Table 2.
Summary of studies on male sexual function.
| Study | Population | Sexual activity |
How sexual function was assessed |
Desire/Arousal | Erectile Function | Ejaculatory/Orgas mic Function |
Satisfaction | Overall Satisfaction / Composite Score |
|---|---|---|---|---|---|---|---|---|
| Bomalaski22 | SB aperta: 16 males >18 yrs | 3/16 (13%) sexually active | Own questionnaire | 9/16 (56%) reported “normal” erections | ||||
| Cardenas3 |
SB*: 52 males ≥15 yrs HC status: 25/52 (48%) HC+ 27/52 (52%) HC− |
30/52 (57.7%) sexually active; 13/27 (48%) HC+ and 17/25 (68%) HC− | Perceived Quality of Life Scale (PQOL) | “Satisfaction with level of sexual activity”: HC−: 5.77 (±3.24), HC+: 4.28 (±3.34) | ||||
| Choi23 |
MMC or LMC: 47 males (mean age 25.2 yrs, range 20-39) SB type: 13/47 (28%) MMC, 34/47 (72%) LMC LOL: 22/47 (47%) lumbar, 11/47 (23%) sacral, 14/47 (30%) unknown |
24/47 (51%) sexually active in last month | IIEF in SA and SI |
SA: mean 6.33 (± 1.54) (TR 2-10) SI: mean 5.30 (±1.77) (p=0.05) Dysfunction in SA: 1/24 (4%)- none 10/24 (41%)- mild 9/24 (38%)- mild to moderate 4/24 (17%)- moderate 0/24 (0%)- severe |
SA: mean 23.58 (±6.91) (TR 1-30, NV >25) SI: mean 6.78 (±3.57) (p<0.001) Dysfunction in SA: 16/24 (67%)- none 4/24 (17%)- mild 1/24 (4%)- mild to moderate 2/24 (8%)- moderate 1/24 (4%)- severe |
ORGASMIC FUNCTION SA: mean 7.83 (±2.18) (TR 0-10) SI: mean 4.30 (±3.20) (p=0.001) Dysfunction in SA: 12/24 (50%)- none 7/24 (30%)- mild 2/24 (8%)- mild to moderate 2/24 (8%)- moderate 1/24 (4%)- severe |
INTERCOURSE SATISFACTION SA: mean 8.36 (±2.26) (TR 0-15) SI: mean 0.26 (±1.25) (p<0.001) Dysfunction in SA: 0/24 (0%)- none 8/24 (33%)- mild 12/24 (50%)- mild to moderate 3/24 (13%)- moderate 1/24 (4%)- severe |
OVERALL SATISFACTION SA: mean 6.21 (±2.00) (TR 2-10) SI: mean 4.35 (±1.30) (p=0.001) Dysfunction in SA: 3/24 (13%)- none 8/24 (33%)- mild 7/24 (29%)- mild to moderate 5/24 (21%)- moderate 1/24 (4%)- severe |
| Decter24 |
SB*: 57 males >18 yrs (median 28.6, range 18-55) LOL: 12/57 thoracic, 3/57 (5%) L1-L2, 13/57 (23%) L3, 11/57 (19%) L4, 8/57 (14%) L5, 10/57 (17.5%) sacral VP shunt status: 33/57 (57%) shunted 24/57 (42%) unshunted |
22/57 (39%) masturbated or attempted sexual intercourse | Own questionnaire | 41/57 (72%) achieved erections, more consistently with lower LOL and absence of a VP shunt Achieved erections by LOL: 6/12 (50%) thoracic, 3/3 (100%) L1-2, 7/11 (64%) L4, 6/8 (75%) L5, 10/10 (100%) sacral Achieved erections by shunt status: 20/33 (61%) shunted, 21/24 (87.5%) not shunted |
30/57 (53%) ejaculated, including 3/57 (5%) without an erection; 24/30 (85%) found ejaculation pleasurable Ability to ejaculate by LOL: 1/12 (17%) thoracic, 2/3 (67%) L1-L2, 5/13 (38%) L3, 6/11 (55%) L4, 6/8 (75%) L5, 10/10 (100%) sacral Ability to ejaculate by shunt status: 10/33 (30%) shunted, 21/24 (88%) not shunted |
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| Diamond13 |
MMC: 52 males ages 12-28 yrs (mean 16.8) LOL: 20/52 (38%) at or above T10 (level of sympathetic outflow) 32/52 (62%) below T10 Anocutaneous reflex status: 27/52 (52%) present 25/52 (48%) absent |
Unknown | Men and parents questioned | 36/52 (70%) had erections Achieved erections by LOL and reflexes: 21/21 (100%) of men with an intact anocutaneous reflex and LOL above T10 had erections; 7/11 (64%) with a negative anocutaneous reflex and LOL at or below T10, 2/14 (14%) with a negative anocutaneous reflex and LOL above T10 |
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| Gamé25 | MMC: 40 men >18 yrs (mean 29) | 16/40 (40%) had sexual intercourse in the last month, those sexually active tended to be older (mean 32 yrs vs 28) | IIEF in SA | 6.94 (±2.4) (TR2-10) | Mean: 11.61 (±9.44) (TR 1-30, NV >25) Erectile Dysfunction: 4/16 (25%)- none 3/16 (19%)- mild 4/16 (25%)- mild to moderate 5/16 (31%)- severe ED significantly more likely if sacral nerve root impairment present −10/12 (83%) with sacral nerve root involvement vs 0/4 (0%) without (p=0.017) |
ORGASMIC FUNCTION: Mean 3.52 (±3.86) (TR 0-10) | INTERCOURSE SATISFACTION: 3.7 (±4.81) (TR 0-15) | OVERALL SATISFACTION: Mean 4.7 (±3.34) (TR 2-10) |
| Gatti26 |
SB aperta and occulta: 125 males ≥18 yrs LOL: 23/125 (19%) L2 or above, 47/125 (39%) L3-L5, 50/125 (42%) sacral |
Sexual Contact: 3/23 (14%) L2 or above, 7/47 (14%) L3-L5, 15/50 (30%) sacral (p<0.05) | Own questionnaire | -3 men used sildenafil with subjective improvement -10 used vacuum constriction devices or intracavernous injection of vasoactive agents |
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| Lassmann17 | SB*: 42 men ≥18 yrs | 9/42 (21%) sexually active | WSFQ in SA |
DESIRE: Mean: 22 (±3) (max score 30) AROUSAL: Mean: 13.8 (±3.5) (max score 20) |
ORGASM: Mean: 14.8 (±3.5) | INTERCOURSE SATISFACTION: Mean: 13.3 (±1.3) (max score 15) | OVERALL SATISFACTION: Mean: 63.9 (±8.9) (TR 18-85) | |
| Lee27 | SB*: 17 males ≥18 yrs | Unknown | SHIM and IIEF in SA and SI combined | Median 5.0 (IQR 2.0-8.0) |
SHIM: Median 5 (IQR 1.0-12.0) (TR 1-25, NV >21) -Better function in lower LOL (p=0.02) but no association with ambulatory status (p=0.15) Erectile Dysfunction: 1/17 (6%)- none 1/17 (6%)- mild ED 3/17 (18%)- mild to moderate 2/17 (12%)- moderate 10/17 (59%)- severe |
ORGASM: Median 1.0 (IQR 0.0-5.0) (TR 0-10) | INTERCOURSE SATISFACTION: Median 3.0 (IQR 2.0-4.0) (TR 0-15) | OVERALL SATISFACTION: Median 3.0 (IQR 2.0-4.0) TR 2-10) |
| Lindehall28 | SB*: 7 males on CIC | Unknown | Qualitative Interviews | 6/7 (86%) able to achieve an erection and/or ejaculate | 6/7 (86%) able to achieve an erection and/or ejaculate | |||
| McCloskey29 | MMC: 24 males (also included other males with other GU anomalies) from a single institution | Unknown | SHIM | SHIM completed for 8 men with SB. Median SHIM was 16.5 (range 10-23) | ||||
| Roth30 | SB*: 122 males ages 18 yrs and older, median age 33 (Interquartile Range 27-41 yrs) | Unknown | Own questionnaire | In last 4 weeks, erections described as: 22/122 (18%)- none 27/122 (22%) not firm enough for sexual activity 23/122 (19%) firm enough for masturbation or foreplay only 50/122 (41%) firm enough for intercourse Ambulators (household, community, or normal) significantly more likely to have no ED than non-ambulators. Age, VP shunt, and history of bladder neck surgery not predictive of ED. |
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| Sandler31 |
SB*: 15 males, mean age 20 yrs (range 16-29) from 2 academic centers LOL: 3/15 (20%) thoracic, 3/15 (20%) mid-high lumbar, 7/15 (47%) low lumbar, 2/15 (13%) sacral |
4/15 (26.7%) | Rigi-Scan recordings, physical exam, structured interviews, own questionnaire | All interested in sex |
STIMULATED ERECTIONS: 11/15 (73.3%) able to stimulate erections -more common in those with lower LOL (p<0.01) and glans sensation (p<0.05) RIGI-SCAN OUTCOMES: 2/15 (13%)- normal 7/15 (46.7%)- intermediate 6/15 (40%)- flat/no nocturnal erections -related to sensory LOL (p<0.05), not ability to stimulate an erection |
11/15 (73.3%) able to ejaculate: −2/15 (13%) ejaculated without erections −3/15 (20%) had “good sexual feelings” with ejaculation -most described ejaculation as “dribbling,” -4/15 (27%) had ejaculate in their urine (retrograde ejaculation) |
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| Sawyer and Roberts4 | MC and MMC: 24 adolescents and young adults from a single institution | -13/24 (54%) kissed someone in a sexual way -5/24 (21%) had “further sexual activity” -3/24 (13%) had intercourse |
Own questionnaire | 19/24 (79%) “has had sexual fantasies” | 21/24 (88%) able to achieve erection | 16/24 (67%) able to ejaculate 14/24 (58%) orgasm | ||
| Shiomi32 |
SB*: 26 males Sharrard Classification: 3/26 (11.5%) Sharrard 1, 5/26 (19%) Sharrard 2, 3/26 (11.5%) Sharrard 3, 2/26 (8%) Sharrard 4, 7/26 (27%) Sharrard 5, 6/26 (23%) Sharrard 6 Genital sensation: 19/26 (73%) with 7/26 (27%) without |
11/26 (42%) had intercourse | Own questionnaire and IIEF | 22/26 (88%) had psychogenic erections by audio-visual stimulation -significant difference based on Sharrard classification [1/3 (33%) Sharrard 1 vs. 21/23 (91%) above Sharrard 2, p<0.05], but not touch sensation [17/19 (89%) with touch sensation vs 5/7 (71%) without] 14/26 (54%) had erections by tactile stimulation -significant difference based on touch sensation [13/19 (68%) with touch sensation vs. 1/7 (14%) without, p<0.05] but not Sharrard classification [10/20 (50%) under Sharrard 5 vs. 5/6 (83%) Sharrard 6] IIEF in SA: ED did not correlate with Sharrard classification or touch sensation -ED in 5/9 (55.5%) with touch sensation vs. 1/2 (50%) without -ED in 3/8 (37.5%) who achieved erections by tactile stimulation, 3/3 (100%) who did not |
23/24 (95.8%) ejaculated, with a significant difference based on Sharrard classification (1/3 (33%) Sharrard 1 vs. 22/23 (96%) above Sharrard 2, p<0.05) but not touch sensation (positive versus negative, 18/19 (94%) vs 5/7 (71%)) 17/24 (65%) orgasmed, with a significant difference based on touch sensation (positive vs. negative, 16/19 (84%) vs. 1/7 (14%), p<0.05) but not Sharrard classification (5/6 (83%) Sharrard 6 versus 12/20 (60%) under Sharrard 5) | |||
| Verhoef33 | SB aperta or occulta: 74 males 16-25 yrs | Sexual activity defined as French kissing or more; 71/119 (60%) of SB aperta HC+, 21/23 (93%) of SB aperta HC−, and 37/37 (100%) of SB occulta sexually active; 36/78 (46%) of men with high LOL, 54/63 (86%) with mid LOL, and 36/38 (94%) with low LOL sexually active | Structured interview and physical exam |
SB Type: ED reported in 8/28 (28.5%) with SB aperta HC+, 1/13 (7.7%) of SB aperta HC−, and 0/12 (0%) of SB occulta -difference not significant LOL: ED reported in 5/13 (48%) with high LOL, 4/25 (16%) with mid LOL, 0/15 (0%) with low LOL -significant difference (p<0.05) |
EJACULATION: SB Type: Problems with ejaculation in 11/28 (39%) with SB aperta HC+, 2/13 (15%) with SB aperta HC−, 0/12 (0%) with SB occulta -significant difference (p<0.05) LOL: Problems with erection in 7/13 (54%) with high LOL, 6/25 (24%) with mid LOL, and 0/15 (0%) with low LOL -significant difference (p<0.01) ORGASM: SB type: 12/28 (43%) with SB aperta HC+, 1/13 (7.7%) SB aperta HC−, 0/12 (0%) with SB occulta -significant difference (p<0.01) LOL: Problems with orgasm in 7/13 (54%) with high LOL, 5/25 (20%) with mid LOL, 1/15 (6.7%) with low LOL -significant difference (p<0.05) |
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| Verhoef34 | SB aperta or occulta: 64 males 16-25 yrs | Sexual intercourse: 13/22 (59%) HC− and 3/42 (7%) HC+ | Structured interview and physical exam | “Desire for sexual contact”: 21/22 (96%) HC− and 25/42 (60%) HC+ (p<0.05) | “Experiencing only sometimes or never, during masturbation or sexual contact”: Erection 1/22 (5%) HC− and 7/25 (28%) HC+ -difference not significant | “Experiencing only sometimes or never, during masturbation or sexual contact”: EJACULATION: 2/22 (9%) HC− and 10/25 (40%) HC+ (p<0.05) -difference not significant ORGASM: 1/22 (5%) HC− and 11/25 (44%) HC+ (p<0.05) -difference not significant |
“Satisfied with present sex life”: 14/22 (68%) HC− and 18/42 (43%) HC+ (p<0.05) | |
| Von Linstow35 | MMC: 26 males, mean age 27.1 yrs (SD 5.2) | Own questionnaire | 8/26 (31%) no erections 18/26 (69%) have erections: -5/18 (28%) have “hard” erections -6/18 (33%) “soft” -7/18 (39%) unknown |
2/26 (8%) had not tried to ejaculate 8/26 (31%) do not ejaculate 16/26 (62%) ejaculate |
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| Vroege36 | MMC: 8 men ≥19 yrs | Sexual contact: 6/8 (75%) Sexual intercourse: 5/8 (63%) |
Own questionnaire | Sexual fantasies in 6/8 (75%) Desire for sexual contact in 7/8 (88%) |
“About their present sexual life”: 2/8 (25%) dissatisfied, 2/8 (25%) neutral, 4/8 (50%) satisfied |
Abbreviations: SB (spina bifida); yrs (years); HC (hydrocephalus); HC+ (with hydrocephalus); HC− (without hydrocephalus); N/A (not applicable or available); MMC (myelomeningocele); LMC (lipomyelomeningocele); LOL (level of lesion); IIEF (International index of erectile function); SA (sexually active); SI (sexually inactive); TR (Theoretic Rank); VP (ventriculoperitoneal); CIC (clean intermittent catheterization); ED (erectile dysfunction); SHIM (sexual health inventory for men); WSFQ (Watts Sexual Function Questionnaire); VP (ventriculoperitoneal); MC (meningocele)
*
no further population description available
+
Spina bifida severity index derived from details regarding ambulation, continence management, decubitus ulcers, and presence or absence of ventriculoperitoneal shunt