The mechanism of erection are complex. When sexually aroused, a man’s brain signals the muscles in the penis to relax and the blood vessels to expand. As more blood flows into the penis, the veins that normally allow blood to flow out of the organ become tightly compressed. The result of all this blood trapped blood is an erection. The consistent inability to maintain erection firm enough for satisfactory sexual intercourse is a common feature in case of SCI. This is because for a man to get erection, his brain must send signals along the spinal cord to tell the nerves in his penis that he is sexually aroused so that the mechanism of erection sets in.

There are two types of erections

Psychogenic-Transmitted by cortical (brain) stimulation and regulated by sympathetic nerves. It is poorly sustained and lasts briefly in case of SIP

Reflexic- It is well sustained and more powerful. Transmitted and integrated – by spinal centers.

Loss of erection may be temporary, often lasting for only first few months after injury, although in men with a lesion below T12 the ability to achieve even a reflex erection may be permanently abolished.

Suprasacral lesions : Reflex erection is possible. It is activated by stimulation procedure Squeezing of penis, Suprapubic tapping, Pulling of pubic hair etc.

Sacral lesion : Weak and ill sustained erection. This requires additional maneuvers through the use of

Vacuum erection aids : A cylinder fits on penis and with a gadget vacuum is created by pumping all the air out of the cylinder. This stimulates blood flow to the area within few minutes and that results in erection. A rubber band is slipped on to the base of penis to maintain erection. A rubber band is slipped on to the base of penis to maintain erection. After intercourse, the rubber band can be removed and the penis becomes flaccid.

Intracavonosal injection of papavrine : 7.5 – l 10mg good erection for 30 minutes. But one has to learn injection under the guidance of a urologist. One should know the right area (Corpocavinosum) and be very particular about the dose. A little extra dose can be very dangerous as the erection does not subside for hours and the blood in the penis gets clotted and there would be no more erections in future by any method. In such a situation one must straight away rush to a doctor specially Urologist.

Energizing Ring : Is made of ebonite and fits behind the man’s penis and testicles. The snug fit sets up a tiny charge of static electricity, which cannot be felt, but has the effect of enlarging the minute blood vessels on which an erection depends. It can nearly always improve an erection which is otherwise incomplete. A cheaper alternative to the energizing ring could be a small loop or tube of latex rubber which fits around the base of the penis. It helps to improve a rather limp erection or helps to maintain an erection which would otherwise be rapidly lost.

MUSE : It is a tiny pellet which is to be inserted into the urethera with the help of an applicator available along with it. The applicator is inserted about one inch into the penis and then the plunger is being pressed to release the Muse. The pellet quickly melts by the body temperature allowing the medication to be absorbed into the penile tissue. It results in erection in 5-10 minutes. Muse must be stored in fridge.

Mini Press or Hypovase : It is a tablet prescribed to relax the internal sphincter. The main constituent of it being the chemical Prazosin. This medicine gives a proper erection along with it’s normal effect of helping in evacuation of bladder due to relaxing of sphincter. The erection is more pronounced in the case of cervical injury cases. The factor that might inhibit erection is presence of Urinary tract infection (UTI). One should put an elastic band once the erection comes, for better results.

Penile Prosthesis : These implants come in two varieties. A surgeon may insert either an inflatable device that can be pumped up to cause an erection or semirigid rods that you can bend yourself either outward or close to your body.

If your partner is non-disabled, she can straddle you, open the lips of her vagina and stuff your soft penis in, using her vaginal muscles to hold it in position. This may stimulate erection, but still if it does not, it may still be very pleasurable for both of you.

Beside these devices & methods posture is very important. Male acts as a passive partner and female as an active partner and on top of the male. Legs can be supported by pillows.

If it is not possible to get the maintain an erection there are a range of artificial penises for use when penetration is desired.

This imitation penis, which straps on the man’s body with a elastic harness, may be solid or hollow so that flaccid penis can fit inside. The more sophisticated models can even squirt a warm fluid to stimulate ejaculation. Some even have a built-in vibrator.

Those who do not have a partner or for whom sexual intercourse is not possible may need a device to assist masturbation. A vibrator can be used in these instances or to improve love-making