Quality of semen after repeated ejaculation treatment in spinal cord injury men.

The study was designed to document the effects of regular drainage after penile vibrator stimulation on the quality of semen in SCI men. Twenty three tetraplegics and 9 paraplegics, 18 to 40 years of age and with neurological levels ranging from C4 to L1, were examined between 1 and 23 years after injury (median 2 years). None had ejaculated after the injury. Penile vibrator stimulation was tried in patients with cervical or thoracic lesions who showed reflex hip flexion on scratching the soles of the feet, 29 out of 32, and rectal electrostimulation in the remaining 3 low lesions with no reflex function in lumbar and sacral segments. The stimulation yielded semen in 29 (91%) of the men; 22 had antegrade and 7 retrograde ejaculation. Sixteen of the 22 patients with antegrade ejaculation entered a home programme of vibrator stimulation prescribed once weekly. Four to 6 months of stimulation resulted in a rise of semen volume and of fructose and acid phosphatase levels in the seminal plasma, suggesting improved function of the seminal vesicles and the prostate. The percentage of motile sperms was low both before and after the treatment period. Despite this, the total count of motile sperms per ejaculate was already high in the patient's first ejaculates compared to the laboratory normal standard, and further clearly increased after the stimulation period. A standardised functional test measuring sperm penetration capacity showed strong evidence of long term stimulation effect. It is suggested that the test is used in the assessment of fertility potential in SCI men.