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Anejaculation - PVS and EEJ
Penile Vibratory Stimulation (PVS)
Even
though the majority of men with spinal cord injuries
can achieve erections and have sexual intercourse,
the percentage who can successfully ejaculate is
very low. We can help these men achieve ejaculation
using Penile Vibratory Stimulation (PVS).
How does PVS work?
The
complication rate of PVS is very low, although mild
skin abrasions and swelling may occur. Patients
should be monitored for autonomic dysreflexia, the
sudden onset of high blood pressure.
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PVS is an office procedure that
requires no anesthetic or sedation.
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A custom-designed mechanical
vibrator is placed at either the
base or glands of the penis and set
to vibrate at designated frequency
and wave amplitude.
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Vibration travels along the sensory
nerves to the spinal cord and
induces a reflex ejaculation. Of
note most store-bought vibrators are
not effective in producing
ejaculation in patients with spinal
cord injury. This technique only
works in patients with an intact
ejaculatory reflex arc and the
results are dependent on the level
of spinal cord injury.
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If enough high-quality sperm are
recovered from the semen, they can
be washed in our laboratory and used
in Intrauterine Insemination (IUI),
a process where prepared sperm are
injected using a small tube or
catheter directly into the uterus to
achieve egg fertilization.
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In general, the quality of sperm in
men with spinal cord injuries is
poor. If a dismal number or quality
of sperm is recovered in the semen,
the recovered sperm can still be
used with In Vitro Fertilization (IVF).
Using Intracytoplasmic Sperm
Injection (ICSI), a single sperm,
processed in our laboratory, is
injected directly into an oocyte
(egg) to fertilize it. Once
fertilized, the developing embryo is
implanted into the uterus. |
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Electroejaculation (EEJ)
Men with
ejaculatory failure due to nerve damage caused by
spinal injury, and occasionally by other conditions,
can produce sperm by electrical stimulation of the
ejaculatory ducts internally. Though sperm quality
is often poor due to remaining too long in the body,
the sperm are usually suitable for ICSI treatment.
EEJ is a method that can be used to stimulate
ejaculation in men with spinal cord injuries.
How does
electroejaculation work?
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In electroejaculation, an electric
probe, or electroejaculator, is
inserted into the rectum near the
prostate to stimulate the nerves and
contract the pelvis muscles, causing
ejaculation.
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Ejaculate is collected from the
urethra, and processed in the
laboratory to determine sperm
quality.
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If enough high-quality sperm are
recovered from the semen, they can
be washed in our laboratory and used
in Intrauterine Insemination (IUI),
a process where, using a small tube
or catheter, prepared sperm is
injected directly into the uterus to
achieve egg fertilization.
|
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>> |
If a
lower number or lower quality of
sperm are recovered in the semen, it
can still be used with In Vitro
Fertilization (IVF). Using
Intracytoplasmic Sperm Injection (ICSI),
a single sperm, processed in our
laboratory, is injected directly
into an oocyte (egg) to fertilize
it. Once fertilized, the developing
embryo is implanted into the uterus. |
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Electroejaculation must be performed under
satisfactory anesthesia in men with spinal cord
injuries with sensation in or below the abdomen. A
complete urologic examination must be performed
prior to the procedure to detect and treat any
urinary tract infections.
Often
during this procedure retrograde ejaculation occurs,
which is a backwards ejaculation into the bladder,
and sperm must be collected from the urine. Men with
SCI with a history of autonomic dysreflexia, or the
sudden onset of high blood pressure, must be
carefully monitored, as electroejaculation can cause
a significant increase in blood pressure and heart
rate. These individuals may benefit from
prophylactic treatment with nifedipine or
phenoxybenzamine.
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