Ejaculatory dysfunction in spinal cord injury men is suggestive of dyssynergic ejaculation

Spinal cord injury (SCI) is associated with impaired ejaculation. After SCI, more stimuli may be required to trigger what remains of sexual reflexes. Penile vibratory stimulation (PVS) induces a strong afferent nerve stimulation and intense activation of the autonomic nervous system, and is considered first-line treatment. Oral midodrine may come as an adjunct to PVS and enhance the success rate. Electroejaculation (EEJ) is successful in most cases of failed PVS. The typical PVS semen characteristics in chronic SCI men demonstrate a normal mean total sperm count, but a low motility rate. Significantly lower sperm motility rates and total motile sperm counts are seen in EEJ compared to PVS. The coordination between external and internal sphincters is essential. In case of a supraconal lesion, a dyssynergic ejaculation may occur, with imbalance between expulsion of the ejaculatory fluid out the prostatic urethra and impaired relaxation of the urethral external sphincter. This leads to incomplete or absent antegrade ejaculation and would explain the high percentage of retrograde ejaculation and the low ejaculate volume observed in SCI men. In some cases, retrograde ejaculation could simply refer to a fraction of ejaculate present in the posterior urethra.