title: Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?
abstract: METHODS
  Systematic review.
  
  
  OBJECTIVE
  Review the literature on the acute or prophylactic treatment of autonomic dysreflexia in the context of sexual activities.
  
  
  METHODS
  International.
  
  
  METHODS
  Medline search using AD and spinal cord injury and all years of publication.
  
  
  RESULTS
  Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population.
  
  
  CONCLUSIONS
  Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.
authors.affiliation: Outpatient Clinic, Institut de Réadaptation en Déficience Physique de Québec, Quebec, Quebec, Canada. courtois.frederique@uqam.ca
authors.forename: F
authors.initials: F
authors.lastname: Courtois
authors.forename: X
authors.initials: X
authors.lastname: Rodrigue
authors.forename: I
authors.initials: I
authors.lastname: Côté
authors.forename: M
authors.initials: M
authors.lastname: Boulet
authors.forename: J-G
authors.initials: JG
authors.lastname: Vézina
authors.forename: K
authors.initials: K
authors.lastname: Charvier
authors.forename: V
authors.initials: V
authors.lastname: Dahan
mesh_terms: D000328:Adult; D020211:Autonomic Dysreflexia / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D004542:Ejaculation / Q000502:physiology; D006801:Humans; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012735:Sexual Dysfunction, Physiological / Q000209:etiology* / Q000628:therapy*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*