Premature ejaculation associated with lumbosacral lesions

Abstract

Study design:Retrospective study.Objectives:Spinal cord injuries are usually associated with anejaculation, but few premature ejaculations (PE) are described in lumbosacral lesions. The objective of the study is to analyze the retrospective files of patients with lumbosacral lesions to explore whether PE is systematic, and which type of lesions (conus teminalis, epiconal, cauda equina) is associated with these PE.Methods:Standard sexological consultations from 34 men with L5-S4 lesions were analyzed including questions on psychogenic and reflexogenic erection, and ejaculation. Medical assessment included bulbocavernosus, anal, and cremasteric reflexes and urodynamics.Results:Thirty one (31/33) patients maintained natural ejaculations, but 18 complained of PE and five of spontaneous ejaculations. Fourteen patients complained of dribbling ejaculation, and 27 of non-climactic ejaculation (13 no sensation, 10 some sensation, 4 painful sensation). Medical assessments showed absent or diminished anal sensation in 28 patients, absent or diminished anal reflexes in 21, absent or diminished bulbocavernosus reflexes in 20, but 12/13 positive cremasteric reflex. Urodynamics showed 12/20 areflex and 2/20 hyperactive bladders.Conclusions:Most men with lower lumbosacral lesions maintain natural ejaculation, but often complain of PE following injury. The PE is such that a mere sexual thought can trigger the response, or appear spontaneously as daytime ('sticky paints') or nighttime ('sticky sheets') emissions. PE appears to be a direct consequence of the lesion as it is reported from the very first ejaculation post injury, in men who otherwise controlled their ejaculation prior to injury. Underlying mechanisms may involve sacral inhibition on ejaculation, or simultaneous activation of psychogenic erection and emission. Clinical implications are discussed.