Pearls & Perspectives: Prioritizing Sexual Health After Spinal Cord Injury, with Emad Ibrahim, MD, HCLD

Welcome back to Pearls & Perspectives!

In this special Urology on the Beach edition of Pearls & Perspectives, host Amy Pearlman, MD, sits down with Emad Ibrahim, MD, HCLD, to tackle a topic that is both critically important and routinely overlooked: sexual and reproductive health in patients with spinal cord injury. Ibrahim, a specialist in male sexual medicine and fertility, underscores that while rehabilitation often prioritizes bladder, bowel, and mobility management, conversations around sexual function are frequently sidelined, despite overwhelming evidence that sexual health ranks among the top quality-of-life priorities for both men and women living with spinal cord injury.

Drawing from patient surveys, clinical experience, and decades of research, Ibrahim explains why sexual function often eclipses even mobility in perceived importance, particularly for men in their 30s and 40s who are navigating relationships, identity, and intimacy after injury. He details how spinal cord injury alters erectile function, sensation, ejaculation, and fertility, and why restoring intimacy, even when sensation or orgasm is limited, remains deeply meaningful for patients and their partners. The conversation also highlights the unique and under-discussed challenges faced by women with spinal cord injury, including gaps in evidence-based guidance for managing sexual dysfunction and supporting reproductive goals.

The episode further explores advances in fertility preservation and treatment, from in-office techniques such as penile vibratory stimulation and electroejaculation to emerging research aimed at improving sperm motility. Ibrahim shares insights from an ongoing Department of Defense–funded clinical trial investigating probenecid as a novel approach to addressing inflammatory pathways that impair semen quality after spinal cord injury. Broadening the lens, Pearlman and Ibrahim also discuss fertility concerns in the general male population, the role of semen analysis as a marker of overall health, and common myths surrounding paternal age and fertility.

Together, the discussion reinforces a central message: addressing sexual and reproductive health is not ancillary care, it is foundational to restoring dignity, intimacy, and quality of life for patients across the urologic spectrum.