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Blessé médullaire: prise en charge en andrologie

Andrological management of spinal cord-injured men

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Résumé

Les réactions sexuelles sont sous contrôle neurologique. Le traumatisme vertébromédullaire altère l’organisation neurologique et génère un dysfonctionnement sexuel. Les substances pharmacologiques actuelles permettent de rétablir la fonction érectile du blessé médullaire, première étape essentielle à la réorganisation d’une vie sexuelle. Le déclenchement de l’éjaculation est souvent difficile. Les techniques de stimulation périnéale isolées ou associées au traitement pharmacologique favorisent la réalisation d’éjaculation et permettent un recueil et une conservation du sperme. La possibilité d’obtenir une éjaculation au cours des rapports sexuels, chez le blessé médullaire, reste rare et sans véritable solution thérapeutique. Malgré l’altération de la qualité du sperme, les blessés médullaires conservent une possibilité de procréation pour 40 à 60 % des couples. Le recours à des techniques d’assistance médicale à la procréation est souvent nécessaire. La prise en charge des dysfonctionnements sexuels des blessés médullaires doit être intégrée dans un programme de rééducation et de réinsertion.

Abstract

Sexual reactions are under neurological control. Spinal cord trauma alters neurological structure and induces sexual dysfunction. Pharmacological drugs used currently allow erectile function to be recovered in spinal cord-injured men, an essential step towards the resumption of a sex life. Triggering of ejaculation is often difficult. Perineal stimulation techniques, used either in isolation or in association with pharmacological treatment, promote ejaculation and allow sperm collection and freezing. The possibility of achieving ejaculation during sexual intercourse in spinal cord-injured men remains rare and there is as yet no real therapy available. Despite poor semen quality, spinal cord-injured men maintain reproductive possibilities in 40 to 60% of couples. The use of assisted reproductive technologies is often required. Management of sexual dysfunction in spinal cord-injured men must be integrated into a rehabilitation and re-insertion programme.

Abbreviations

AMP:

assistance médicale à la procréation

FIV:

fécondation in vitro

ICSI:

injection intracyptoplasmique d’un spermatozoïde

IIEF:

index international de la fonction érectile

IPDE5:

inhibiteur de la phosphodiestérase de type 5

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Correspondence to J. -M. Soler.

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Soler, J.-., Mieusset, R. Blessé médullaire: prise en charge en andrologie. Basic Clin. Androl. 19, 90–98 (2009) doi:10.1007/s12610-009-0007-1

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Mots clés

  • Blessé médullaire
  • Érection
  • Éjaculation
  • Substances vasoactives
  • Vibromassage
  • électroéjaculation
  • Procréation
  • Spermatozoïdes
  • Liquide séminal

Keywords

  • Spinal cord-injured man
  • Erection
  • Ejaculation
  • Vasoactive drugs
  • Vibratory penile stimulation
  • Electroejaculation
  • Reproduction
  • Sperm
  • Semen