Sexual dysfunction, neck pain, and cervical spine surgery: understanding the connections

By Ross Hauser, MD

Sexual difficulties can be an important part of the loss of quality of life that accompanies chronic neck problems. A person may avoid intimacy because movement hurts, feel less interested because of exhaustion, or experience changes in erection, sensation, or orgasm. At Caring Medical, our clinical perspective is that a person’s neck symptoms should be understood within the broader picture of their health. However, sexual dysfunction and neck pain occurring together do not establish that one caused the other, only that they should be explored as some patients report poorer sexual function after cervical surgery. Others improve after surgery for a herniated disc or spinal cord compression.  Let’s explore.

I don’t like being touched, especially softly, it now hurts.

One such woman described her case:

I have a lot of strange symptoms. I have been to a chiropractor, optometrist, cardiologist, and gynecologist, and so far, nothing seems wrong with me, no one can find anything wrong with me. Some symptoms come and go, some are very extreme, and others are persistent.

I have had tinnitus, extreme migraines for a few days, eye pain, and blurry vision. I had fluctuating heart rate and blood pressure. The cardiologist said he couldn’t find the problem. One more thing bothers me. I have no sexual need or sensation, I don’t like being touched, especially softly, it now hurts.

Another woman, this way:

I have a complete loss of sex drive, a “vibrating” feeling in my pelvis, Pelvic Floor Dysfunction, Dyspareunia pain associated with intercourse), Dysuria (persistent urinary frequency and urgency intermittently.) They say they always felt like I was never getting enough blood flow to my brain to do anything productive. This person also described, neck pain, ocular migraines, heart palpitations, Presyncope, Idiopathic hypersomnia (extreme fatigue), Narcolepsy with Cataplexy (loss of muscle function when laughing hard or a state of excitability as in being angry or mad or frightened.

The ability to resume sexual activity is seen as a positive outcome of cervical spine treatment

Degenerative cervical myelopathy means spinal cord dysfunction caused by degenerative changes in the neck. It is different from uncomplicated neck pain.

A 2019 international online survey examined what people with this condition most wanted to recover. Pain relief was the most common first priority, followed by walking, sensation, and hand and arm function. Sexual function was also among the recovery priorities. This was a survey of a self-selected online community, so its findings should not be treated as the priorities of every person with cervical disease. The useful lesson is that recovery includes personal activities that standard neck questionnaires may overlook. (1)

A person who has less pain but still cannot participate comfortably in intimacy may consider their recovery incomplete. Conversely, improved comfort does not necessarily mean that erectile or hormonal difficulties have resolved. These are related aspects of health, but they are not interchangeable outcomes.

What patients reported after cervical spine surgery

One of the studies discussed in the original version of this article surveyed 59 patients after cervical surgery: 31 men and 28 women, with a mean age of approximately 56.

Researchers found lower sexual function scores than in age-matched comparison populations. Forty-six percent reported difficulty with a previously enjoyed sexual position. Thirty-nine percent described worse sexual function after surgery, while 5% reported improvement. Neck disability, mental health, back pain, and medication use were among the associated factors. (2)

These findings document an important patient concern. They do not establish that surgery caused every reported difficulty. This was a small postoperative survey, with patients recalling changes rather than a prospective assessment using the same sexual function measures before and after surgery. Comparison with population norms cannot fully account for pre-existing disease or differences in health.

The percentages therefore should not be presented as a universal risk estimate for cervical fusion or as proof that surgery generally worsens sexual function.

New 2026 research: the evidence remains mixed

A 2026 systematic review examined 15 studies of sexual function following elective spine surgery. Its scope included different spinal conditions and procedures, so it was broader than cervical surgery alone.

The authors found limited, heterogeneous evidence. Studies differed in their populations, methods, and definitions of sexual dysfunction. Psychological factors and sex-specific outcomes remained underexplored. (3)

This distinction matters when interpreting research. A questionnaire item asking whether pain interferes with sex does not measure the same thing as a detailed assessment of desire, arousal, lubrication, erection, orgasm, and satisfaction. Improvement in one domain can coexist with persistent problems in another.

A result from lumbar surgery also cannot automatically predict what will happen after cervical surgery. Likewise, a study of spinal cord compression cannot establish outcomes for someone whose primary problem is painful movement without cord involvement.

Cervical spinal cord compression may affect sexual function

The cervical spinal cord carries signals between the brain and lower parts of the body. Disease affecting those pathways can influence functions beyond the neck and arms.

A 2025 systematic review specifically examined sexual dysfunction in degenerative cervical myelopathy. It included seven articles involving 910 patients overall. Some smaller studies reported improvement after decompressive surgery, but results were not uniform. Evidence concerning women and ejaculation was particularly limited. (4)

This is a possible neurological connection, but it does not make erectile dysfunction a reliable test for cervical cord compression.

“Psychogenic erection” does not automatically mean a psychological disorder

An older prospective study followed 22 men with cervical myelopathy and sexual dysfunction. Eighteen had abnormal psychogenic erections before surgery, while four had abnormal reflexogenic erections. Sexual function improved after surgery in this selected group. (5)

In this context, a psychogenic erection is initiated by sexual thoughts or other arousing cues through pathways involving the brain. A reflexogenic erection begins in response to direct physical stimulation through reflex pathways. The study cannot establish that postoperative improvement resulted simply from less anxiety about waiting for surgery.

Neurologists find erectile dysfunction, walking difficulties, and urinary hesitation as curious aspects of neck problems

Many patients think sexual dysfunction, or in the case of men, erectile dysfunction, is seemingly unrelated to their neck problems. Generally, they see these problems as what we have described above, one problem in a constellation of problems. For some, this has been reinforced by their medical professionals who look at problems of the neck as problems of the neck and problems of erectile or sexual dysfunction a problem that needs to be recommended to a urologist. While the recommendation to a urologist is seen as a precautionary measure to rule out other problems, once the referral is made to the urologist and the report comes back that there does not seem to be a problem in this area, the problems of erectile and sexual dysfunction will then simply be dismissed or ignored.

A 51-year-old man went to the hospital with neck pain and erectile dysfunction

A report in the medical journal Neurology (10) reveals how doctors are now seeing erectile and sexual dysfunction as components of a cervical spine, and neck problem.

In this report, a 51-year-old man went to University Hospital at the University of Athens in Greece. He had neck pain, right-hand weakness, and a progressively deteriorating gait. The onset of symptoms occurred one month before hospital admission with cervical neck pain that worsened during neck flexion (the movement of the chin on the chest). A few days later he noticed reduced dexterity and numbness of his right hand. During the following three weeks, his gait became increasingly unstable. Additionally, he reported erectile dysfunction and urinary hesitancy. No previous trauma was recalled. In other words, he did not know how this started but it was getting worse fast.

This turned out to be a very complicated case. But for the purpose of this article, the example is that this patient’s erectile dysfunction and walking problems were related to spinal cord compression and the patient has an excellent response to steroids, however, the response was short-lived and the symptoms got that much worse. The connection? Erectile dysfunction can be a problem of the cervical spine.

Newer research includes women with cervical disc herniation

A 2024 prospective study enrolled 50 sexually active women with cervical disc herniation, 50 with lumbar disc herniation, and 50 healthy controls. Researchers assessed sexual function, pain, disability, and depressive symptoms, including a postoperative assessment at two months.

Sexual function scores improved after surgery in both patient groups. (6)

This adds evidence that sexual difficulties can accompany painful spinal conditions and may improve following successful treatment. It also challenges a blanket statement that cervical surgery worsens sexual health.

The study had important limits: short follow-up, selected women of reproductive age, and no comparable nonsurgical treatment group. It excluded several illnesses and medication exposures that can affect sexuality. Its findings do not establish long-term outcomes for all women, nor do they show which part of the improvement came from pain relief, mood changes, or another mechanism.

Pain, medication, and sexual function can overlap

Pain and fear of provoking symptoms

Sexual activity involves movement, positioning, and exertion. Someone may retain normal sexual desire and physiological responses but avoid activity because of neck pain or fear of aggravating symptoms.

That experience is different from being unable to achieve an erection, having genital numbness, or experiencing pain in the pelvis. Distinguishing the actual difficulty helps prevent an overly broad label from hiding the problem.

Fear is also not proof that the neck is being damaged. After an operation, appropriate activity restrictions depend on the procedure and the individual’s recovery. There is no single timetable for everyone.

Opioids and hormone changes

Medication is another possible contributor. A systematic review and meta-analysis found that hypogonadism—reduced sex hormone production—was common in studied opioid users. Across 15 studies involving 3,250 participants, almost all male, its estimated prevalence was 63%. That estimate applies to the studied populations, not to every person prescribed a short course of pain medication. (7)

This provides an alternative explanation for reduced desire or erectile symptoms in some people with chronic pain. Our related article discusses opioids, painkillers, and low testosterone.

Medication changes should be medically supervised. Symptoms alone cannot diagnose a hormone deficiency.

Vertigo and sexual dysfunction.

As mentioned above, many patients with secondary symptoms and conditions of cervical spine instability will report problems with vertigo. A 2019 paper published in the journal Frontiers in Neurology (12) suggested neurologic disorders, like those we see in neck instability patients, may be the result of blood and fluid flow blockage in the neck and brain. This is what they said:

“Like other physical activities, sexual intercourse increases the pulse rate, respiration rate, and blood pressure. Furthermore, the heart rate rises up to 110–180 beats per minute, and the respiration rate up to 40 breaths per minute during orgasm. These systemic and cerebral hemodynamic (blood flow)  changes may explain the neurological disorders that occur in association with coitus (intercourse), which include coital cephalalgia (sex headaches), transient monocular blindness (you suffer from a temporary loss, or a slow fading out to gray, in the vision of one of your eyes), reversible cerebral vasoconstriction syndrome (sudden constriction of the arteries that supply blood to the brain), transient global amnesia (temporary memory loss), syncope (fainting), subarachnoid and intracerebral hemorrhage (blood leakage), and ischemic strokes (Please see our article Treating Vertebrobasilar insufficiency, vertebrobasilar artery insufficiency, rotational vertebral artery occlusion syndrome, or Bow Hunter Syndrome.)

Referring back to vertigo, the researchers noted: “. . . however, the characteristics, underlying disorders, and mechanisms of coital dizziness/vertigo have not been explored systematically in a large number of patients. The aim of this study is to draw the attention of physicians to this potentially important, but easily overlooked phenomenon.”

Here are the learning points of their study: Again we note the high collaboration with their findings and the possible association of cervical spine instability we see in our patients.

• Vertigo associated with sex can be caused by hormonal dysfunction. They noted a possible frequency of post-sex vertigo after hormone replacement therapy in patients.
• Peripheral vestibulopathy should be suspected in recurrent coital vertigo. (An imbalance in the ears. Please see our article When Cervical Spine Instability Causes Ear Pain, Ear Fullness, Sound Sensitivity, and Hearing Problems.)
• It is noteworthy that nearly half of the patients reported their vertigo also occurs during exercises requiring physical strains other than sexual intercourse. According to their observation, vertigo may be just an effect of coitus and orgasm rather than a direct effect of those. Indeed, it is common to encounter individuals with vestibular deficits who report exacerbation of their symptoms during physical or emotional stress.
• More than half (67% of the patients in this study) of exertional dizziness replicates symptoms during the tilt table and it is better explained by autonomic dysregulation. (Something is causing dysfunction in messages the nervous system is sending – cervical instability can be suspected.)

Tinnitus is a symptom of cervical spine instability, erectile dysfunction can be a problem of cervical spine instability. Is there a connection between ringing in the ears and sexual dysfunction?

Not every person we see with sexual dysfunction secondary to cervical spine instability suffers from tinnitus or “ringing in the ears.” If you have been diagnosed with tinnitus you have probably been subjected to many tests, scans, and other studies, have yourself researched the condition extensively, and have had more people look into your ears than you can count. Yet you still may suffer from ringing in the ears. For more information on tinnitus please see my article Tinnitus, cervical spine instability, and neck pain. Let’s now return to the problem of sexual dysfunction as being caused by cervical instability.

“With many previous studies indicating a higher prevalence of sexual problems in patients with tinnitus, the association between tinnitus and erectile dysfunction has become an interesting topic that warrants further research. In (this) study, (the researchers suggested) that tinnitus may be associated with erectile dysfunction and aimed to further explore the relationship between these two medical conditions.”

What did they find? A review of over 38,000 patients, (3.23%) received a tinnitus diagnosis within the year before the erectile dysfunction diagnosis and observed that patients were more likely to develop erectile dysfunction after a tinnitus diagnosis. The researchers concluded:

“Through our investigation, we have ultimately detected a novel (unique) association between erectile dysfunction and tinnitus and urge physicians to be alert to the possibility of the development of erectile dysfunction in patients treated for tinnitus.”

In other words, if you are a man, diagnosed with tinnitus, there is a risk that you will develop erectile dysfunction. How? One cause may be cervical spine instability.

We will often hear from women who have been diagnosed with many conditions who will also report that among their many issues they first developed tinnitus and then started experiencing a burning and tightness sensation in their vaginal area with problems of urinary frequency and urgency.

Other causes should remain part of the explanation

Erectile dysfunction may involve vascular, metabolic, hormonal, neurological, medication-related, and psychological factors. Urological guidance supports assessment of medical, sexual, and psychosocial history, physical examination, and appropriate laboratory testing. Erectile dysfunction can also be a marker of underlying cardiovascular disease. (8)

For women, painful intercourse or reduced arousal may involve pelvic floor dysfunction, menopausal changes, vulvar pain conditions, gynecological disease, medications, or other contributors. Having neck pain does not exclude these possibilities. Our discussion of pelvic floor disorders and pelvic girdle pain addresses a separate area of musculoskeletal health.

Retrograde ejaculation, in which semen enters the bladder rather than exiting normally, also requires its own explanation. It should not be assumed to result from cervical instability simply because both are reported by the same person.

Similarly, tinnitus, dizziness, urinary symptoms, and sexual difficulties may coexist without sharing a single cause. Their presence should broaden the clinical questions, not settle the diagnosis.

Our perspective on cervical instability and autonomic symptoms

Our interest in neck pain and cervical instability includes the potential effects of ligament injury and abnormal cervical mechanics.

In our 2025 hypothesis-and-theory paper, we proposed that cervical instability and changes in neck structure may contribute to vagus nerve dysfunction in selected patients. The paper included observational findings from a symptomatic clinic population and a case example. (9)

This work offers a hypothesis about cervical and autonomic relationships. It does not prove that vagus nerve compression causes erectile dysfunction, painful intercourse, or retrograde ejaculation. It also does not establish that treating cervical ligaments restores sexual function.

Sexual responses involve multiple nervous system pathways, circulation, hormones, and local tissues. “Autonomic dysfunction” is therefore not a sufficiently specific explanation by itself. Readers can learn more about our proposed mechanism in the cervicovagopathy discussion.

What can we say about prolotherapy?

Prolotherapy is discussed in our work as a treatment directed at selected musculoskeletal ligament problems. The studies reviewed here do not establish cervical prolotherapy as a treatment for sexual dysfunction.

Improved comfort during intimacy after reduced neck pain would be meaningful to a patient. However, it would not by itself demonstrate regeneration of sexual nerves, correction of a hormone deficiency, or reversal of a vascular cause of erectile dysfunction.

For confirmed degenerative cervical myelopathy, published guidance recommends surgery for moderate or severe disease. Mild disease may be managed with surgery or a supervised rehabilitation trial, with surgery recommended if neurological deterioration occurs. A proposed ligament or autonomic mechanism should not delay assessment of cord compression. (10)

A sudden severe headache during sexual activity, particularly with fainting, weakness, or vision loss, also requires emergency evaluation.

This article is for education and does not provide an individual diagnosis or treatment recommendation.

References

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