title: Application of 2 vibrators salvages ejaculatory failures to 1 vibrator during penile vibratory stimulation in men with spinal cord injuries.
abstract: OBJECTIVE
  Penile vibratory stimulation is the treatment of first choice for anejaculation in men with spinal cord injury. Nonresponders to penile vibratory stimulation are usually referred for electroejaculation or surgical sperm retrieval. Compared to penile vibratory stimulation these methods are invasive and usually yield lower total motile sperm, potentially limiting options for assisted reproductive technologies. To avoid these less than ideal options a simple method to salvage penile vibratory stimulation failures would be of benefit to spinal cord injured patients. We investigated the recovery rate when 2 vibrators were used to salvage ejaculatory failures to 1 vibrator in men with spinal cord injury.
  
  
  METHODS
  A retrospective chart review was performed in 297 spinal cord injured men who underwent a total of 965 trials of penile vibratory stimulation at our center between 1991 and 2006. Only trials with high amplitude vibrators were examined. All men underwent 2 or more penile vibratory stimulation trials using 1 vibrator applied to the dorsum or frenulum of the glans penis. Men failing to ejaculate with 1 vibrator received 1 or more trials in which the glans penis was then sandwiched between 2 vibrators.
  
  
  RESULTS
  Of all men 49% and 57% of those whose level of injury was T10 or above responded to penile vibratory stimulation with 1 vibrator. Of failures with 1 vibrator 22% responded to penile vibratory stimulation with 2 vibrators.
  
  
  CONCLUSIONS
  Application of 2 vibrators salvaged ejaculatory failures to 1 vibrator during penile vibratory stimulation procedures in men with spinal cord injury. This simple penile vibratory stimulation sandwich method is recommended before referring patients for electroejaculation or surgical sperm retrieval.
authors.affiliation: Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, Florida, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Brackett
authors.forename: Apostolos
authors.initials: A
authors.lastname: Kafetsoulis
authors.forename: Emad
authors.initials: E
authors.lastname: Ibrahim
authors.forename: Teodoro C
authors.initials: TC
authors.lastname: Aballa
authors.forename: Charles M
authors.initials: CM
authors.lastname: Lynne
mesh_terms: D000293:Adolescent; D000328:Adult; D004542:Ejaculation; D004867:Equipment Design; D006801:Humans; D008297:Male; D008875:Middle Aged; D010413:Penis; D010812:Physical Stimulation / Q000295:instrumentation*; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000503:physiopathology*