Introduction With the advances in penile vibrator stimulation (PVS), most spinal cord injured (SCI) men can self-ejaculate. Oral midodrine may further increase ejaculation success, while maintaining autonomy. Since most SCI men attempt ejaculation for sexual rather than reproductive purposes, self-ejaculation should be emphasized and sensations explored. Aims Explore (i) self-ejaculation success rate in SCI men; (ii) vascular parameters indicative of autonomic dysreflexia (AD) during sexual stimulation and ejaculation; and (iii) sensations associated with ejaculation. Methods Ejaculation was assessed on 81 SCI men with complete ASIA A (49%) and incomplete B to D lesions (51%), subdivided into tetraplegics (C2–T2), paraplegics sensitive to AD (T3–T6), paraplegics not sensitive to AD (T7–T10), paraplegics with lesions to the emission pathway (T11–L2), and paraplegics with lesions interrupting the emission-ejaculation pathways (L3–below). Natural stimulation was attempted first followed, if negative, by PVS followed, if again negative, by PVS combined with oral midodrine (5–25 mg). Main Outcome Measures Ejaculation success, systolic and diastolic blood pressure, and perceived physiological and orgasmic sensations. Results Overall 91% reached ejaculation, 30% with natural stimulation, 49% with PVS and 12% with midodrine plus PVS. Midodrine savalged up to 27% depending upon the lesion. Physiological and orgasmic sensations were perceived significantly more at ejaculation than sexual stimulation. Tetraplegics did not differ from paraplegics sensitive to AD on perceived cardiovascular and muscular sensations, but perceived significantly more autonomic sensations, and generally more physiological sensations than lower lesions unsensitive to AD. Conclusion Most SCI men can self-ejaculate and perceive physiological and orgasmic sensations. The climactic experience of ejaculation seems related to AD, few sensations being reported when AD is not reached, pleasurable climactic sensations being reported when mild to moderate AD is reached, and unpleasant or painful sensations reported with severe AD. Sexual rehabilitation should emphasize self-ejaculation and self-exploration and consider cognitive reframing to maximize sexual perceptions.
pressure (BP) changes measured at baseline and at ejaculation (or on the last trial if the test was negative). Reported sensations were also recorded and compared during positive and negative tests. RESULTSOverall, 89% of the patients reached ejaculation with one mode or another of stimulation. When patients had a negative result with natural stimulation, 56% were salvaged by PVS, and when PVS was negative, another 22% were salvaged by midodrine combined with PVS. The mean systolic BP increased by 35 mmHg at ejaculation during PVS and by 11 mmHg after midodrine, and a subsequent 29 mmHg at ejaculation during PVS combined with midodrine. By contrast, negative tests showed a relatively stable BP; the difference in changes in BP during positive and negative tests was significant ( P < 0.01). Increases in BP during positive tests declined significantly more often within the limits of autonomic dysreflexia than negative tests ( P < 0.01).Study Type -Therapy (case series) Level of Evidence 4 OBJECTIVESTo explore the effectiveness of various sources of self-stimulation, including oral midodrine, in triggering ejaculation in men with spinal cord injury (SCI), and to document the systematic variations in blood pressure at ejaculation and consider a revised definition of autonomic dysreflexia. PATIENTS AND METHODSThe study included 62 men with SCI lesions from C2 to L2. Ejaculation potential was assessed with various sources of stimulation, beginning with natural stimulation, followed, if the test was negative, by penile vibrator stimulation (PVS) followed, if the test was again negative, by PVS combined with oral midodrine, started at 5 mg and increased in 5 mg steps up to 25 mg. The success rate of ejaculation was recorded, as were blood
• Responses to the questionnaire were divided into four categories: cardiovascular, muscular, autonomic and dysreflexic sensations. RESULTS• Significantly more sensations were described at ejaculation than with sexual stimulation alone.• Men with SCI who experienced AHR at ejaculation reported significantly more cardiovascular, muscular, autonomic and dysreflexic responses than those who did not.• There was no difference between men with complete and those with incomplete lesions. CONCLUSIONS• The findings show that the questionnaire is a useful tool to assess orgasm and to guide patients in identifying the bodily sensations that accompany or build up to orgasm.• The findings also support the hypothesis that orgasm may be related to the presence of AHR in individuals with SCI. Data from able-bodied men also suggest that AHR could be related to orgasm, as increases in blood pressure are observed at ejaculation along with cardiovascular, autonomic and muscular sensations. OBJECTIVES• To provide a questionnaire for assessing the sensations characterizing orgasm.• To test the hypothesis that orgasm is related to autonomic hyperreflexia (AHR) in individuals with a spinal cord injury (SCI). SUBJECTS AND METHODS• A total of 97 men with SCI, of whom 50 showed AHR at ejaculation and 39 showed no AHR, were compared.• Ejaculation was obtained through natural stimulation, vibrostimulation or vibrostimulation combined with midodrine (5-25 mg).• Cardiovascular measures were recorded before, at, and after each test.
Depuis les travaux sur l'utilisation du Gutron ® en Europe et au Canada (Québec), nous avons étudié les sensations somatiques et autonomiques pouvant être associées à l'éjaculation chez les hommes blessés médullaires. Puisque l'éjaculation est associée à une activité sympathique, que le Gutron ® est un alphastimulant et que l'activité sympathique peut être transmise par divers circuits nerveux, nous avons émis l'hypothèse que l'éjaculation serait associée à des perceptions autonomiques malgré les lésions. Un total de 41 hommes tétraplégiques et paraplégiques avec des lésions situées de C2 à T2 et de T3 à T6 ont obtenu des éjaculations par vibromassage avec et sans Gutron ® . Les mesures de la tension artérielle systolique (TAS) ont montré des hausses de 51 mmHg (113 à 164 mmHg) chez les sujets tétraplégiques lors de l'éjaculation, avec peu de différences entre les patients utilisant le Gutron ® et ceux ne l'utilisant pas. Chez les hommes paraplégiques, l'éjaculation avec Gutron ® montre des hausses de TAS de 39 mmHg, mais la TAS n'augmente que de 13 mmHg chez les paraplégiques éjaculant sans Gutron ® . La fréquence cardiaque diminue chez tous les sujets lors de l'éjaculation (de 8 à 24 b/min) mais de façon plus importante chez les paraplégiques sous Gutron ® . Les sensations physiologiques sont perçues plus fréquemment en cas d'éjaculation par opposition à la stimulation sexuelle sans éjaculation (test négatif) et plus fréquemment chez les hommes utilisant le vibromassage seul plutôt que couplé avec le Gutron ® . Les sensations physiologiques (cardiovasculaire, musculaire, autonomique) sont plus fréquentes que les sensations orgasmiques (relaxante, paroxystique, intime). Ces résultats suggèrent que le Gutron ® affecte moins les hommes tétraplégiques que les paraplégiques, probablement parce que l'activité sympathique est maximale chez le tétraplégique lors de l'éjaculation en raison de l'hyperréflexie autonome. Les sensations semblent par ailleurs plus généra-lisées en cas d'éjaculation par vibromassage seul et ne sont donc pas uniquement attribuables à un effet secondaire du Gutron ® . Les implications cliniques de ces résultats sur l'autonomie des hommes blessés médullaires sont discutées.Ejaculatory sensations during vibrator and midodrine stimulation in men suffering from damage to the spinal cord Abstract: Since the first studies on midodrine hydrochloride, carried out in Europe and Canada (Quebec), we have been interested in the somatic and autonomic sensations that might be associated with ejaculation in men suffering from lesion to the spinal cord. Since ejaculation is associated with sympathetic activity, since midodrine is an alpha stimulating drug and since sympathetic activity can be transmitted to the brain through several neural pathways, we hypothesized that ejaculation might be associated with autonomic perceptions despite the spinal lesions. A total of 41 tetraplegic and paraplegic men with lesions located between C2-T2 and T3-T6 achieved ejaculation with penile vibrator stimulation with and with...
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