Effects of repeated ejaculations on semen characteristics following spinal cord injury

Abstract

Study design: Prospective randomised controlled study. Objective: To evaluate the effects of repeated ejaculation on semen characteristics following spinal cord injury (SCI) in a prospective randomised controlled study. Setting: Spinal Research Centre, Stanmore, UK and Institute of Urology and Nephrology, London, UK. Methods: A total of 74 patients with SCI above T10 were tested by vibro-ejaculation using a Ferticare penile vibrator (Multicept A/S Horsholm, Denmark) using a standardised technique. The ejaculate was examined according to WHO protocol. The successfully vibro-ejaculated subjects (n ¼ 32) were randomised into a study group (n ¼ 18) and a control group (n ¼ 14). The patients in the study group vibro-ejaculated weekly for 3 months with semen analysis performed at baseline and then monthly. The control group vibro-ejaculated at baseline and at the end of the 3-month period. Two experienced observers performed the semen analysis independently. All measures were compared for statistical significance across the two groups at the beginning and at the end of the 3-month period using a two-tailed student t-test. Significance was determined at the 95% confidence interval (Po0.05). Results: In total, 10 patients in the study group and nine in the control group have completed the study so far. Six patients have dropped out of the study group and three from the control group for varied reasons. Two patients are currently enrolled in the study and control groups. The morphology and forward progression of sperm shows a statistically significant increase in the study group. The motility improves but is not statistically significant in the study group. No significant adverse effects were reported. Conclusions: We have shown in this unique randomised controlled study that repeated ejaculation does improve the sperm characteristics in SCI patients. It is suggested that SCI men should undergo repeated ejaculation for at least 3 months before trying intravaginal or intrauterine insemination techniques. If this fails then in vitro fertilisation can be used. This method promotes natural conception, is intimate and cost effective.

Effects of Spinal Cord Injury on Semen Parameters

“…This study indicates abnormal transport and storage of sperm in the seminal vesicles of men with SCI. In concordance, Hamid et al reported that repeated vibroejaculation in men with SCI seems to improve the spermatozoa morphology and forward progression, but this finding is not consistent (16).…”

“…Sonksen et al have reported no improvement in semen quality with repeated vibroejaculation, although this does not represent general experience (17,74). In a prospective, controlled study, Hamid et al have shown statistically significant improvement in morphology and forward progression with repeated vibroejaculation over a period of 12 weeks (16).…”

“…It does not appear to be related to time since injury, elevated scrotal temperature (especially in the wheel chair-bound population), method of bladder management, or method of ejaculation (12)(13)(14)(15). The evidence for frequency of ejaculation as a cause of poor semen quality remains contradictory (16)(17)(18). In this paper, we review factors that may contribute to poor semen quality and subfertility in men with SCI.…”

Long-term effects of spinal cord injury on sexual function in men: implications for neuroplasticity

“…22 There is conflicting evidence as to whether repeated ejaculation via PVS has a beneficial effect on semen quality. 23,24 A significant side effect of assisted ejaculation is that both PVS and electroejaculation can induce autonomic dysreflexia (AD) in men with injuries above T6. 25 In some cases, the symptoms of AD can be protracted for several days following an ejaculatory event and this dangerous situation has been termed 'malignant' AD.…”

Fertility in men with spinal cord injury

“…However, no statistically significant improvement in sperm quality and normalization in sperm motility following repeated ejaculation by PVS or EEJ has been reported [37,38]. Via nvestigating the method of assisted ejaculation in patients with SCI much has been reported about their semen quality.…”