Ejaculation Problems after Spinal Injury

Q. I’m 28 years old. About six years ago I was in an accident and suffered spinal cord injury. I’m numb with little feeling from the waist down. I have no problem getting an erection, but I do not ejaculate during intercourse. I do ejaculate during oral sex, but only in a certain position. Help!

A. You are not alone. Most men after spinal cord damage suffer some degree of ejaculatory dysfunction. That means that depending on the level of injury, you get different degrees of dysfunction. If you have little feeling from the waist down, your level of injury might be at the thoracic or upper lumbar vertebral level.

An area in the spinal cord called the thoracolumbar ejaculation center normally controls the reflex of ejaculation. Here, feelings (nerve stimulation) from the stimulated penis are integrated with stimuli from the brain; then impulses are sent to the organs in the pelvis to prompt ejaculation. Spinal cord damage can interfere with impulses to and from the brain as well as to and from the penis. If the reflex center for ejaculation itself is damaged, ejaculation is difficult to achieve.

In general, only about 5 percent of men with spinal cord injury are able to ejaculate without medical intervention. For men who can ejaculate with additional stimuli (such as oral sex), there is a good chance that the reflex center is intact, and all they need is extra stimulation. For instance, during intercourse, some men with spinal-cord injuries have benefited from using a vibrator on the scrotum and base of the penis. Even though they may not feel the vibrations, it can trigger the reflex of ejaculation. In fact, most spinal-cord research centers can use vibratory stimulation to retrieve sperm from men with these injuries.

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