Colm Treacy

The nature and severity of a man’s neurological condition may have a profound effect on erectile function and this warrants careful consideration in relation to providing supportive treatment options that are effective, safe and acceptable for the individual and his partner. Neurological disorders contribute to erectile dysfunction (ED) in a number of different ways and may occur as a direct result of impairment in the central nervous system, the peripheral nervous system, or a combination of both. Functional loss associated with the condition itself and subsequent damage to CNS structures (including spinal tracts, cerebral cortex, spinal cord or the autonomic nerves), may reduce the capacity to physically experience genital sensation, engage in physical intimacy and achieve erection, normally associated with sexual intercourse. In most neurological disorders, comorbid depression, altered body image, and the prescription of various medicines used to manage symptoms such as pain, spasticity, continence (amongst others) may nefariously contribute to patient’s psychological wellbeing, negatively impact on quality of life and affect relationships. Nurses are ideally placed to assess the relative impact of the neurological condition and the effects of various treatments on erectile function. Proactively addressing patients’ sexuality and making it a natural part of holistic nursing care allows for early detection of any problems that otherwise would go unidentified. Availability of guidelines & information about how to access various treatments for ED may be useful in all neurological care units, so that nurses and other health professionals are adequately equipped to provide appropriate information, reassurance and acceptable treatment interventions. Decisions regarding selection of specific treatments should take into account the preferences and expectations of patient and his partner. As first-line therapy and in the absence of contraindications to their use, conventional treatments such as the phosphodiesterase-5 inhibitors (PDE5Is) have been shown to significantly improve erectile function. Taking into account the patient’s mobility, dexterity and ability to self-administer, other treatments such as intracavernosal injections, medicated urethral system for erection (MUSE) and the use of vacuum constriction devices (VCDs) may be reserved for patients who do not have a response to PDE5Is, or in whom these drugs are poorly tolerated, or contraindicated. Psychosexual counselling may be helpful in cases of erectile dysfunction with psychological needs or relationship difficulties. This talk begins by focusing on the neurobiology of sexual arousal and the biological basis for erectile dysfunction in men with a variety of neurological disorders, including stroke, MS, Parkinson’s disease, Epilepsy, autonomic dysfunction and spinal cord injury (SCI). After considering the range of problems men typically experience with ED secondary to neurological impairment, we will discuss the relative benefits of various treatment options and current guidelines and good clinical practice for management of ED.