Sexual Dysfunction in Cervical Spondylomyelopathy and Its Prognosis Following Surgical Decompression: A Systematic Review.

Study design: Systematic review.

Objective: While the occurrence of sexual dysfunction in patients sustaining traumatic cervical or thoracic injuries is well acknowledged, the evidence regarding its prevalence and outcome in individuals with degenerative cervical myelopathy (DCM) is still limited. The current systematic review was planned to comprehensively evaluate the existing literature regarding the prevalence, patterns, presentation, and outcome of sexual dysfunction in patients presenting with DCM.

Methods: A thorough search of the literature was performed on October 15, 2024, using 5 different databases (Google Scholar, Embase, PubMed, Web of Science and Cochrane Library). Studies on sexual dysfunction in DCM published until 2024 were scrutinized. Narrative or systematic reviews, opinions, letters to the editor, and manuscripts published in non-English languages were excluded.

Results: Overall, the literature search yielded a total of 384 articles of which 7 articles with 910 patients were included in the analysis. The overall prevalence of erectile dysfunction (ED) in CSM ranges between 3 and 6%. 82% of patients with preoperative ED had an abnormal psychogenic erection while the remaining had an abnormal reflexogenic erectile function. The erectile function was reported to improve substantially following decompressive surgery (68% recovery rate; P = 0.05). The presence of preoperative sexual dysfunction has been associated with poorer neurological outcomes (50% recovery rate; including poorer gait recovery). The data regarding ejaculatory disturbances and female sexual dysfunction in DCM patients are still limited.

Conclusion: ED occurs in 3 to 6% of patients with DCM, with a majority of patients suffering from ED from psychogenic origin. Surgical decompression can significantly improve the sexual recovery in these patients. Patients with ED have overall poorer neurological recovery.