Ejaculatory sensations during vibrator and midodrine stimulation in men suffering from damage to the spinal cord

Since the first studies on midodrine hydrochloride, carried out in Europe and Canada (Quebec), we have been interested in the somatic and autonomic sensations that might be associated with ejaculation in men suffering from lesion to the spinal cord. Since ejaculation is associated with sympathetic activity, since midodrine is an alpha stimulating drug and since sympathetic activity can be transmitted to the brain through several neural pathways, we hypothesized that ejaculation might be associated with autonomic perceptions despite the spinal lesions. A total of 41 tetraplegic and paraplegic men with lesions located between C2-T2 and T3-T6 achieved ejaculation with penile vibrator stimulation with and without midodrine. The results showed that systolic blood pressure increased in tetraplegic men by 51 mmHg (113 to 164 mmHg) at ejaculation, with little difference between patients using midodrine and those using vibrator stimulation alone. In contrast, paraplegic men using midodrine showed an increase in systolic blood pressure of 39 mmHg at ejaculation, as opposed to 13 mmHg when vibrator stimulation was used without midodrine. Heart rate measures showed a decrease in all subjects at ejaculation (from 8 to 24b/min) with greater changes recorded amongst paraplegic men using midodrine. Physiological sensations were perceived more frequently when ejaculation occurred as opposed to when it failed, the sensations being reported more frequently when vibrator stimulation was used alone as opposed to when it was used with midodrine. These physiological sensations (cardiovascular, muscular, autonomic) were more frequently reported than orgasmic sensations (relaxing, climactic, intimate). The results suggest that midodrine has less effect on tetraplegic men than paraplegic, possibly because maximal sympathetic activity already occurs in tetraplegic men as a result of autonomic dysreflexia triggered by ejaculation. The sensations also appeared more generalized when ejaculation was triggered by vibrator stimulation alone, suggesting that they occur as a result of the ejaculation itself and not as a side effect of medication. The results are discussed in terms of their clinical applications affecting the autonomy of men suffering from damage to the spinal cord.