title: Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men.
abstract: 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.
authors.affiliation: Departement of Sexology, Université du Québec à Montréal, Québec, Montreal, Quebec, Canada. frederique@uqam.ca
authors.forename: Frédérique
authors.initials: F
authors.lastname: Courtois
authors.forename: Kathleen
authors.initials: K
authors.lastname: Charvier
authors.forename: Albert
authors.initials: A
authors.lastname: Leriche
authors.forename: Jean-Guy
authors.initials: JG
authors.lastname: Vézina
authors.forename: Isabelle
authors.initials: I
authors.lastname: Côté
authors.forename: Denis
authors.initials: D
authors.lastname: Raymond
authors.forename: Géraldine
authors.initials: G
authors.lastname: Jacquemin
authors.forename: Christine
authors.initials: C
authors.lastname: Fournier
authors.forename: Marc
authors.initials: M
authors.lastname: Bélanger
mesh_terms: 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
chemical_list: D000316:Adrenergic alpha-Agonists; D013566:Sympathomimetics; D008879:Midodrine