Infertility Diagnosis and Treatment
Sujoy K. Guba in Bioengineering in Reproductive Medicine, 2020
Neurogenic influence for erection may arise from psychic stimulation mediated via the thoracolumbar erection center located in the L2-L4 spinal segments and from genital or bowel and bladder stimulation mediated via the pudendal nerve and the sacrospinal erection center in the S2-S4 spinal segments. Neural pathways involved are so widespread that derangement of neurological function at almost all levels can adversely affect the erection response. Attempts have been made to evaluate neurological status vis a vis impotence. Higher neurological centers are examined by electroencephalography (EEG) and electroculography (EOG) but as yet specific diagnostic indices based on these investigations have not emerged. Our current knowledge allows better correlation of neurological findings at the spinal levels, including autonomic functions, with impotence. A clinical sign, the bulbocavernosus reflex which produces transient constriction of the anal sphincters on squeezing the glans penis, is well known. Now with modern technological inputs more quantitative assessments are possible.
Clinical evaluation: History and physical examination
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
There should also be a thorough evaluation of both cutaneous and motor reflexes at the time of the initial encounter (Table 29.3). The bulbocavernosus reflex, which is elicited by gently squeezing the glans penis in men or gentle compression of the clitoris against the pubis in women and simultaneously feeling for an anal sphincter contraction (by placing a finger in the rectum), assesses the integrity of the S2–S4 reflex arc. The anal reflex, which assesses integrity of S2–S5 can be checked by applying a pinprick to the mucocutaneous junction of the anus and evaluating for anal sphincter contraction. The cremasteric reflex may be somewhat less reliable, but assesses sensory dermatomes supplied by L1–L2.
Considerations for the Focused Neuro-Urologic History and Physical Exam
Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg in Essentials of the Adult Neurogenic Bladder, 2020
Next, test the genital reflexes including the bulbocavernosus and anal reflex while the patient is in the lithotomy position, since the exam should flow from least to most invasive. In the male patient, we can also check the cremasteric reflex first. The bulbocavernosus reflex is important to assess since it is one of the first reflexes to return in patients with spinal shock after their injury (Table 19.9).8
Physiotherapeutic assessment and management of overactive bladder syndrome: a case report
Published in Physiotherapy Theory and Practice, 2023
Bartlomiej Burzynski, Tomasz Jurys, Karolina Kwiatkowska, Katarzyna Cempa, Andrzej Paradysz
The physiotherapist next carried out per vaginum examination of the patient in the same position. The examination began with an observation of perineal area, during which the physiotherapist observed skin color and the appearance of the vaginal orifice and checked for the existence of scar tissue. There were no visible pathological changes in the perineal area or vaginal orifice. Thereafter, the bulbocavernosus reflex was tested by squeezing the clitoral glans (Previnaire, 2018), and a correct reflex response was observed suggesting proper innervation from the S2-S4 level. The physiotherapist also assessed the flexibility of and prevalence of pain in the central tendon of the perineum by means of palpation. The patient did not report any painful symptoms, and the central tendon of her perineum was flexible. In addition, the dynamic function of the central tendon of the perineum was evaluated during coughing. The patient was asked to cough and the physiotherapist observed a correct reflex response and correct timing, which is to say that the central tendon first moved upward and then downward. The perineal behavior was visually assessed, excluding possible external pathologies.
What is the best treatment option for cervical spinal cord injury by os odontoideum in a patient with athetoid dystonic cerebral palsy?
Published in The Journal of Spinal Cord Medicine, 2021
Sungche Lee, Dong Hyun Kim, Yoon-Hee Choi
Neurologic examination revealed bilateral upper and lower limb weakness, and the left upper limb was more severely affected than other limbs (right upper limb, grade 2–3; left upper, grade 1–2; both lower, grade 2–3 on MRC grading scale). Hypesthesia was shown below the C2/C3 dermatome and hypoalgesia was shown below the C4/C4 dermatome (ASIA impairment scale D). A modified Ashworth Scale (MAS) of 1+ was checked on both elbow flexor and extensor muscles. The right and left knee extensor muscles were MAS 1+ and 1 each with ankle clonus. The bulbocavernosus reflex, perianal, and deep anal sensations were preserved. The patient scored 2 on the Berg balance scale (BBS) and 25 on the Spinal Cord Independence Measure III (SCIM III). Jebsen-Taylor hand function test (JHFT) was not performed due to poor trunk control ability and impaired fine motor skills of the patient. The patient also suffered from severe orthostatic hypotension symptoms.
Genital vibration for sexual function and enhancement: a review of evidence
Published in Sexual and Relationship Therapy, 2018
Jordan E. Rullo, Tierney Lorenz, Matthew J. Ziegelmann, Laura Meihofer, Debra Herbenick, Stephanie S. Faubion
Efferent neuronal signals originating from the spinal cord result in predictable changes in sexual physiology (e.g. erection, ejaculation, orgasm) (Everaert et al., 2010; Steers, 2000). It is hypothesized that, by stimulating spinal reflexes, vibratory stimulation can be used to promote normal sexual function (Nelson, Ahmed, Valenzuela, Parker, & Mulhall, 2007). For instance, the bulbocavernosus reflux results from stimulation of the DNP or other distal pudendal branches. Afferent signals traveling to the sacral spinal cord via the PN are integrated within Onuf's nucleus, and subsequent efferent output from both autonomic and somatic neurons results in rhythmic contraction of the bulbospongiosus and ischiocavernosus muscles. This reflex contributes not only to penile rigidity and tumescence but also to ejaculatory function (Granata et al., 2013; Steers, 2000). Clinically, this reflex is utilized to ascertain the integrity of the sacral spinal cord and is elicited in males by squeezing the glans penis and observing contraction of the anal musculature. While higher level processes including signals from the cerebral cortex play an important role in normal sexual function, reflexes such as the bulbocavernosus reflex help explain why digital (hand), oral, vaginal, and vibratory stimulation have a major role in eliciting erections as well.
Related Knowledge Centers
- Bulbospongiosus Muscle
- Glans Penis
- Internal Anal Sphincter
- Reflex
- Reflex Arc
- Spinal Cord Injury
- Spinal Shock
- Foley Catheter
- Clitoris
- External Anal Sphincter