Abstract
Objectives. We investigated which nerve pathways are necessary to achieve ejaculation
using penile vibratory stimulation (PVS) in men with spinal cord injury (SCI).
Methods. Eight men with SCI were selected based on the presence of a bulbocavernosus
reflex (BCR) and consistent antegrade ejaculation with PVS. Level of injury was cervical
(4), upper thoracic (4), and lower thoracic (1). Mean age was 30.4 years (range 22
to 38). Usual responses to PVS included autonomic dysreflexia (4), erection (4), and
consistent somatic responses such as abdominal contractions (8). Local anesthesia
of the dorsal penile nerves (penile block) was achieved using 1% plain lidocaine injection.
Effective penile block was confirmed by loss of the BCR. Two PVS ejaculation trials
were performed: one trial during the penile block and one trial when the penile block
had worn off. In 4 subjects, the bladder contents were analyzed for retrograde ejaculation.
Results. With the penile block, ejaculation was inhibited in 100% of the subjects.
None of the bladder washings demonstrated sperm, indicating absence of retrograde
ejaculation. None of the subjects exhibited their usual erectile response, somatic
responses, or signs of autonomic dysreflexia. After the penile block wore off, PVS
induced ejaculation in all subjects. If subjects usually had erection, somatic responses,
or signs of autonomic dysreflexia, these also returned.
Conclusions. Our data suggest that ejaculatory response to PVS in SCI men requires
the presence of intact dorsal penile nerves.
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Article info
Publication history
Accepted:
December 1,
1999
Received in revised form:
December 1,
1999
Received:
October 19,
1999
Footnotes
☆Supported by the Miami Project to Cure Paralysis and The State of Florida Specific Appropriations
Identification
Copyright
© 2000 Elsevier Science Inc. Published by Elsevier Inc. All rights reserved.
