Laboratoire d'Urodynamique et de Sexologie, Centre Bouffard Vercelli, Cap Peyrefite, Cerbère, France.
Eur J Phys Rehabil Med. 2011 Dec;47(4):677-81.
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.
脊髓损伤（SCI）与射精功能障碍有关。SCI 后，可能需要更多刺激才能引发残留的性反射。阴茎振动刺激（PVS）可引起强烈的传入神经刺激和自主神经系统的强烈激活，被认为是一线治疗方法。口服米多君可作为 PVS 的辅助治疗，提高成功率。电刺激射精（EEJ）在大多数 PVS 失败的情况下都能成功。慢性 SCI 男性的典型 PVS 精液特征表现为正常的平均总精子数，但运动率较低。与 PVS 相比，EEJ 中精子的运动率和总活动精子数明显较低。外部和内部括约肌之间的协调至关重要。在圆锥以上损伤的情况下，可能会出现不协调的射精，导致前列腺尿道射出的精液和尿道外括约肌松弛之间失去平衡。这会导致不完全或不存在顺行射精，这可以解释 SCI 男性中逆行射精的高比例和精液量低的情况。在某些情况下，逆行射精可能只是指后尿道中存在的部分精液。
