Midodrine improves orgasm in spinal cord-injured men: the effects of autonomic stimulation.
BACKGROUND
Orgasm is less frequent in men with spinal cord injury (SCI) than in able-bodied subjects, and is poorly understood.


OBJECTIVE
To assess the effect of autonomic stimulation on orgasm in SCI men using midodrine, an alpha1-adrenergic agonist agent.


METHODS
Penile vibratory stimulation (PVS) was performed in 158 SCI men on midodrine as part of a treatment for anejaculation, after they failed a baseline PVS. A maximum of four trials were performed, weekly, with increasing doses of midodrine.


METHODS
The presence and type of ejaculation, orgasm experiences, and cardiovascular data were collected.


RESULTS
Ejaculation either antegrade or retrograde was obtained in 102 SCI men (65%). Orgasm without ejaculation was reported by 14 patients (9%) on baseline PVS. Ninety-three patients (59%) experienced orgasm during PVS on midodrine. Orgasm was significantly related to the presence of ejaculation in 86 patients (84%), and more strikingly to antegrade ejaculation (pure or mixed with retrograde), i.e., in 98% of 70 patients. Orgasm was significantly more frequent in patients with upper motor neuron and incomplete lesions who present somatic responses during PVS. There was no effect of the presence of psychogenic erection. There was a significant increase in both systolic and diastolic blood pressure. Sixteen patients, mainly tetraplegics, developed intense autonomic dysreflexia (AD) that required an oral nicardipine chlorhydrate.


CONCLUSIONS
Orgasm is the brain's cognitive interpretation of genital sensations and somatic responses, AD, and ejaculation. Intact sacral and T10-L2 cord segments are mandatory, allowing coordination between internal and external sphincters. Autonomic stimulation with midodrine enhances orgasm rate, mainly by creating antegrade ejaculation.
Soler
Jean Marc
JM
Laboratoire d'urodynamique et de sexologie-Centre Bouffard Vercelli-Cap Peyrefite 66290 Cerbère, France.
Previnaire
Jean Gabriel
JG
Plante
Pierre
P
Denys
Pierre
P
Chartier-Kastler
Emmanuel
E
D000316:Adrenergic alpha-Agonists / Q000009:adverse effects / Q000627:therapeutic use*; D000328:Adult; D001341:Autonomic Nervous System / Q000187:drug effects*; D001794:Blood Pressure / Q000187:drug effects; D004305:Dose-Response Relationship, Drug; D004542:Ejaculation / Q000187:drug effects; D006801:Humans; D008297:Male; D008879:Midodrine / Q000009:adverse effects / Q000627:therapeutic use*; D009948:Orgasm / Q000187:drug effects*; D013119:Spinal Cord Injuries / Q000188:drug therapy*; D014732:Vibration / Q000627:therapeutic use
D000316:Adrenergic alpha-Agonists; D008879:Midodrine