(275) Beyond Continence: Addressing Sexual Function and Fertility Knowledge Gaps in Men with Spina Bifida

Abstract Introduction As advances in medical and surgical management have extended the life expectancy of individuals with spina bifida (SB), increasing numbers of men are reaching adulthood. Yet, their sexual and reproductive health needs remain poorly understood and frequently under-addressed. Erectile dysfunction (ED), ejaculatory impairment, fertility uncertainty, and psychosocial barriers contribute to diminished quality of life. Transitional urology programs have largely focused on urinary continence and renal preservation, often overlooking sexual wellness and fertility counseling. This study aims to characterize erectile function, fertility knowledge, and relationship dynamics in men with SB to guide integration of structured sexual health discussions into adult care pathways. Objective To assess sexual function, fertility awareness, and relationship patterns among men with spina bifida (SB) within a transitional urology program, and to identify gaps in counseling and education that limit comprehensive sexual and reproductive health care. Methods A prospectively maintained transitional urology database (2015–2022) encompassing 221 patients was reviewed. All male SB patients were included. Extracted variables included demographics, ambulatory status, reconstructive history (defined as bowel incorporation in urinary reconstruction), Sexual Health Inventory for Men (SHIM) scores, and responses to non-standardized questionnaires assessing sexual activity, fertility awareness, and relationship status. Descriptive analyses were performed, and associations between erectile function and clinical variables were evaluated. Results Fifty-five men met inclusion; 44 completed SHIM surveys (mean age = 29.6 years). Seventy-one percent (31/44) had ED-18% severe, 52% mild-to-moderate, and only one patient (2%) reported normal function. ED severity did not differ by ambulation (p = 0.91) or reconstructive history (p = 0.75). Only 25% were currently sexually active, despite 73% expressing desire for sexual activity. Fertility awareness was limited: 28% had heard of IVF, and only 7% received fertility counseling. One man reported paternity. Over 40% expressed interest in learning more about sexuality and fertility. Conclusions ED and fertility knowledge deficits are pervasive among men with SB, independent of physical function or reconstructive status. These findings highlight a critical blind spot in adult urologic care-where continence goals overshadow sexual and reproductive well-being. Integration of structured sexual counseling and fertility education into transitional urology programs is urgently needed to optimize quality of life and enable comprehensive survivorship care. Disclosure No