Sexual Dysfunction in Patients with Peripheral Nervous System Disorders

Erectile dysfunction, decreased lubrication, disturbances of ejaculation, orgasm, and even loss of sexual desire can occur in patients with peripheral nervous system lesions. In patients with cauda equina damage there are erectile and ejaculatory disturbances (delayed or absent, dribbling; occasionally premature). In a group of 46 men with cauda equina lesions of differing causes and variable severity, only 15% reported normal sexual function. Women report loss of erotic sensation, dyspareunia, loss of lubrication, loss of feeling during vaginal intercourse, difficulties in achieving orgasm, and changes in the feeling of orgasm. Among long-distance cyclists, it was found in one study that 22 percent had penile sensory symptoms and 13 percent had erectile dysfunction; symptoms were transient but persisted for up to 8 months. Erectile dysfunction may follow pelvic injury or surgery (abdominoperineal resection for carcinoma, hysterectomy, radical prostatectomy, sphincterotomy…), owing to involvement of the neurovascular bundles. In diabetes, neuropathy is contributing to erectile and lubrication problems, and causing retrograde ejaculation. Overall the incidence of erectile dysfunction in a population of 9500 diabetic men (20 to 70 years old) was 38 percent. Sexual dysfunction occurs in a significant proportion of patients with chronic renal failure; dysfunction improves after transplantation. Dysfunction occurs in other peripheral neuropathies: HIV, toxins, amyloidosis, vitamin B1 or vitamin B12 deficiency, parainfectious, paraneoplastic, hereditary sensory neuropathy and Charcot–Marie–Tooth syndrome.