Sexual and climactic responses in men with traumatic spinal injury: A model for rehabilitation

Sexuality and Fertility after Spinal Cord Injury

“…Cumulative success rates of ejaculation of ~ 86% have been reported using either PVS or EEJ in men with SCI, 15 but they have more recently been found to be up to 100% when all sperm retrieval methods, including surgical aspiration, are utilized. 10 Finger massage of the prostate and seminal vesicles can also mechanically express stored sperm that can then be used for insemination when PVS or EEJ is not available, but it is not clear whether this is yet indicated in men with SCI. 16 Surgical sperm retrieval methods (where sperm are surgically retrieved from the internal accessory glands) are also possible, but the use of this in men with SCI when other less invasive and costly methods are available, is controversial.…”

“…6,10 Unless significant increases in blood pressure (BP) occur with sexual stimulation, ejaculation is unlikely to happen. 10 The chance of either reaching ejaculation or experiencing orgasm after SCI appears to be modestly enhanced by the utilization of oral erection medications 11 or sympathomimetic drugs such as mididrone. 10 Approximately 40 to 50% of men and women after SCI are able to reach either selfdefined or laboratory-recorded orgasmic release, although the length and intensity of stimulation required to reach orgasm may exceed preinjury requirements.…”

“…10 The chance of either reaching ejaculation or experiencing orgasm after SCI appears to be modestly enhanced by the utilization of oral erection medications 11 or sympathomimetic drugs such as mididrone. 10 Approximately 40 to 50% of men and women after SCI are able to reach either selfdefined or laboratory-recorded orgasmic release, although the length and intensity of stimulation required to reach orgasm may exceed preinjury requirements. 8 In both sexes, having a complete versus incomplete injury (regardless of level of injury), having an intact sacral reflex arc, and having genital sensation are more predictive of orgasm.…”

“…11 The use of mididrone, a sympathomimetic drug, with or without PVS, is also helpful to induce ejaculation in some men but should be utilized with caution in men who experience AD because it can increase AD severity. 10 Those individuals who do not respond to PVS or other efforts should then be referred for EEJ. An electrical current, delivered through an anal probe with the man in a lateral decubitus or supine position, stimulates seminal emission.…”