Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

Courtois, F.; Charvier, K.; Leriche, A.; Vézina, Jean-Guy; Côté, M.; Bélanger, Marcel

doi:10.1111/j.1464-410x.2007.07254.x

Cited by 54 publications

(55 citation statements)

References 34 publications

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“…Both vibrostimulation and midodrine maximize ejaculation, but both carry the risk of AD. Studies on midodrine, 7 however, do not show higher increases in SBP at ejaculation compared with vibrostimulation alone, but increases in baseline SBP (that lowers the threshold for ejaculation). 7 AD risk with midodrine is therefore similar to that with vibrostimulation and seems related to the occurrence of ejaculation itself.…”

Section: Discussionmentioning

confidence: 85%

“…Studies on midodrine, 7 however, do not show higher increases in SBP at ejaculation compared with vibrostimulation alone, but increases in baseline SBP (that lowers the threshold for ejaculation). 7 AD risk with midodrine is therefore similar to that with vibrostimulation and seems related to the occurrence of ejaculation itself. Upon AD risks, the Consortium for Spinal Cord Medicine 32 suggests that the ideal drug should have a rapid onset, short duration of action, few side effects, and be safely used at home.…”

Section: Discussionmentioning

confidence: 85%

“…The same applies for the other cardiovascular parameters, DBP or HR. Knowing that men with SCI experience sexual activities at home, and knowing that options such as vibrostimulation and oral midodrine are available to help them achieving ejaculation, [3][4][5][6][7] these issues become essential in the management of sexual function in individuals with SCI.…”

Section: Discussionmentioning

confidence: 99%

“…34 In our clinics, we therefore tend to use a threshold of 180 mm Hg SBP before considering pharmacological intervention 5,7,12 unless the individual reports negative or uncomfortable side effects in which case the test is ceased and treatment implemented if side effects persist and blood pressure fails to diminish. Furthermore, when an individual is at risk of AD, prophylaxis treatment may also be considered.…”

Section: Pathophysiology Of Admentioning

confidence: 99%

“…[3][4][5] Sexual options for men with SCI Ejaculation dysfunctions in men with SCI can be treated with a variety of options, starting with commercial vibrators, followed if unsuccessful by the use of the Ferticare device, 6 which has been shown much more effective, followed if still negative by vibrostimulation combined with midodrine. 7 When fertility is aimed for, rectal probe electroejaculation 8,9 and other assisted reproductive technologies can be offered, allowing intravaginal home injection, 10 intrauterine or in vitro fertilization. 11 Sexuality and fertility are therefore definite options for men with SCI, and considering the currently available treatments, more than 90% of men with SCI can achieve ejaculation.…”

Section: Introductionmentioning

confidence: 99%

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Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

Courtois

Rodrigue²,

Côté³

et al. 2012

Spinal Cord

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Study design: Systematic review. Objectives: Review the literature on the acute or prophylactic treatment of autonomic dysreflexia (AD) in the context of sexual activities. Setting: International Methods: Medline search using AD and spinal cord injury (SCI). Selected titles for AD treatment included all levels of evidence (randomized placebo control studies, case reports, literature reviews) and all years of publication. Results: Thirty-seven papers on the specific treatment of AD showed that nifedipine, prazosin, captopril and clonidine are candidates in the context of sexual activities. Prazosin, however, has an initial hypotensive effect requiring to begin treatment 12 h before intercourse, which makes it less ideal for spontaneous sexual activities. Captopril has an initial hypotensive effect and was only studied in acute AD. Its usefulness in prophylaxis remains to be demonstrated. Clonidine has successfully been used clinically for decades, but never studied in randomized control trials. Nifedipine remains the most widely studied and significant treatment of AD whether in acute or prophylactic conditions. Recent concerns suggest increased cardiovascular risks with sublingual nifedipine in non-SCI populations, but negative long-term effects have not been reported in the SCI population. Conclusion: Sexual function is a priority for men with SCI. As sexual activities, in particular ejaculation, can be a source of AD, adequate treatments and prophylaxis must be considered in the context of sexual activities. Experts must meet and conclude on the thresholds, parameters and treatments that should be considered in the long-term management of AD in the context of sexual function in men with SCI.

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Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Pathophysiology Of Admentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

Courtois

Rodrigue²,

Côté³

et al. 2012

Spinal Cord

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The intermolecular structural heterogeneity of a propylene‐ethylene random copolymer was studied by preparative temperature rising elution fractionation combined with GPC, 13C‐NMR, differential scanning calorimetry, and wide‐angle X‐ray diffraction analysis of the obtained fractions. The isotacticity of fractions increased with increasing elution temperature, and the ethylene content decreased monotonously. Fitting of the obtained comonomer triad sequences by Bernoullian and first‐order Markovian statistical models indicated that lower isospecific active sites are more active toward ethylene. The isolated ethylene unit disrupted the crystallizable isotactic sequence and lowered the crystallizability of the polypropylene chain. © 2005 Wiley Periodicals, Inc. J Appl Polym Sci 97: 232–239, 2005

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Autonomic Consequences of Spinal Cord Injury

Hou

Rabchevsky

2014

Comprehensive Physiology

178

112

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Spinal cord injury (SCI) results not only in motor and sensory deficits but also in autonomic dysfunctions. The disruption of connections between higher brain centers and the spinal cord, or the impaired autonomic nervous system itself, manifests a broad range of autonomic abnormalities. This includes compromised cardiovascular, respiratory, urinary, gastrointestinal, thermoregulatory, and sexual activities. These disabilities evoke potentially life-threatening symptoms that severely interfere with the daily living of those with SCI. In particular, high thoracic or cervical SCI often causes disordered hemodynamics due to deregulated sympathetic outflow. Episodic hypertension associated with autonomic dysreflexia develops as a result of massive sympathetic discharge often triggered by unpleasant visceral or sensory stimuli below the injury level. In the pelvic floor, bladder and urethral dysfunctions are classified according to upper motor neuron versus lower motor neuron injuries; this is dependent on the level of lesion. Most impairments of the lower urinary tract manifest in two interrelated complications: bladder storage and emptying. Inadequate or excessive detrusor and sphincter functions as well as detrusor-sphincter dyssynergia are examples of micturition abnormalities stemming from SCI. Gastrointestinal motility disorders in spinal cord injured-individuals are comprised of gastric dilation, delayed gastric emptying, and diminished propulsive transit along the entire gastrointestinal tract. As a critical consequence of SCI, neurogenic bowel dysfunction exhibits constipation and/or incontinence. Thus, it is essential to recognize neural mechanisms and pathophysiology underlying various complications of autonomic dysfunctions after SCI. This overview provides both vital information for better understanding these disorders and guides to pursue novel therapeutic approaches to alleviate secondary complications.

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Blood pressure changes during sexual stimulation, ejaculation and midodrine treatment in men with spinal cord injury

Cited by 54 publications

References 34 publications

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

Sexual function and autonomic dysreflexia in men with spinal cord injuries: how should we treat?

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Autonomic Consequences of Spinal Cord Injury

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