Preliminary Report of the Use of Electroejaculation for the Treatment of Anejaculation

Abstract

Electroejaculation was used to treat anejaculation in 12 patients in 37 sessions at our institution. The average age of the patients was 35 years. The etiology of anejaculation was spinal cord injury in five (42%) and other causes in seven (58%), which included diabetes mellitus, pelvic or retropubic surgery usually for a congenital disorder, and in one case psychological anejaculation. The mean time that had elapsed from the original spinal cord injury was 13 years. General anesthesia was used at the time of anejaculation in 32 (86%) of the sessions and IV sedation in five (14%). Patients with a history of predilection for autonomic dysreflexia were treated with nifedipine.Ejaculation occurred in 34 of the 37 sessions (92%). No ejaculation occurred in only three sessions (8%). Antegrade and retrograde specimens containing sperm were found in 25 of the 37 sessions (68%). Antegrade specimens alone were obtained in eight of the patients (22%), and a retrograde specimen alone was obtained in only one patient (3%). Semen analysis of the specimens showed an average total sperm count of 932 × 108/ml with 11.6% motility, thus giving an average total motile sperm of 100 × 108 with a grade of 2.4/4. There was no change in total sperm count with regard to session to session, duration of time of injury or surgery, or level of spinal cord injury.In these 12 patients, there have been three pregnancies obtained with intrauterine insemination; and to date there has been delivery of four normal healthy children.These 12 patients were part of a multi‐institutional trial using an electroejaculation machine developed by Dr. S. W. J. Seager of the National Rehabilitation Hospital in Washington, D.C. The results of the multi‐institutional study have not been reported. The patients were entered into the study, as part of the protocol approved by our local Institution Review Board, after signing an approved consent form. Prior to electroejaculation in the patients where orgasm occurred, postorgasm urine was checked for retrograde ejaculation. None of these had sperm. The couples were also instructed in the use of the vibrator trial at home in order to try to produce an ejaculation prior to the electroejaculation; however, all failed.The use of electroejaculation in humans was first reported by Horne et al (1948). The first pregnancy in a human was reported by Thomas et al (1975). More recent reports in the American experience with electroejaculation have been reported by Bennett and Ohl (Bennett, 1990; Ohl et al, 1989; Ohl, 1993). Ohl reported that age of the patient and interval of time since spinal cord injury had no effect on the outcome of electroejaculation (Ohl et al, 1989). In this same report in 1989, he reported better outcome in thoracic spinal cord injured patients compared to cervical or lumbar level injuries, better outcome in those on self‐intermittent catheterization compared to catheterized individuals or those using Credé bladder emptying, better outcome in complete vs. incomplete spinal cord lesions, and lower outcome success in those who had a history of sphincterotomy.