Penile vibratory stimulation and electroejaculation in the treatment of ejaculatory dysfunction¹

Abstract

The purpose of this review is to present the current understanding of penile vibratory stimulation (PVS) and electroejaculation (EEJ) procedures and its clinical use in men with ejaculatory dysfunction. Unfortunately, the record of treating such individuals has been quite poor, but within recent years development and refinement of PVS and EEJ in men with spinal cord injury (SCI) has significantly enhanced the prospects for treatment of ejaculatory dysfunction. The majority of spinal cord injured men are not able to produce antegrade ejaculation by masturbation or sexual stimulation. However, approximately 80% of all spinal cord injured men with an intact ejaculatory reflex arc (above T10) can obtain antegrade ejaculation with PVS. Electroejaculation may be successful in obtaining ejaculate from men with all types of SCI, including men who do not have major components of the ejaculatory reflex arc. Because vibratory stimulation is very simple in use, non-invasive, it does not require anaesthesia and is preferred by the patients when compared with EEJ, PVS is recommended to be the first choice of treatment in spinal cord injured men. Furthermore, EEJ has been successfully used to induce ejaculation in men with multiple sclerosis and diabetic neuropathy. Any other conditions which affect the ejaculatory mechanism of the central and/or peripheral nervous system including surgical nerve injury may be treated successfully with EEJ. Finally, for sperm retrieval and sperm cryopreservation before intensive anticancer therapy in pubertal boys, PVS and EEJ have been successfully performed in patients who failed to obtain ejaculation by masturbation. Nearly all data concerning semen characteristics in men with ejaculatory dysfuntion originate from spinal cord injured men. Semen analyses demonstrate low sperm motility rates in the majority of spinal cord injured men. The data give evidence of a decline in spermatogenesis and motility of ejaculated spermatozoa shortly after (few weeks) an acute SCI. Furthermore, it is suggested that some factors in the seminal plasma and/or disordered storage of spermatozoa in the seminal vesicles are mainly responsible for the impaired semen profiles in men with chronic SCI. Home insemination with semen obtained by penile vibratory and introduced intravaginally in order to achieve successful pregnancies may be an option for some spinal cord injured men and their partners. The majority of men will further enhance their fertility potential when using either penile vibratory or EEJ combined with assisted reproduction techniques such as intrauterine insemination or in-vitro fertilization with or without intracytoplasmic sperm injection.

Cutaneous vasoconstriction as a measure of incipient autonomic dysreflexia during penile vibratory stimulation in spinal cord injury

“…4 Recent times have shown considerable advances in rehabilitation medicine 16 as well as in assisted reproductive techniques for individuals with sexual dysfunction. 17 As the majority of men who suffer from an SCI are in their reproductive years, procreation is of major concern to them and their partners. Therefore, techniques such as PVS and electroejaculation offer a significant advantage to these individuals.…”

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

“…16,17 Penile vibrostimulation (PVS) and electroejaculation are the two most commonly used methods for inducing ejaculation to collect sperm for fertility purposes. 3,18 Semen retrieved for fertility is not without problems. 3 High levels of leukocytes and inflammatory cytokines have been found in the seminal plasma of men with SCI and these have been shown to play a role in reducing sperm motility, [19][20][21] thus reducing the likelihood of fertilization.…”

Sexual and reproductive abnormalities in patients with spinal cord injuries

“…[32] Spinal kord yaralanmalarında ejakulasyon işlevi de etkilenir. [12,33] Ejakulasyonun otonomik komponenti emisyon, somatik komponenti ekspulsiyondur (Şekil 2). Nokturnal ejakulasyon psikojenik ejakulasyon olarak da bilinmektedir.…”

“…[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Torakolomber bölge ile sakral merkezler arasındaki spinal kord lezyonlarında refleks ereksiyonlar görülürken psikojenik ereksiyon oluşmaz. [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Ancak bu seviyede lezyonu olan olgularda psikojenik ereksiyonların da görülebildiği rapor edilmiştir. Bu durum torakolomber bölgenin altında paravertebral gongliyonlardaki parasempatiklerin normal kalması ve azalmış hipogastrik (sempatik) tonusa bağlı nöroplastite ile açıklanmıştır.…”