Spinal cord epidural stimulation for male sexual function in spinal cord injured rats.

Abstract

Background: 95% of men with spinal cord injuries exhibit difficulties with sexual function, including erectile dysfunction, anejaculation, retrograde ejaculation, poor ejaculatory force, and poor sperm quality.

Aim: The primary goal is to determine if well-established interventions, such as spinal cord epidural stimulation, are a feasible treatment for sexual dysfunction and if locomotor recovery training can be used to improve ejaculatory function in a rodent model of spinal cord injury (SCI).

Methods: Male Wistar rats underwent thoracic laminectomies (shams), spinal cord transections, or moderate spinal cord contusion injuries. In urethane-anesthetized rodents, terminal spinal cord epidural stimulation was performed to target the mid-lumbar level spinal generator for ejaculation (SGE) in animals with transection spinal cord injuries at 3-, 14-, or 70-days post-injury and in animals with sham surgeries and spinal cord contusions at 70 days post-injury. The impact of locomotor training frequency was examined in two groups of rats with spinal cord contusion, which underwent 1-hr of assisted plantar stepping on a treadmill, training two or five times weekly for 6 weeks. Terminal experiments in all groups were followed by measures of sperm concentration and post-mortem testicular weight and morphology.

Outcomes: Spinal cord epidural stimulation consistently induced the expulsion phase of ejaculation, and occasionally the emission phase of ejaculation in rats with chronic SCI.

Results: All animals were most responsive to spinal cord epidural stimulation combined with manual stimulation to induce ejaculation, with chronic injury resulting in the most consistent responses. Locomotor training improved response rates to spinal cord epidural stimulation, with intermittent training resulting in the most consistent induction of both the emission and expulsion phases of ejaculation. Sperm concentration was impacted by injury completeness and time-post injury, which was lowest in the chronic complete transection group of rats. Locomotor training resulted in an overall increase in sperm concentration, with 2 days per week of training resulting in a significant improvement of sperm motility.

Clinical implications: Spinal cord epidural stimulation combined with locomotor training is a feasible intervention for individuals with SCI who seek to regain sexual function.

Strengths and limitations: Although we have anecdotal reports of non-targeted L3 spinal cord epidural stimulation inducing ejaculation in humans having spinal cord injuries, the current outcomes may be underestimated as stimulation was carried out in anesthetized animals.

Conclusion: Spinal cord epidural stimulation to target the SGE is a feasible intervention for sexual dysfunction following SCI.