Men with paraplegia frequently experience impaired sexual function. Spinal cord injuries can cause erectile dysfunction as well as difficulty achieving orgasm.
In order for ejaculation to occur, various nerves must work together—but these often no longer function properly after a spinal cord injury. For this reason, affected men can sometimes only ejaculate a few drops of semen or may not be able to ejaculate at all. Retrograde ejaculation, in which the ejaculate enters the bladder rather than the urethra, may also occur. Only 55 percent of men with spinal cord injuries are able to ejaculate via intercourse or masturbation. Despite these problems, those affected may still be able to have children. Various techniques can be used in hopes of obtaining sperm for fertilization.
Central nervous system injection
This procedure was developed in 1946 by Ludwig Gutmann, known as a pioneer of the holistic rehabilitation of paraplegics. He helped his patients ejaculate by injecting the enzyme cholinesterase into their nerve sheaths. However, since this high-risk method caused serious health problems such as high blood pressure, abdominal cramps and vomiting, it is no longer used today.
Penile vibratory stimulation
In this method, which goes back to Comarr und Brindley, the penis is stimulated with a vibrator. The patient may be in a reclined or sitting position, while his penis, the connective tissue of the glans and shaft, and the muscle between the anus and scrotum are stimulated in order to trigger a series of successive ejaculations. But this procedure can also cause side effects such as abdominal and muscle cramps, headache and high blood pressure. In addition, the method is only successful if the spinal cord has not been injured between T11 and S4.
This procedure, which dates back to the American physician Dr. Stephen W. J. Seager, is among the most effective methods. The transrectal electroejaculation developed by Seager is considered the most successful form of electroejaculation. Transrectal electroejaculation involves stimulating the area adjacent to the prostate gland with an electric probe inserted through the anus. In the course of several cycles that last a few seconds each, various nerves are stimulated, and the voltage is increased. This leads to contractions of the pelvic floor muscles that trigger an erection and eventually ejaculation. Depending on the stimulation, the procedure can take anywhere from a few seconds to a few minutes. Subsequently, the obtained sperm sample is prepared in a laboratory and can be used for different fertilization procedures such as IUI, IVF or ICSI. Since electroejaculation is quite painful, it is usually performed under general or regional anesthesia.
In one study with 17 participants that examined the success rate of electroejaculation, 10 men suffered from anejaculation (inability to ejaculate) caused by a spinal cord injury, another five experienced anejaculation due to a retroperitoneal lymph node dissection, and two exhibited idiopathic (without known cause) anejaculation. After the electroejaculation, a total of 34 ICSI cycles could be completed, 60 percent of which led to fertilization and resulted in a total of six pregnancies. These results were compared with those of 620 ICSI cycles in which men with fertility problems ejaculated spontaneously. In these cases, the fertilization rate was 58 percent.
Successes using electroejaculation were also achieved at the University of Michigan. Out of 198 men who received the procedure, sperm of adequate quality could be obtained in 75 percent of paraplegics and 87 percent of patients who had undergone retroperitoneal lymphadenectomy. After subsequent artificial insemination procedures, two-thirds of the men were able to achieve a pregnancy, with a total of 35 healthy children being born.
For men who suffer from neurogenic anejaculation, electroejaculation offers an effective treatment method with few complications.