Midodrine Improves Orgasm in Spinal Cord-Injured Men: The Effects of Autonomic Stimulation

Soler, J. M.; Prévinaire, J G; Plante, Pierre; Denys, Pierre; Chartier‐Kastler, Emmanuel

doi:10.1111/j.1743-6109.2008.00844.x

Cited by 49 publications

(44 citation statements)

References 28 publications

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“…57,58,[75][76][77] No severe side effects have been noted; those that were reported were limited to tingling, hot flashes, and spasms, which also appear during vibrostimulation and ejaculation. The drug is ingested 45 minutes before sexual activity with vibrostimulation; the dose is started at 5 mg and increased gradually (in separate sessions) up to 25 mg or 30 mg.…”

Section: More Advanced Techniques To Attain Orgasm and Ejaculationmentioning

confidence: 99%

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Alexander

Courtois

Elliott

et al. 2017

Topics in Spinal Cord Injury Rehabilitation

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Sexuality is an important part of life, and it is necessary for clinicians to have a specific format in which to address sexual issues with their patients. A systematic approach to working with patients with spinal cord injury (SCI) to improve their sexual functioning and response is presented. Nonjudgmental communication about sexual concerns is followed by a detailed pre-and postinjury medical, psychosocial, and sexual history. If preexisting sexual issues are present, it is recommended that the patient be referred for assessment and treatment of these separate from the patient's SCI-related concerns. Physical examination, with special attention to issues that could impact the patient's sexuality, is followed by a detailed neurologic assessment with specific attention to the T11-L2 and S3-5 spinal segments. Education of the patient with regard to his or her sexual potential and the need to be flexible in his or her sexual repertoire is followed by self-exploration and practice. Routine follow-up is suggested after patient's initial sexual exploration. Treatment of confounding and iatrogenic factors related to SCI is followed by more sexual experience. Afterwards the clinician is encouraged to use simple techniques to treat sexual issues and follow-up with the patient to assess the outcome. A structured program utilizing vibratory stimulation with or without midodrine is described as a way to achieve ejaculation and potentially orgasm, and techniques for treating severe autonomic dysreflexia are discussed. If these interventions do not alleviate the patient's sexual concerns, the clinician should refer the patient for more specialized consultation.

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Section: More Advanced Techniques To Attain Orgasm and Ejaculationmentioning

confidence: 99%

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Alexander

Courtois

Elliott

et al. 2017

Topics in Spinal Cord Injury Rehabilitation

View full text Add to dashboard Cite

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“…[33] Vibrostimülasyona yanıt vermeyen olgularda midodrine eklenebilir. [42] T10 altı lezyonlularda ve vibrostimülasyona yanıt alınamayan olgularda elektroejakulasyon ikinci basamak seçim olmalıdır. [39] Vibrove elektroejakulasyonun başarısız kaldığı olgularda mikroskopik epididimal sperm aspirasyonu (MESA) ve mikroskopik testiküler sperm ekstraksiyonu sperm elde etmede kullanılan cerrahi yöntemlerdir.…”

Section: İkinci Basamak Tedaviunclassified

Sexual and reproductive abnormalities in patients with spinal cord injuries

Aşçı

Açıkgöz²,

Büyükalpelli³

2012

Turkish Journal of Urology

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Spinal cord injuries (SCIs) may cause predictable abnormalities in genital sexual arousal and changes in the ability to achieve orgasm. In this review, sexual dysfunction and reproductive abnormalities and their treatment possibilities in male and female patients with SCI were reviewed. Literature from 1982-2011 examining the neuroanatomy of sexual functions, sexual dysfunction and reproductive abnormalities and their treatment alternatives both in male and female patients with SCI was reviewed with PubMed. In both genders, the sympathetic, parasympathetic and motor-sensory innervations of genitals are localized at the T11-L2, and S2-4 and S2-3 spinal cord levels, respectively. Patients with lesions above or at level of T11-L2 have reflex erections but no psychogenic erections. Patients with lesions in between levels of L2 and S2 spinal segments have reflex and psychogenic erections. Patients with lesions at level of S2-3 or below can have psychogenic erections but no reflex erections. Patients with lesions above the T10 level have autonomic, somatic, vibration and electroejaculations but no nocturnal ejaculation. Patients with lesions at the level of the thoracolumbar (T11-L2) region can have electroejaculation but no autonomic, somatic, vibration and nocturnal ejaculations. Patients with lesions below the L2 levels can produce emissions and electroejaculation but no other type of ejaculation. Reproductive dysfunction in men with SCI is due to a combination of ED, ejaculatory failure, and abnormal semen parameters. Women with no lesions at the T11-L2 levels may have psychogenic genital vasocongestion, while reflex lubrication and orgasm is more prevalent in women who have preserved the sacral reflex arc (S2-S5). A better knowledge of neuroanatomy and neurophysiology in SCI patients provides a more predictable understanding of sexual and reproductive dysfunctions. ÖZETSpinal kord yaralanmaları (SKY) genital cinsel uyarımlarda öngörülebilir bozukluklara ve orgazma ulaşma yeteneğinde değişikliklere neden olabilir. Bu derlemede SKY'li erkek ve kadın olgularda cinsel işlev ve üre-me bozuklukları ile tedavi olanakları gözden geçirilmiştir. PubMed taraması ile 1982-2011 yılları arasında yayımlanmış literatür eşliğinde cinsel işlevlerin nöroanatomisi, spinal kord yaralanmalarında ortaya çıkan cinsel işlev ve üreme bozuklukları ile tedavi olanakları gözden geçirilmiştir. Her iki cinste genital sistemin sempatik, parasempatik ve motor-duyu inervasyonları sırasıyla T11-L2, S2-5, S2-3 spinal kord seviyelerinde lokalizedir. T11-L2 veya üzerindeki SKY'de refleks ereksiyonlar sürdürülürken, psikojenik (nokturnal) ereksiyonlar kaybolabilir. L2-S2 spinal segmentler arasındaki lezyonlarda ise her iki ereksiyon tipi sürdü-rülürken, S2 seviyesi altında ve komplet konus medullaris lezyonlarında sadece psikojenik ereksiyonlar sürdürülür. T10 ve üzeri lezyonlarda otonomik, somatik, vibro-ve elektro-ejakulasyonlar sürdürülürken, nokturnal ejakulasyon görülmez. T10 altındaki tüm lezyonlarda somatik ve vibroejakulasyon kaybolur...

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“…The average dose of midodrine required for ejaculation was 18.7 mg [Soler et al 2007]. Orgasm without ejaculation was reported by 9% of patients on baseline penile vibratory stimulation, and 59% experienced orgasm during penile vibratory stimulation on midodrine [Soler et al 2008]. Of patients with a complete spinal cord section and suffering from loss of ejaculation, physostigmine allowed 55.6% to ejaculate [Chapelle et al 1988].…”

Section: Treatment Of Non-pe Ejdmentioning

confidence: 99%

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

Seyam

2013

Therapeutic Advances in Urology

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BackgroundThere is an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). The frontier of sexual medicine has shifted slowly from erectile dysfunction (ED) to premature ejaculation (PE) and now to non-PE EjD. Two factors have contributed to this shift. First is the search for new areas of research and of novel treatments and second is the better characterization of ejaculatory disorders. The development of questionnaires that better characterize the type of ejaculatory dysfunction (EjD) has helped to identify the problem with more precision in different populations.Interest in the global sexual practice patterns gave insight into the prevalence of non-PE EjD in different areas of the world. Within the non-PE EjD itself, a shift in focus occurred over the years. Early and related to prostatic surgery and retroperitoneal lymph node dissection (RPLND) retrograde ejaculation was reported. With the development of α-blockers and finasteride, retrograde ejaculation, EjD and/or orgasmic dysfunction were reported as A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men Raouf SeyamAbstract Introduction: A better understanding of ejaculatory disorders has led to an increasing interest in nonpremature ejaculatory dysfunction (non-PE EjD). Current reviews on the subject use a symptom-based classification to describe ejaculatory dysfunction even when it is a single case report. While these reviews provide important information on the disorder, a clearer picture of the prevalence of non-PE EjD in relation to the community and various pathophysiologic states is needed. Objectives: The objective of this study was to provide a systematic review of studies of non-PE EjD excluding single case reports. Methods: A systematic review of Medline for terms including ejaculation, orgasm or hematospermia. Association with terms delay, pain or headache was made. The search was restricted to male gender and articles written in English. Abstracts were reviewed and those mainly concerned with premature ejaculation were excluded. Results: A total of 333 articles on non-PE EjD were identified. The condition was reported in community-based studies. In certain patient populations, non-PE EjD was commonly reported in association with antidepressant and antipsychotic treatments, in patients with chronic prostatitis/chronic pelvic pain syndrome, patients with lower urinary tract symptoms particularly in association with medical or surgical treatment, patients with retroperitoneal surgery and in patients with neurological diseases. Few articles were concerned with treatment options. Conclusion: There is a significant prevalence of non-PE EjD in the community and in association with particular disease states or as a side effect of medical or surgical interventions. There is a need to direct efforts to prevent and treat these conditions. Keywords: anhedonia, aspermia, ejaculation, epidemiology, headache, hemospermia, orgasm, pain, prevalence adverse events. It became clear ...

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Midodrine Improves Orgasm in Spinal Cord-Injured Men: The Effects of Autonomic Stimulation

Cited by 49 publications

References 28 publications

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Improving Sexual Satisfaction in Persons with Spinal Cord Injuries: Collective Wisdom

Sexual and reproductive abnormalities in patients with spinal cord injuries

A systematic review of the correlates and management of nonpremature ejaculatory dysfunction in heterosexual men

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