Sexual Dysfunction and Infertility in Male Patients With Spinal Cord Injury: A Narrative Review.

Spinal cord injury (SCI) is a life-altering neurological condition that profoundly impairs male sexual function, fertility potential, and overall quality of life (QoL), affecting multiple aspects of physical, psychological, and social well-being. These effects arise from a complex interplay of neurological disruption, autonomic dysfunction, endocrine alterations, and psychosocial factors, with the level and completeness of injury serving as key determinants of functional outcomes. In recent years, growing evidence has highlighted the underlying neurophysiological mechanisms of sexual dysfunction, as well as significant impairments in semen quality primarily related to reduced motility, oxidative stress, and sperm DNA damage. Alongside these findings, advances in therapeutic approaches - including pharmacological treatments, assisted ejaculation techniques, and assisted reproductive technologies - have improved the management of sexual and reproductive dysfunction in men with SCI. This review aimed to synthesize evidence on sexual dysfunction, fertility impairment, semen quality, and therapeutic management in adult men with spinal cord injury, while also addressing the need for structured approaches to optimize patient care.