

Mikkel Fode1, Sheila Krogh-Jespersen2, Nancy L Brackett3, Dana A Ohl4, Charles M Lynne5 and Jens Sønksen1

1 Department of Urology, Herlev Hospital, University of Copenhagen, DK-2770 Herlev, Denmark
2 Department of Psychology, Florida International University, Miami, FL 33199, USA
3 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
4 Department of Urology, University of Michigan, Ann Arbor, MI 48108, USA
5 Department of Urology, University of Miami Miller School of Medicine, Miami, FL 33101, USA

Correspondence: Dr J Sønksen, (jens@sonksen.dk)

Received 13 May 2011; Revised 8 August 2011; Accepted 11 August 2011; Published online 5 December 2011

Abstract

Normal sexual and reproductive functions depend largely on neurological mechanisms. Neurological defects in men can cause infertility through erectile dysfunction, ejaculatory dysfunction and semen abnormalities. Among the major conditions contributing to these symptoms are pelvic and retroperitoneal surgery, diabetes, congenital spinal abnormalities, multiple sclerosis and spinal cord injury. Erectile dysfunction can be managed by an increasingly invasive range of treatments including medications, injection therapy and the surgical insertion of a penile implant. Retrograde ejaculation is managed by medications to reverse the condition in mild cases and in bladder harvest of semen after ejaculation in more severe cases. Anejaculation might also be managed by medication in mild cases while assisted ejaculatory techniques including penile vibratory stimulation and electroejaculation are used in more severe cases. If these measures fail, surgical sperm retrieval can be attempted. Ejaculation with penile vibratory stimulation can be done by some spinal cord injured men and their partners at home, followed by in-home insemination if circumstances and sperm quality are adequate. The other options always require assisted reproductive techniques including intrauterine insemination or in vitro fertilization with or without intracytoplasmic sperm injection. The method of choice depends largely on the number of motile sperm in the ejaculate.

Keywords: assisted reproductive techniques; ejaculation; electroejaculation; erectile dysfunction; infertility; nervous system diseases; penile vibratory stimulation; retrograde ejaculation; surgical sperm retrieval

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