Stacy Elliott, MD

Matt: Here’s a story for you. U2FP used to have a board member with a C7 injury. His name was Dave, and he was a dedicated quad rugby player. He and I used to talk about how hard it was for him to get his rugby friends to care about research. The light came on when Dave said this to me about how it is to hang out with the rugby guys …

  • You need a PhD when four guys share a hotel room to figure out the bowel program schedule
  • You have to work around everybody’s need to cath during a game
  • After the game at the bar, we talk about … sex.

These are the things that Dave thought would be needed to get that particular group of friends into the research world. Basically, it’s a lot of our focus this weekend. So, let’s do sex!

Here’s Stacy Elliott, whose work at iCord is all about sexuality post SCI.

I really appreciate being asked to talk … sexual function is right after hands and arms in quads and first in paras when they were asked what they most want back.

We have a sexual health rehab in our hospital. (Wow.)

In women, you can have a psychogenic, reflexogenic, or both kind of orgasm, depending on what’s preserved in the cord. More genital sensation = more arousal.

Marca Sipski has done a lot of work in this area.

Pre injury 90% of women are orgasmic, and about 40 to 50% after.

For men, there’s difficulty with erection, getting and maintaining.

Only about 10% of men with SCI can ejaculate … but you don’t need to have an erection to experience orgasm.

45 – 60% of men with SCI have low testosterone. This is 4 times as many as in the non-injured population. Causes include obesity, brain injury, meds, esp. opioids, hyperprolactimnemia …

In 1987, Dr George Srtasz was working on this .. there were very few options for men.

  • penile injections
  • penile prosthesis
  • poor bladder management for sex
  • rarely children

For women

  • no medications for sexual enhancement
  • stigma against even trying to be being mothers

Now for men:

  • more options for erection enhancement
  • better bladder management
  • ejaculation for pleasure with vibrostimulation
  • orgasm pursued over time
  • awareness of testosterone deficiency

For fertility, more than a 60% chance of being a biological father; the turkey baster  works 40% of the time, so IVF is often not needed.

Now for women:

  • still no meds for sexual arousal enhancement
  • use of Addyi
  • orgasmic pursuit through all kinds of vibrators
  • pregnancy  is now okay

Stacy works at Blouson Spinal Cord Center

Research in Sex and SCI with chronic conditions is her focus.

it’s harder to do than body research

We’re just catching up in studying sexuality in the ab population

We don’t have validated scales for sexual function

We don’t even know what orgasm is …

What she’s learned:

  • sexual potential extends far past plataeued somatic recovery
  • the brain remains the biggest sexual organ …
  • SCIsexualhealth.ca is a good resource
  • visceral sensations override “completeness”

30 years of clinical experience has taught me more than the literature. Patients are my teachers

There is only anecdotal evidence for many positive changes seen, but patients are to be believed.

Sexual experiences and subjective satisfaction are private and involve intimacy and emotion and are not lab reproducible (which makes it mighty hard to study them)

Boys will be boys … men want to have an orgasm (image of a baby grinning from behind a playboy magazine)

What about crosstalk between bladder and bowel?

Many men find that regular pvs (vibrator) leading to ejaculation is helpful with regulation of bowel and bladder function.

Dr Krassioukov and colleagues have been asking questions of participants with both epistim and transcutaneous about sexual changes, so we’re getting some data from those studies.

For those who missed this one, there’s a surgery called TOMAX that can restore sexual sensation in lower injuries. Some info here: https://www.washington.edu/news/2012/12/28/surgery-establishes-penile-sensation-in-men-with-spina-bifida/

At iCord they have a sperm retrieval clinic; PVS works best on injuries above T10. Semen quality is affected during the first couple of weeks post injury, but then seems to stay the same forever after that.

What are the risks of sexual activity?

  • AD stops people
  • Symptoms do get better with time, but BP readings don’t improve
  • Many people have silent AD
  • AD may transform into pleasurable sensation …

They’ve done some work that shows you want to gradually allow BP to rise — over time, a bunch of very sudden jumps in BP can cause impairment in the brain. (Ugh.)

Perinatal issues for women with sci

  • post injury no period for 6-9 months
  • breastfeeding is tough for women with cervical injuries, and not just because they lack hand function; half of them get AD from breastfeeding.

Pleasure …

Lots of work on orgasm being done right now …

Neuroplasticity works in sexual function, too. The brain can decide what turns it on, and “change its mind” about that.

Ferticare has a new model for 2019.

Okay, they did a study with this tongue device/sensory substitution that people  found to enhance their sensation, but nobody got to orgasm with it.

Time for questions.

Question: You said there’s a study of reduced semen quality with an indwelling foley.

That’s true for superpubic, too.

Okay, that was my question.

Question: Can FES be applied to the lower abs to cause ejaculation … do you know about that?

I couldn’t do it in the clinic, but I know patients are trying it – a combination of vibrator plus FES stim to the lower abs.

Question: It’s important to get the “free testosterone” test and not just the regular one. Does T help with semen quality?

In a negative way … it makes for worse semen.

Question: Does semen quality improve over time with ejaculation?

Studies say no, but we have patients who are using vibrators at home and getting pregnant.

Question: Are there any studies being done with pre-menopause or menopause?

Nope. We know there will be acceleration of all the usual problems — bone density, drying, etc.

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