Perceived Physiological and Orgasmic Sensations at Ejaculation in Spinal Cord Injured Men

Abstract

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.

Premature ejaculation associated with lumbosacral lesions

“…First, Bors and Comarr, 3 then Comarr, 4 and more recently Hubscher 15 and Chéhensse et al, 1 reported that only 5-10% of men with SCI maintain a natural potential for ejaculation Ejaculation and lumbosacral lesions F Courtois and K Charvier despite their lesion. Although these figures increase drastically when vibrostimulation is used, 11,12,15,16 and even more so when midodrine is added to vibrostimulation, 12,14 studies generally emphasize the difficulty in obtaining ejaculation in men with SCI. In this context, report of PE with psychogenic arousal is extremely unusual, especially as these men report that prematurity appeared following the injury.…”

“…Lost climactic sensation during ejaculation might also be explained by the fact that these men with lumbosacral lesions cannot experience even mild autonomic hyperreflexia which has been associated with climactic responses in men with SCI. 12,13,18 Yet, the premature nature of ejaculation following lower SCI remains a mystery.…”

“…3,6 This phenomenon is in marked contrast with the reflex expulsive ejaculations that are observed in men with higher spinal lesions (for example, cervical or thoracic lesions). [10][11][12][13][14] This study was designed to analyze the retrospective data from patients with lower lumbosacral lesions who have consulted our sexual dysfunction clinic in rehabilitation over the past 20 years. The goal was to explore to what extent these PEs are systematic in men with lower lumbosacral lesions (that is, L5 and below), and if so which specific type of lumbosacral lesions (that is, conus terminalis, epiconus, cauda equina) appear to be associated with this phenomenon.…”

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

“…34 In our clinics, we therefore tend to use a threshold of 180 mm Hg SBP before considering pharmacological intervention 5,7,12 unless the individual reports negative or uncomfortable side effects in which case the test is ceased and treatment implemented if side effects persist and blood pressure fails to diminish. Furthermore, when an individual is at risk of AD, prophylaxis treatment may also be considered.…”

“…11 Sexuality and fertility are therefore definite options for men with SCI, and considering the currently available treatments, more than 90% of men with SCI can achieve ejaculation. 4,5 The resulting response is accompanied with many sexual sensations 12 including orgasm 13,14 despite the spinal cord lesion. Vibrostimulation is a common prescription in this context and a key option, as it can use it at home, with no medical assistance, alone or with a partner.…”