Erectile dysfunction in disorders of the spinal roots and peripheral mononeuropathies in the sacral region
Knowledge of sexual function in patients with spinal root disordersor sacral mononeuropathies is limited (see Lundberg (1992). Sacral root lesions cause pain at coitus and ejaculation, perhaps leading to Impotence. Bilateral S2-5 root lesions results in dribbling ejaculation, since seminal emission is preserved, but there is weakness of bulbo- and ischiocavernosus muscles. The sacral sensory disorder prevents reflex erection but psychogenic erections are unaffected. Unilateral sacral root lesions causing ipsilateral genital anaesthesia do not usually inhibit sexual activity. Lumbar spinal stenosis may be accompanied by spontaneous erections after walking a short distance (Hopkins et al 1973, Laha 1979), in addition to the classic presenting features. Sitting down relieves all symptoms including the erection over a few minutes. Erections may also appear after kneeling for a few minutes, relieved by sitting with spine flexed. Laminectomy results in complete relief. Mononeuropathies of the pudendal nerve or its branches are common in women (Lundberg 2001) and may cause local pain and dyspareunia.
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