Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men.
BACKGROUND
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.


OBJECTIVE
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).


METHODS
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 salvaged 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.


CONCLUSIONS
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.
Courtois
Frédérique
F
Departement of Sexology, Université du Québec à Montréal, Québec, Montreal, Quebec, Canada. frederique@uqam.ca
Charvier
Kathleen
K
Leriche
Albert
A
Vézina
Jean-Guy
JG
Côté
Isabelle
I
Raymond
Denis
D
Jacquemin
Géraldine
G
Fournier
Christine
C
Bélanger
Marc
M
D000293:Adolescent; D000316:Adrenergic alpha-Agonists / Q000627:therapeutic use; D000328:Adult; D020211:Autonomic Dysreflexia / Q000209:etiology / Q000503:physiopathology; D001342:Autonomic Nervous System Diseases; D001794:Blood Pressure; D004542:Ejaculation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008879:Midodrine / Q000627:therapeutic use; D009948:Orgasm; D010413:Penis / Q000294:innervation*; D011434:Proprioception; D012677:Sensation; D013119:Spinal Cord Injuries / Q000150:complications* / Q000503:physiopathology*; D011795:Surveys and Questionnaires; D013566:Sympathomimetics / Q000627:therapeutic use; D055815:Young Adult
D000316:Adrenergic alpha-Agonists; D013566:Sympathomimetics; D008879:Midodrine