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Ejaculation provoquée chez le paraplégique

Induced ejaculation in paraplegics

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Resume

90% des blessés médullaires n’obtiennent pas d’éjaculation lors des rapports sexuels, ou lors de masturbation. De 1987 à 1993, 52 patients ont été traités par vibromassage, 21 par électrostimulation et 4 par Physostigmine. Le taux global de succès lors du vibromassage est de 65% et de 83% si on considère seulement les patients avec syndrome sous-lésionnel au moins dès D11. Seize patients sur les 21 traités par électrostimulation obtiennent une éjaculation. Onze éjaculations ont été rétrogrades sur les 30 effectuées. Le volume et la qualité du sperme sont très inférieurs à ce qui a été obtenu par vibromassage. Deux des 4 patients qui ont eu un traitement à la physostigmine, ont obtenu une éjaculation. L’éjaculation par vibromassage est la technique la plus simple, et elle doit être proposée en première intention. L’électrostimulation intra-rectale proposée en cas d’échec du vibro-massage permet presque toujours d’obtenir du sperme, si un nombre suffisant de fibres sympathiques dorso-lombaires sont conservées.

Abstract

90% of spinal cord injury patients cannot have an ejaculation during either sexual intercourse or masturbation From 1987 to 1993: 52 patients were treated by vibratory stimulation, 21 by electrostimulation, 4 by Physostigmine. Overall success rate during vibratory stimulation is of 65% and 83% if one considers only patients with a sublesional syndrome below T10. We obtained 15 successes among 21 tetraplegic patients and 19 successes among 20 paraplegic patients. Ejaculation was always obtained within three minutes. We did not obtain any success in paraplegic patients group whose lesional level was T12, L1, L2. After having trained the couple for the technique, we realised on two occasions, during ovulation (twelfth to sixteenth day before next menstruation date), intravaginal autoinseminations with a syringe for a minimal duration of one year, necessary time to improve semen quality before treating procreation as a medical issue. Among these 52 patients treated by vibratory stimulation, only 12 couples came to take our advice in order to procreate. Out of the 12 followed up couples, we obtained 3 births and 1 current pregnancy. 16 patients out of the 21 treated by electrostimulation have an ejaculation. Out of the 30 realised ejaculations, 11 were retrograde. Semen volume and quality are much lower to what we obtained by vibratory stimulation. Actually, this technique has not allowed a pregnancy. 2 out of the 4 patients having had a treatment by Physostigmine had an ejaculation. Ejaculation by vibratory stimulation is the easiest technique and it must be proposed as a first purpose. In a second time, proposed intrarectal electrostimulation allows nearly always to get semen if a sufficient number of sympathetic thoracolumbar fibres are preserved.

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Correspondence to Guy Egon.

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Egon, G., Isambert, J., Filipetti, P. et al. Ejaculation provoquée chez le paraplégique. Androl. 4, 160–168 (1994) doi:10.1007/BF03034281

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Mots-clés

  • paraplégie
  • éjaculation
  • procréation
  • fertilité
  • vibro-éjaculation
  • électro-éjaculation

Key words

  • spinal cord injury
  • assisted ejaculation
  • fertility
  • vibratory ejaculation
  • electroejaculation