Question 1
Biruk is in an automobile accident that cuts his spinal cord at waist level. After his recovery, he wonders if he will still be able to have an erection, enjoy sex, and father a child. What would you tell him?Question 2
In a condition known as endometriosis, endometrial cells are present in the uterine tubes and/or in the peritoneal cavity where they become established tissues. A major symptom of endometriosis is periodic pain. Why do you think this occurs?Answer 1
Yes, he would still be able to have an erection, though he would lack the pleasurable sensations that normally accompany erection. Erection is controlled primarily by a parasympathetic reflex originating in the sacral region of the spinal cord (inferior to the injury). Tactile stimulation of the penis would initiate the parasympathetic reflex that controls erection. Biruk would also be able to experience an erection by a sympathetic route, since this would be controlled in the T12 to L2 area of the cord (superior to the injury). Stimulation by higher centers could produce a decreased sympathetic tone in the vessels to the penis resulting in an erection. His injury should have no effect on sperm production and ejaculation should still be possible, so he should be able to father a child.Answer 2
The endometrial cells have receptors for the hormones estrogen and progesterone and respond to these hormones the same as they would if they were in the body of the uterus. Under the influence of estrogen, they proliferate at the beginning of the menstrual cycle and begin to develop glands and blood vessels, which then further develop under the control of progesterone. This dramatic change in tissue size and characteristics interferes with neighboring tissues by pressing on them or interrupting function in other ways. It is this interference that causes the periodic painful sensations.