Original research| Volume 97, ISSUE 6, P947-952, June 2016

Evaluation of Sexual Dysfunction in Men With Spinal Cord Injury Using the Male Sexual Quotient

Published:January 28, 2016DOI:



      To assess different aspects of sexual function in men with spinal cord injury (SCI) using the Male Sexual Quotient (MSQ), a newly developed tool to assess sexual function and satisfaction.


      Cross-sectional study.


      Tertiary rehabilitation center.


      Patients (N=295) older than 18 years (mean age ± SD, 40.7±14.5y) with SCI for more than 1 year (median time since SCI, 3.6y; range, 1.6–7.0y) were assessed from February to August 2012. Patients completed the MSQ questionnaire and the Sexual Health Inventory for Men (SHIM).


      Not applicable.

      Main Outcome Measures

      Performance in various domains of sexual function was evaluated using the MSQ and SHIM questionnaires.


      Erectile function, ejaculation, and orgasm were the most severely affected domains. The median MSQ score was 40 (range, 8–66), and the median SHIM score was 5 (range, 0–16). The diagnostic properties of the 2 instruments were similar in the discrimination of sexually active subjects. The area under the receiver operating characteristic curve was .950 (95% confidence interval [CI], .923–.979) for the MSQ and .942 (95% CI, .915–.968) for the SHIM. There was a strong correlation between the 2 instruments (r=.826; 95% CI, .802–.878).


      Different domains of sexual function are severely impaired in men with SCI, although their sexual interest remains high. The MSQ and SHIM scores strongly correlate, but the MSQ provides a more comprehensive assessment of sexual dysfunction in male patients with SCI.


      List of abbreviations:

      AUC (area under the curve), CI (confidence interval), ED (erectile dysfunction), MSQ (Male Sexual Quotient), ROC (receiver operating characteristic), SCI (spinal cord injury), SHIM (Sexual Health Inventory for Men)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Ragnarsson K.T.
        Medical rehabilitation of people with spinal cord injury during 40 years of academic physiatric practice.
        Am J Phys Med Rehabil. 2012; 91: 231-242
        • Jackson A.B.
        • Dijkers M.
        • Devivo M.J.
        • Poczatek R.B.
        A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years.
        Arch Phys Med Rehabil. 2004; 85: 1740-1748
        • Valtonen K.
        • Karlsson A.K.
        • Siosteen A.
        • Dahlof L.G.
        • Viikari-Juntura E.
        Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele.
        Disabil Rehabil. 2006; 28: 965-976
        • Barbonetti A.
        • Cavallo F.
        • Felzani G.
        • Francavilla S.
        • Francavilla F.
        Erectile dysfunction is the main determinant of psychological distress in men with spinal cord injury.
        J Sex Med. 2012; 9: 830-836
        • Cobo Cuenca A.I.
        • Sampietro-Crespo A.
        • Virseda-Chamorro M.
        • Martin-Espinosa N.
        Psychological impact and sexual dysfunction in men with and without spinal cord injury.
        J Sex Med. 2015; 12: 436-444
        • Reitz A.
        • Tobe V.
        • Knapp P.A.
        • Schurch B.
        Impact of spinal cord injury on sexual health and quality of life.
        Int J Impot Res. 2004; 16: 167-174
        • Dahlberg A.
        • Alaranta H.T.
        • Kautiainen H.
        • Kotila M.
        Sexual activity and satisfaction in men with traumatic spinal cord lesion.
        J Rehabil Med. 2007; 39: 152-155
        • Ku J.H.
        • Oh S.J.
        • Jeon H.G.
        • et al.
        Sexual activity in Korean male patients on clean intermittent catheterization with neurogenic bladder due to spinal cord injury.
        Int J Urol. 2006; 13: 42-46
        • Anderson K.D.
        • Borisoff J.F.
        • Johnson R.D.
        • Stiens S.A.
        • Elliott S.L.
        The impact of spinal cord injury on sexual function: concerns of the general population.
        Spinal Cord. 2007; 45: 328-337
        • Rosen R.C.
        • Cappelleri J.C.
        • Gendrano III, N.
        The International Index of Erectile Function (IIEF): a state-of-the-science review.
        Int J Impot Res. 2002; 14: 226-244
        • Abdo C.H.
        The Male Sexual Quotient: a brief, self-administered questionnaire to assess male sexual satisfaction.
        J Sex Med. 2007; 4: 382-389
        • Cappelleri J.C.
        • Rosen R.C.
        The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience.
        Int J Impot Res. 2005; 17: 307-319
        • Rosen R.C.
        • Cappelleri J.C.
        • Smith M.D.
        • Lipsky J.
        • Pena B.M.
        Development and evaluation of an abridged, 5-item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction.
        Int J Impot Res. 1999; 11: 319-326
        • Wood-Dauphinee S.
        • Exner G.
        • Bostanci B.
        • et al.
        Quality of life in patients with spinal cord injury—basic issues, assessment, and recommendations.
        Restor Neurol Neurosci. 2002; 20: 135-149
        • Post M.W.
        • Van Dijk A.J.
        • Van Asbeck F.W.
        • Schrijvers A.J.
        Life satisfaction of persons with spinal cord injury compared to a population group.
        Scand J Rehabil Med. 1998; 30: 23-30
        • Anderson K.D.
        Targeting recovery: priorities of the spinal cord-injured population.
        J Neurotrauma. 2004; 21: 1371-1383
        • Akman R.Y.
        • Coskun Celik E.
        • Karatas M.
        Sexuality and sexual dysfunction in spinal cord-injured men in Turkey.
        Turk J Med Sci. 2015; 45: 758-761
        • Fisher T.L.
        • Laud P.W.
        • Byfield M.G.
        • Brown T.T.
        • Hayat M.J.
        • Fiedler I.G.
        Sexual health after spinal cord injury: a longitudinal study.
        Arch Phys Med Rehabil. 2002; 83: 1043-1051
        • Biering-Sorensen I.
        • Hansen R.B.
        • Biering-Sorensen F.
        Sexual function in a traumatic spinal cord injured population 10-45 years after injury.
        J Rehabil Med. 2012; 44: 926-931
        • Benevento B.T.
        • Sipski M.L.
        Neurogenic bladder, neurogenic bowel, and sexual dysfunction in people with spinal cord injury.
        Phys Ther. 2002; 82: 601-612
        • Moreira Jr., E.D.
        • Abdo C.H.
        • Torres E.B.
        • Lobo C.F.
        • Fittipaldi J.A.
        Prevalence and correlates of erectile dysfunction: results of the Brazilian study of sexual behavior.
        Urology. 2001; 58: 583-588
        • Raina R.
        • Pahlajani G.
        • Agarwal A.
        • Zippe C.D.
        The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity.
        BJU Int. 2007; 100: 1317-1321
        • Arrington R.
        • Cofrancesco J.
        • Wu A.W.
        Questionnaires to measure sexual quality of life.
        Qual Life Res. 2004; 13: 1643-1658
        • Choi H.
        • Kim J.H.
        • Shim J.S.
        • et al.
        Comparison of the efficacy and safety of 5-mg once-daily versus 5-mg alternate-day tadalafil in men with erectile dysfunction and lower urinary tract symptoms.
        Int J Impot Res. 2015; 27: 33-37
        • Bocchio M.
        • Pelliccione F.
        • Mihalca R.
        • et al.
        Treatment of erectile dysfunction reduces psychological distress.
        Int J Androl. 2009; 32: 74-80
        • Sipski M.
        • Alexander C.J.
        • Gomez-Marin O.
        Effects of level and degree of spinal cord injury on male orgasm.
        Spinal Cord. 2006; 44: 798-804
        • Alexander M.
        • Rosen R.C.
        Spinal cord injuries and orgasm: a review.
        J Sex Marital Ther. 2008; 34: 308-324
        • Castle S.M.
        • Jenkins L.C.
        • Ibrahim E.
        • Aballa T.C.
        • Lynne C.M.
        • Brackett N.L.
        Safety and efficacy of a new device for inducing ejaculation in men with spinal cord injuries.
        Spinal Cord. 2014; 52: S27-S29
        • Brackett N.L.
        • Lynne C.M.
        • Ibrahim E.
        • Ohl D.A.
        • Sonksen J.
        Treatment of infertility in men with spinal cord injury.
        Nat Rev Urol. 2010; 7: 162-172
        • Gan M.
        • Smit M.
        • Dohle G.R.
        • Bosch J.L.
        • Bohnen A.
        Determinants of ejaculatory dysfunction in a community-based longitudinal study.
        BJU Int. 2007; 99: 1443-1448
        • Calabro R.S.
        • Polimeni G.
        • Ciurleo R.
        • Casella C.
        • Bramanti P.
        Neurogenic ejaculatory disorders: focus on current and future treatments.
        Recent Pat CNS Drug Discov. 2011; 6: 205-221
        • Previnaire J.G.
        • Lecourt G.
        • Soler J.M.
        • Denys P.
        Sexual disorders in men with multiple sclerosis: evaluation and management.
        Ann Phys Rehabil Med. 2014; 57: 329-336
        • Hanley J.A.
        • McNeil B.J.
        The meaning and use of the area under a receiver operating characteristic (ROC) curve.
        Radiology. 1982; 143: 29-36