Sexual activity and function of adult men with spina bifida: an international study
Konrad M. Szymanski, MD MPH1, Devon J. Hensel, PhD2, Joshua D. Roth, MD1, John S. Wiener, MD3, Benjamin Whittam, MD MS1, Martin Kaefer, MD1, Katherine H. Chan, MD MPH1, Richard C. Rink, MD1, Mark P. Cain, MD1, Rosalia Misseri, MD1.
1Riley Hospital for Children, Indianapolis, IN, USA, 2Department of Pediatrics and Department of Sociology, Indiana University Purdue University Indianapolis,, Indianapolis, IN, USA, 3Section of Pediatric Urology, Duke University Medical Center, Durham, NC, USA.
BACKGROUND: Little is known about sexual function of men with spina bifida (SB). The aim of this study was to assess sexual activity and erectile dysfunction (ED) in men with SB.
METHODS: We performed an international online survey of men ≥18yo with SB. Participants were recruited via SB clinics and social media. We collected data on demographics, ambulation (Hoffer classification), penile rigidity (Erection Hardness Score), sexual activity and ED (International Index of Erectile Function). Non-parametric tests were used for analysis.
RESULTS: Of 69 men (median age 35, 62.3% shunted, 27.1% community ambulators), 50.7% were single and 43.4% in a relationship (18.8% married). Overall, 35.3% reported full penile rigidity with erections, more commonly in men with better ambulation (p=0.04). 66.2% of men achieved orgasm and 78.3% ejaculated.Lifetime solo masturbation was reported by 91.3%, partnered non-genital contact: 85.5%, mutual masturbation: 78.3%, and partnered intercourse: 75.4% (62.3% vaginal). Median age at first sexual contact was 19 years, with a median 3.5 lifetime partners. Of 25 men who previously used phosphodiasterase type 5 (PDE5) inhibitors, 76.0% had improved erections and 56.0% improved intercourse.Overall, 46.3% of men reported non-genital erogenous zones as most pleasurable, more commonly in men with poorer ambulation (p=0.03). Nipples (38.7%) and chest (22.6%) were most common.In 18 men (26.9%) who attempted sexual intercourse in the last 4 weeks, 61.1% had ED (16.7% severe, 5.6% moderate, 22.2% mild-moderate, 16.7% mild). In this group, ED was present in 7/7 men with less than full penile rigidity, compared to 4/11 (36.4%) with full penile rigidity (p=0.01). CONCLUSIONS: While ED is common in men with SB, PDE5 inhibitors are frequently used and may benefit the SB population. Better ambulation is associated with better erectile function. Partnered sexual activity is common, although may not involve penetrative intercourse.
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