We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
Online ordering will be unavailable from 17:00 GMT on Friday, April 25 until 17:00 GMT on Sunday, April 27 due to maintenance. We apologise for the inconvenience.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Men with spinal cord injury often suffer from erectile dysfunction, ejaculatory dysfunction, infertility, and hypogonadism. Restoration of sexual and reproductive functions is a top priority and efficient treatment modalities exist. Erectile dysfunction can be treated with phosphodiesterase-5 inhibitors and if unsuccessful intracavernosal injections can be tried. When injections fail a penile implant can ultimately be an option. Anejaculation and the resulting infertility are treated in a stepwise approach with penile vibratory stimulation, electroejaculation and surgical sperm retrieval followed by assisted reproduction. Assisted ejaculation is an effective and safe procedure but carries a risk of autonomic dysreflexia, especially in men with injuries at the level of T6 or above. Autonomic dysreflexia is an unregulated and uncontrolled response of the sympathetic nervous system but it can be safely managed. Hypogonadism is more prevalent in men with spinal cord injury compared to the general population and testosterone replacement therapy can be beneficial for alleviating symptoms of low testosterone, but testosterone-related spermatogenic suppression needs to be considered in men who wish to initiate a pregnancy.
Reproductive endocrinologists use the concept of fecundability in addition to discussing pregnancy rates. Fecundability is a valuable clinical and scientific concept, as it creates the framework for the quantitative analysis of fertility potential. The factor affecting prognosis is the age of the female partner. An important part of the basic infertility evaluation is assessment of fallopian tube patency. A hysterosalpingogram (HSG) is the frequently utilized modality for tubal assessment. Patients who are prepared to enter into in-vitro fertilization (IVF) treatment are encouraged to undergo salpingectomy because of very low pregnancy rates after neosalpingostomy, high rate of recurrent occlusion, risk of ectopic pregnancy, and decreased success rates after IVF when hydrosalpinx is present. Ovarian reserve testing should be offered routinely to women over 35, as well as to those with unexplained infertility to respond to conventional infertility treatment, and to those contemplating assisted reproductive technologies (ART) therapy.
Recommend this
Email your librarian or administrator to recommend adding this to your organisation's collection.