A male patient with C6 AIS A SCI has an intact sacral reflex arc (S2-S4) but has lost supraspinal connections to the thoracolumbar cord. Which type of erection would this patient MOST likely be able to achieve?

A male patient with C6 AIS A SCI has an intact sacral reflex arc (S2-S4) but has lost supraspinal connections to the thoracolumbar cord. Which type of erection would this patient MOST likely be able to achieve?

• A. Psychogenic erection only
• B. Both psychogenic and reflexive erection
• C. Reflexive erection only
• D. Neither psychogenic nor reflexive erection

Answer: (C)

The main idea is that there are two pathways to penile erection: a brain-driven (psychogenic) pathway that travels down the thoracolumbar spinal cord, and a local reflex pathway that uses the sacral spinal cord (S2–S4). In this scenario, the injury is at C6 with loss of supraspinal connections to the thoracolumbar cord, so the brain-driven pathway to trigger erection is disrupted. However, the sacral reflex arc is intact (S2–S4), meaning the reflexogenic pathway can still operate if the genital area is stimulated. Therefore, the patient can achieve a reflexive erection independent of brain input, but the psychogenic pathway is not available. That’s why the best answer is reflexive erection only.

The main idea is that there are two pathways to penile erection: a brain-driven (psychogenic) pathway that travels down the thoracolumbar spinal cord, and a local reflex pathway that uses the sacral spinal cord (S2–S4). In this scenario, the injury is at C6 with loss of supraspinal connections to the thoracolumbar cord, so the brain-driven pathway to trigger erection is disrupted. However, the sacral reflex arc is intact (S2–S4), meaning the reflexogenic pathway can still operate if the genital area is stimulated. Therefore, the patient can achieve a reflexive erection independent of brain input, but the psychogenic pathway is not available. That’s why the best answer is reflexive erection only.