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April 19, 1971

Impotence in the Low-Back Syndrome

JAMA. 1971;216(3):520. doi:10.1001/jama.1971.03180290094027

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To the Editor:—  We should like to disagree with the answer given to the questioner who asked for an explanation of the difficulty in erection and sexual intercourse associated with herniated lumbar disks.The answer given implies that the sexual impotence in the male patient with lumbar disk disease is related to psychologic causes secondary to "a nearly fatal assault on his manhood."We have found that impotence can often be associated with lumbar disk disease, and that the cause is organic and not psychologic in these cases. It is not necessary that there be a massive posterior protrusion of the L4-5 disk with paraplegia in order for impotence to occur. Indeed, impotence may occasionally be the presenting complaint in patients with occult lumbar disk disease (New York Med J69:2465, 1969), and can be completely relieved following surgical correction of the herniated disk.Clinical experience in patients with