Article

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.

Langue : ANGLAIS