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THE EFFECTS OF REPEATED EJACULATIONS ON THE QUALITY OF SPERMS FOLLOWING SPINAL CORD INJURY

Hamid R.¹, Bywater H.¹, Patki P.¹, Knight S.¹, Shah P.², Craggs M.¹

¹Royal National Orthopaedic Hospital, Spinal Research Centre, London, United Kingdom, ²Institute of Urology, Department of Urology, London, United Kingdom

INTRODUCTION & OBJECTIVES: Spontaneous ejaculation is a major problem following spinal cord injury (SCI). The sperm quality is poor even with assisted techniques. The exact cause is not known although Brindley in 1984 and Beretta in 1989 showed repeated ejaculations to improve the quality of sperms. Sonsken in 1999 showed no appreciable effect on the sperm quality in SCI men. However none of the above observations were derived from a randomized control trial. We examined the effects of repeated ejaculation on the quality of sperm in SCI patients in a randomized controlled study.

MATERIAL & METHODS: Sixty-two patients with lesions at T10 and above were vibro-ejaculated using Ferticare penile vibrator (Multicept A/S, Horsholm). Mean age was 34.5 years (range 18-56 years). Mean duration of injury was 6.5 years (range 0.5 – 27 years). The group comprises; cervical: n=29; thoracic 1-6: n=20; thoracic 7-10: n=13. 32 had complete while 30 had incomplete SCI. 27 were performing self- intermittent catheterization, 22 had a suprapubic catheter, 9 were voiding on urge and 4 voiding reflexly. The ejaculate was examined using the WHO protocol. Patients who were successfully ejaculated on screening were invited to enter the study. In the study arm, patients vibro-ejaculated weekly for 3 months with semen analysis performed monthly. Patients in the control arm were vibro-ejaculated at the beginning and after 3 months. The ejaculate was analysed by two experienced independent observers and compared for statistical significance across the two arms at baseline and 3 months using a two-tailed student t-test. Significance was determined at the 95% confidence level (p < 0.05).

RESULTS: 32/62 (51.6%) men vibro-ejaculated successfully. 5 refused to participate in the study. 27/32 successfully vibro-ejaculated patients were randomized into study arm (n=15) and control arm (n=12). 19 (study n=10; control n=9) have completed the study. 8 have been withdrawn; 5 from the study (3 stopped ejaculating 1-2 months into the study; 2 were non-compliant) and 3 from the control arm (1 admitted elsewhere; 2 non-complaint). Two patients developed autonomic dysreflexia requiring nifedipine while 3 developed minor penile skin abrasions. A statistically significant improvement (p <0.05) has been demonstrated in morphology and forward progression between the study and the control arms. However no significant improvement was shown in motility, count or volume of the ejaculate.

CONCLUSIONS: This is the 1^st randomized study evaluating the effects of repeated ejaculations on sperm quality in SCI. - We confirm that morphology and forward progression of sperms shows statistically significant improvement by repeated vibro-ejaculation however motility does not appear to improve significantly. - We vibro-ejaculated 51% of patients with a lesion at T10 or above, but at this stage there are no predicators for successful outcome.

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