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Sexual function in men with cauda equina lesions: a clinical and electromyographic study
  1. S Podnar1,
  2. C Oblak2,
  3. D B Vodušek1
  1. 1Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, Slovenia
  2. 2Department of Urology, Division of Surgery, University Medical Centre Ljubljana
  1. Correspondence to:
 Dr S Podnar, Institute of Clinical Neurophysiology, Division of Neurology, University Medical Centre Ljubljana, SI-1525 Ljubljana, Slovenia;


Objective: To investigate the effects of cauda equina lesions on sexual function in men.

Methods: Sexual function was investigated in 46 men with long standing cauda equina/conus medullaris lesions. All had clinical and radiological findings supporting the diagnosis. The validated Slovene translation of the international index of erectile function (IIEF) was used. The responses were scored and sexual dysfunction categorised as absent, mild, moderate, or severe. The number of patients receiving help for sexual dysfunction was noted. Neurological examination of the trunk and lower limbs, electromyographic (EMG) evaluation of the sacral reflex, and quantitative EMG of the external anal sphincter muscles were done.

Results: Severe sexual dysfunction was reported by 35% of patients, moderate dysfunction by 24%, and slight dysfunction by 26%; normal sexual function was reported by 15%. Orgasmic function was slightly more impaired than erectile function, and sexual desire slightly less. The patients’ age, but no findings on clinical neurological or EMG examination, correlated with sexual function. Only five men had received medical attention for sexual dysfunction.

Conclusions: There is significant sexual impairment in men with lesions of the cauda equina or conus medullaris. This is poorly correlated with neurological and EMG findings and has received insufficient medical attention.

  • cauda equina lesion
  • electromyography
  • erectile function
  • sexual function
  • IIEF, international index of erectile function
  • MUP, motor unit potentials

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  • Competing interests: none declared