Sexual dysfunction in cauda equina syndrome

Cauda equina syndrome (CES) is diagnosed in cases of urinary and/or anorectal dysfunction accompanied by loss of sensation in the perineum. The effect on sexual function is not normally discovered until later, often during the postoperative period, some considerable time after the onset of neurological and/or urogenital symptoms. There are few reports concerning sexual problems in CES, yet they are very common in both men and women. Loss of feeling is a significant source of sexual dissatisfaction, particularly in women. The most frequent sexual disorders reported by men are reduction in orgasm and erectile dysfunction. Ejaculatory disorders are less common. Sexual problems are often accompanied by urinary symptoms. Women most often report reduced or absent lubrication and significantly diminished libido and orgasm, often associated with local pain. Sexual dysfunction in CES is permanent and often incurable. Aglobal approach to treatment is needed, particularly where the population suffers little motor disability and wishes to regain sexual function.