opinions and comments Sexual Dysfunction To the Editor:

The Authors Respond: We appreciate the kind comments by Nancy Manus-Garlinghouse. She has called to our attention an error. The word "incomplete" was omitted by mistake. The statement should have read, "Absence of any type of erection is more common in complete upper-motor-neuron lesions than with incomplete lower-motor-neuron lesions." Ms. Manus-Garlinghouse is correct in her obser­ vation that, when the lesion is complete, the higher the lesion, the better the chances for a man to have an erection. This is an unfortunate complication, for a complete lesion diminishes the potential for the patient to be functionally more independent and ac­ tive. Volume 59 / Number 11, November 1979

NANCY MANUS-GARLINGHOUSE, RPT Topeka-Shawnee County Health Department PO Box 118 1615 West 8th St Topeka, KS 66601

REFERENCES 1. Conine T, Disher C, Gilmore S, et al: Physical therapists' knowledge of sexuality of adults with spinal cord injury. Phys Ther 59:395-398, 1979 2. Bors E and Comarr AE, as cited in Weber D, Wessman H: A review of sexual function following spinal cord trauma. Phys Ther 51:290-294, 1971 3. Griffith E: Sexual function in spinal cord injured patients. Arch Phys Med Rehabil 54:539-543, 1973

Male erection can be either psychogenic or reflexogenic. Psychogenic erection requires an intact spinal cord and parasympathetic nervous system. Any inter­ ruption in the pathway between the brain, the psy­ chogenic center in the thoracic section of the spinal cord, and the parasympathetic connection to the penis will interfere with psychogenic erection. Thus if the injury is complete, the man is unlikely to get a psychogenic erection. Reflexogenic erection requires that the sacral section of the spinal cord and the second, third, and fourth sacral nerve roots be intact. Any complete injury in these areas not only will interfere with reflex erection but will probably also prevent psychogenic erection as well. This, therefore, explains the statistics that indicate a higher percentage of erections in men with complete upper-motor-

1417

Downloaded from https://academic.oup.com/ptj/article-abstract/59/11/1417/4559961 by guest on 27 October 2019

Thanks for the article by Conine, Disher, Gilmore, and Fischer, "Physical Therapists' Knowledge of Sex­ uality of Adults with Spinal Cord Injury," in the April issue. It was a thorough study and made an excellent point. However, there was one fact in Table 3 on which I have found some controversial statistics. That is, "absence of any type of erection is more common in complete upper-motor-neuron lesions than with lower-motor-neuron lesions."1 This "unrecognized truth" (as the table is titled) does not specify whether the lower-motor-neuron lesions referred to are complete or incomplete. Usu­ ally comparisons are made between complete uppermotor-neuron lesions and complete lower-motorneuron lesions and the same type of comparisons are made between incomplete lesions. Comparisons as such are scientifically useful. Thus, I will assume that the comparison about the lower-motor-neuron lesion in Table 3, in fact, refers to a complete lesion. I have found just the opposite statistics in my own study of sexual dysfunction. Patients with uppermotor-neuron lesions have a much higher incidence of return in ability to obtain erections than do those with lower-motor-neuron lesions. In Bors and Comarr's 1960 study, 85 to 90 percent of patients with upper-motor-neuron lesions could have erections, but

only 25 percent of patients with lower-motor-neuron lesions could. Men with injuries to the cervical part of the spinal cord had the largest percentage of erec­ tions compared to men with injuries at other levels.2 Also, Griffith compiled information on the inci­ dence of erection in subjects from nine studies (his Tab. 2) and found a composite range of 54 to 87 percent.3 Men with incomplete lesions had more erec­ tions than did men with complete lesions, men with upper-motor-neuron lesions had more erections than did men with lower-motqr-neuron lesions, and men with higher-level spinal cord lesions had more erec­ tions than did men with lower-level spinal cord le­ sions. I would again like to express my appreciation for the thought-provoking and stimulating article in our Journal.

Sexual dysfunction.

opinions and comments Sexual Dysfunction To the Editor: The Authors Respond: We appreciate the kind comments by Nancy Manus-Garlinghouse. She has cal...
225KB Sizes 0 Downloads 0 Views