A therapeutic effect for males with spinal cord injury using abdominal functional electrical stimulation for sexual functioning



Sexual functioning is a high priority for people with a spinal cord injury (SCI) yet this area has received little attention. Two SCI case reports are presented which suggests there may be greater potential for the recovery of sexual functioning than previously recognised.

Case presentation

A 74-year-old SCI male (AIS D, C5/C6) and a 36-year-old SCI male (AIS A, T4/T5) were treated for neurogenic bowel using 6 weeks of abdominal FES (ABFES) (40 Hz, 300 µ pulse width (current typically 30–60 MA) simultaneously delivered (8 s contraction with 2 s ramps and 3 s off period) from both channels). The 74-year-old AIS D, C5/C6 participant reported improved strength and duration of erectile function after using ABFES for 3 weeks. The 36-year-old AIS A, T4/T5 participant reported improvements in ejaculatory function and urine flow. Both reported a reduction in time required for bowel management.


The findings could be attributed to an improved vascularisation of the abdominal area, an improved body image and self-esteem, direct innervation of nerves involved in parasympathetic pathways or innervation of the T11/T1 area implicated in the alternative psychogenic pathway. Both participants reported they had not used ABFES during sexual activity suggesting a therapeutic effect from the treatment.

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  1. 1.

    Anderson KD. Targeting recovery: priorities of the spinal cord-injured population. J Neurotrauma. 2004;21:1371–83.

    Article  Google Scholar 

  2. 2.

    Hess MJ, Hough S. Impact of spinal cord injury on sexuality: broad-based clinical practice intervention and practical application. J Spinal Cord Med. 2012;35:211–8.

    Article  Google Scholar 

  3. 3.

    Korsten MA, Fajardo NR, Rosman AS, Creasey GH, Spungen AM, Bauman WA. Difficulty with evacuation after spinal cord injury: colonic motility during sleep and effects of abdominal wall stimulation. J Rehabil Res Dev. 2004;41:95–100.

    Article  Google Scholar 

  4. 4.

    Hascakova-Bartova R, Dinant J-F, Parent A, Ventura M. Neuromuscular electrical stimulation of completely paralyzed abdominal muscles in spinal cord-injured patients: a pilot study. Spinal Cord. 2008;46:445–50.

    CAS  Article  Google Scholar 

  5. 5.

    Street T, Peace C, Padfield E, Singleton C. Abdominal functional electrical stimulation for bowel management in multiple sclerosis. Neurodegener Dis Manag. 2019;9:83–9.

    Article  Google Scholar 

  6. 6.

    Benevento T, Sipski M. B. Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury. Phys Ther. 2002;82:601–12.

    Article  Google Scholar 

  7. 7.

    Alexander MS, Marson L. The neurologic control of arousal and orgasm with specific attention to spinal cord lesions: Integrating preclinical and clinical sciences. Auton Neurosci. 2018;209:90–9.

    Article  Google Scholar 

  8. 8.

    Lombardi G, Musco S, Kessler TM, Li Marzi V, Lanciotti M, Del Popolo G. Management of sexual dysfunction due to central nervous system disorders: a systematic review. BJU Int. 2015;115(Suppl 6):47–56.

    Article  Google Scholar 

  9. 9.

    Sinha V, Elliott S, Ibrahim E, Lynne CM, Brackett NL. Reproductive health of men with spinal cord injury. Top Spinal Cord Inj Rehabil. 2017;23:31–41.

    Article  Google Scholar 

  10. 10.

    Silva AB, Sousa N, Azevedo LF, Martins C. Physical activity and exercise for erectile dysfunction: systematic review and meta-analysis. Br J Sports Med. 2017;51:1419.

    Article  Google Scholar 

  11. 11.

    Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Gater DR. The effects of electrical stimulation on body composition and metabolic profile after spinal cord injury—Part II. J Spinal Cord Med. 2015;38:23–37.

    Article  Google Scholar 

  12. 12.

    Phillips W, Burkett LN, Munro R, Davis M, Pomeroy K. Relative changes in blood flow with functional electrical stimulation during exercise of the paralyzed lower limbs. Spinal Cord. 1995;33:90–3.

    CAS  Article  Google Scholar 

  13. 13.

    Chilibeck PD, Jeon J, Weiss C, Bell G, Burnham R. Histochemical changes in muscle of individuals with spinal cord injury following functional electrical stimulated exercise training. Spinal Cord. 1999;37:264–8.

    CAS  Article  Google Scholar 

  14. 14.

    Gorgey AS, Dolbow DR, Dolbow JD, Khalil RK, Castillo C, Gater DR. Effects of spinal cord injury on body composition and metabolic profile—Part I. J Spinal Cord Med. 2014;37:693–702.

    Article  Google Scholar 

  15. 15.

    Barton TJ, Low DA, Janssen TWJ, Sloots M, Smit CAJ, Thijssen DHJ. Femoral artery blood flow and microcirculatory perfusion during acute, low-level functional electrical stimulation in spinal cord injury. Am J Phys Med Rehabil. 2018;97:721–6.

    Article  Google Scholar 

  16. 16.

    Creasey GH, Craggs MD. Functional electrical stimulation for bladder, bowel, and sexual function. Handb Clin Neurol. 2012;109:247–57.

    Article  Google Scholar 

  17. 17.

    Creasey G. Lecture 6 restoration of male sexual function following spinal cord injury. Int J Impot Res. 2000;12:S54–S55.

    Article  Google Scholar 

  18. 18.

    Harkema S, Gerasimenko Y, Hodes J, Burdick J, Angeli C, Chen Y, et al. Effect of epidural stimulation of the lumbosacral spinal cord on voluntary movement, standing, and assisted stepping after motor complete paraplegia: a case study. Lancet. 2011;377:1938–47.

    Article  Google Scholar 

  19. 19.

    Adams M, Carlstedt T, Cavanagh J, Lemon RN, McKernan R, Priestley JV, et al. International spinal research trust research strategy. III: a discussion document. Spinal Cord. 2006;45:2.

    Article  Google Scholar 

  20. 20.

    Goetz LL, Stiens SA. Abdominal electric stimulation facilitates penile vibratory stimulation for ejaculation after spinal cord injury: a single-subject trial. Arch Phys Med Rehab. 2005;86:1879–83.

    Article  Google Scholar 

  21. 21.

    Kafetsoulis A, Ibrahim E, C Aballa T, Goetz L, Lynne C, Brackett N. Abdominal electrical stimulation rescues failures to penile vibratory stimulation in men with spinal cord injury: a report of two cases. Urology. 2006;204:9–11.

    Google Scholar 

  22. 22.

    Previnaire JG, Soler JM, Alexander MS, Courtois F, Elliott S, McLain A. Prediction of sexual function following spinal cord injury: a case series. Spinal Cord Ser Cases. 2017;3:17096.

    CAS  Article  Google Scholar 

  23. 23.

    Alexander MS, New PW, Biering-Sørensen F, Courtois F, Popolo GD, Elliott S, et al. International spinal cord injury male sexual function and female sexual and reproductive function basic data sets-version 2.0. Spinal Cord Ser Cases. 2017;3:17050.

    Article  Google Scholar 

  24. 24.

    Alexander MS, Biering-Sorensen F, Bodner D, Brackett NL, Cardenas D, Charlifue S, et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord 2009;47:36–43.

    CAS  Article  Google Scholar 

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The authors acknowledge the contribution of Joe Green, Mary Fenn and Earl Merson from the National Clinical FES Centre, Salisbury, UK for administering the ABFES treatment for one of the participants. With thanks to Odstock Medical for providing the use of an electrical stimulator and consumables for treatment of one of the participants. All other treatment was funded by the UK National Health Service.

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Correspondence to Tamsyn Street.

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Street, T., Padfield, E. A therapeutic effect for males with spinal cord injury using abdominal functional electrical stimulation for sexual functioning. Spinal Cord Ser Cases 6, 24 (2020). https://doi.org/10.1038/s41394-020-0273-x

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