What Level of Spinal Cord Injury Leads to Erectile Dysfunction?

Erections depend on two main nerve pathways. One is the reflex pathway that runs through the sacral segments (S2-S4) of the spinal cord. If these segments and the reflex arc are intact, a man may still have reflex erections even if higher pathways are injured. However, if the injury directly affects these sacral segments or the conus medullaris (where these nerves come together), then the ability to have an erection is often lost. In contrast, injuries higher up in the spinal cord (above T11, for example) might preserve the reflex erection while affecting psychogenic (brain-driven) erections. In summary, injuries at the S2-S4 level are most strongly associated with causing erectile dysfunction because they interrupt the nerve signals essential for reflex-based erections. The overall impact on erectile function depends on the level and completeness of the injury, so a thorough evaluation by a specialist is important for personalized management.