Ejaculatory stimulation in spinal-cord injured men

Anejaculation is a common problem among spinal-cord injured (SCI) men. Only 1-20 per cent of SCI men can ejaculate. Methods of ejaculatory stimulation are needed to obtain sperm for artificial insemination purposes. The methods of stimulation heretofore used include intrathecal neostigmine, rectal probe electro-ejaculation, vibratory stimulation of the penis, and subcutaneous physostigmine. Ejaculatory ability increased to as much as 58 per cent using these techniques, but complications such as nausea and vomiting, elevated blood pressure, and headaches have been reported. The mechanisms of action of these techniques are poorly understood; they are believed to stimulate either reflex spinal ejaculatory centers or efferent peripheral nerves from these centers. The studies with these techniques often fail to use scientific methods of evaluation and are deficient in characterizing the subject population, description of stimulator and technique utilized, definition and presentation of "success" and/or complications observed. The criteria by which future studies of ejaculatory stimulation should be measured are suggested.