Cardiovascular Responses to Sexual Activity in Able-Bodied Individuals and Those Living with Spinal Cord Injury

Sexuality is an integral part of the human experience and persists in health and disability. The cardiovascular system is crucial to sexual function and can be affected profoundly by spinal cord injury (SCI). The effects of sexual activity on the cardiovascular system in SCI have not been summarized and compared with sexual activity in able-bodied individuals. A keyword search of Embase, PubMed, and Medline was conducted. From 471 retrieved studies for able-bodied individuals, 11 were included that met the strict criteria of medically uncomplicated participants. In the SCI literature, 117 studies were screened, with 18 meeting criteria. In able-bodied persons, sexual activity resulted in modest increases in systolic blood pressure peaking at orgasm (males of 163mm Hg and females of 142mm Hg) and returning to baseline shortly afterward. In persons with SCI, results varied from minimal changes to significant elevations in systolic blood pressure because of episodes of autonomic dysreflexia, especially in those with high thoracic and cervical lesions. Peak systolic blood pressure in these individuals was measured to be as high as 325mm Hg. In the SCI population, more intense stimuli (including penile vibrostimulation and electroejaculation) tended to result in a greater increase in systolic blood pressure compared with self-stimulation. Studies that used continuous versus intermittent monitoring were more likely to report greater changes in systolic blood pressure. In able-bodied persons, sexual activity results in modest increases in blood pressure. In those with SCI, intense stimulation and higher injury levels result in a higher likelihood of autonomic dysreflexia and elevated blood pressure. Because of rapid changes in blood pressure, continuous monitoring is more advantageous than intermittent measurement, because the latter may miss peak values.