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The application of 2 FertiCare devices (sandwich method, M2) resulted in the best success rate (100%) compared to the other two methods (87% for both M1 and M3). The Viberect-X3 method (M3) required more time to induce ejaculation than the single FertiCare method (M1) or the sandwich method (M2). Following each PVS trial, patients were asked to answer a survey about their experience. The Viberect-X3 (M3) was the least preferred method, and the single FertiCare method (M1) was the most recommended method by the study subjects. Subjects’ reasons for preferring one method over another were variable. For example, the reasons given by subjects who preferred M1 (application of one FertiCare) included the following: ‘it is effective and you get good results,’ ‘good feeling,’ and ‘it is fast and easy.’ Reasons given by subjects who gave a lower rating for M3 (Viberect-X3) included the following: ‘it did not feel right,’ ‘not as fast and easy to use’ and ‘when my penis is squeezed with the vibrator, it is more difficult to ejaculate.’ Although M3 had the lowest mean rating for patient preference, there were individual subjects who preferred M3 to M1 or M2. For example, subject no. 13 commented that M3 was ‘very comfortable, very fast and convenient.’ It's not a sphere, but if it was (and it's not miles off), a 30cc sphere would be 3.9cm diameter (high), and a 60cc sphere would be 4.9cm.
There is some ideological controversy regarding the use of pornography leading to sexual dysfunctions. Landripet et al reported that there was little evidence, if any, of the association between pornography use and male sexual dysfunction ( 28). A review of clinical case reports has suggested, but not demonstrated, that some patterns of porn consumption may generate arousal, attraction, and sexual performance problems ( 29). We agree that abuse of pornography may be comorbid with some sexual dysfunctions, but current data do not allow to establish a cause-effect relationship. Betz R, Biering-Sørensen F, Burns SP. et al. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)-What's new? Spinal Cord 2019;57:815–7. Krassioukov A, Warburton DE, Teasell R, Eng JJ. A systematic review of the management of autonomic dysreflexia after spinal cord injury. Arch Phys Med Rehabilit. 2009;90:682–95. In addition, the orgasmic experience of ejaculation seems to be unrelated to anejaculation. Pleasurable orgasm has been reported with mild to moderate anejaculatory dysfunction (AD), and unpleasant or painful sensations have been reported with severe AD; as demonstrated by Courtois et al in a cohort of 81 men with different degrees of neurological impairment following SCI ( 89). Vibrator use may play an important role in sexual rehabilitation of SCI patients.
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Ohl DA, Sonksen J, Menge AC, McCabe M, Keller LM . Electroejaculation versus vibratory stimulation in spinal cord injured men: sperm quality and patient preference. J Urol 1997; 157: 2147–2149. Thirteen of 15 participants ejaculated with the device. No adverse events occurred. All participants commented they would recommend the device to other men with spinal cord injury. Conclusions A recent epidemiological study of the use of vibrators by American women and men has shown no complaints, and generally high satisfaction and improvement in sexual response. Sonksen J, Fode M, Lochner-Ernst D, Ohl DA. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 2012;50:63–6. Petroleum-based lubricants are not recommended since they may increase the risk of vaginal infection ( 51) and also tend to have an unpleasant odor. Oil-based or petroleum-based lubricating products in combination with latex condoms have been shown to increase the risk of condom breakage ( 52). Natural oils, such as mineral and coconut oils, can also break down latex products. The damage may go unnoticed, increasing the risk of pregnancy or sexually transmitted infections ( 53). Therefore, the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA) recommend using water-based lubricant with condoms. One theoretical adverse effect is that lubrication sufficient to noticeably reduce friction may also reduce sensation, potentially impacting negatively upon sexual pleasure and making it more difficult for some individuals to reach orgasm. However, no study has ever demonstrated such adverse event. Despite the fact that lubricant could be very helpful during vaginal or anal penetration, it is important to counsel patients that they should not be considered a replacement for sexual stimulation and arousal.
Kathiresan AS, Ibrahim E, Aballa TC, Attia GR, Ory SJ, Hoffman DI et al. Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries. Fertil Steril 2011; 96: 562–566. Sweis R, Biller J . Systemic complications of spinal cord injury. Curr Neurol Neurosci Rep 2017; 17: 8. The following stimulation protocol was administered to each subject. Step 1: One Ferticare 2.0 was applied to the dorsum of the glans penis. The amplitude of the device was 2.5 mm, and the frequency was 100 Hz. If no ejaculation occurred after 2 min of stimulation, PVS was stopped. The integrity of the penile skin was assessed. Step 2: If the subject’s penile skin and vital signs were stable, the Ferticare 2.0 was again applied to the dorsum of the glans penis, with the amplitude of the device increased to 4.0 mm and the frequency remaining at 100 Hz for 2 min. If no ejaculation occurred, PVS was stopped. Step 3: If the penile skin and vital signs remained stable, PVS was again administered with two Ferticare 2.0 devices, one placed on the dorsum of the glans penis and one placed on the frenulum of the glans penis for 2 min. Each device was set at 2.5 mm amplitude and 100 Hz frequency. If no ejaculation occurred, the patient was considered a PVS failure for this study. Evaluation of retrograde ejaculationI don't think the pump will do anything to make recovery of natural erections happen faster. That's down to the nerves healing. " some progress" here would be detecting the slight beginning of extra blood in the penis when aroused without the use of a pump. That varies enormously - I was talking with a guy yesterday who's seeing this after 4 weeks (which is very fast), but some others here have said it took them up to 2 years. On the basis of these findings, we recommend attempting PVS with one FertiCare device. If that fails, use two FertiCare devices. Although the Viberect-X3 was preferred less by patients, it had similar efficacy as the Ferticare vibrator(s) and may be suitable for home use by some patients. Kanto S, Uto H, Toya M, Ohnuma T, Arai Y, Kyono K. Fresh testicular sperm retrieved from men with spinal cord injury retains equal fecundity to that from men with obstructive azoospermia via intracytoplasmic sperm injection. Fertil Steril. 2009;92:1333–6.
To achieve biologic fatherhood, men with spinal cord injury (SCI) and the clinicians treating them are faced with the following (current) scenario: 1. In general, sperm production is in the normal range although sperm motility is impaired [ 1]. 2. Approximately 90% of men with SCI cannot ejaculate via sexual activity [ 2]. 3. Following a simple and proven protocol, with the application of penile vibratory stimulation (PVS) of an appropriate amplitude and frequency, an ejaculate can be obtained in up to 85% of these men with neurogenic anejaculation [ 3]. The majority of the ejaculates obtained will have >5 million total motile sperm; about half of all ejaculation trials will have >10 million total motile sperm [ 4]. 4. These ejaculated sperm can be used in an assisted reproductive technology protocol such as intrauterine insemination and achieve results similar to those seen using sperm from non-SCI men with male factor infertility. In fact, there are many published reports showing that, with appropriate guidance, patients can be taught to collect sperm at home, and achieve pregnancy via at-home intravaginal insemination [ 5, 6, 7]. 5. Surgical sperm retrieval (SSR) of testicular or epididymal sperm yields adequate numbers of sperm for IVF/ICSI, but SSR essentially eliminates any of the other options mentioned above [ 8, 9, 10]. Simultaneous vibratory stimulation of both surfaces of the penis at high frequency (70-110 Hz) for 7-10 minutes can lead to gradual filling of the penis with arterial blood within minutes by activating the pudendo-cavernosal reflex. In a previous article, Vibrators for Men: Can They Help Treat the Symptoms of ED?, I stated that I believe that vibrators are overlooked and undervalued as an option for treating the symptoms of ED. In connection with PeniMasterPRO the rod pulling force generator allows for elongating the penis in an axially symmetrical manner without abutment far from the penis (attachment location). This means that no other bodily part or piece of clothing is required to generate the pulling force on the glans chamber and that the pulling force is nearly the same at all positions of the penis. By using the rod expander the penis can be elongated either in an upwards or a downwards direction or diagonally – and this has proven to be unobtrusive, even under normal clothing. Thus, many activities of day-to-day life can be implemented without any problems. Participants were 15 men with SCI who were participants in the Male Fertility Research Program of the Miami Project to Cure Paralysis located at the University of Miami Miller School of Medicine in Miami, Florida. The study was approved by the University of Miami IRB and all participants signed an informed consent form. Participants’ neurological level and completeness of injury was determined by the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) [ 12, 13]. The level of injury for all participants included in this study was T10 or rostral based on our previously reported success rate with PVS [ 3].
National SCI Statistical Center. Spinal cord injury (SCI) facts and figures at a glance. J Spinal Cord Med 2016; 39: 370–371.
Sonksen J, Biering-Sorensen F, Kristensen JK . Ejaculation induced by penile vibratory stimulation in men with spinal cord injuries. the importance of the vibratory amplitude. Paraplegia 1994; 32: 651–660. Subsequent orgasm and ejaculation can be very strong and amplified due to stronger contraction of the bulbospongiosus muscle and activation of higher ejaculatory centers.
The Ferticare 2.0 device was applied to 15 men with spinal cord injury in a three-step protocol simulating normal use. Step 1: one device (2.5 mm amplitude, 100 Hz) was applied to the glans penis for 2 min. Step 2: If no ejaculation occurred, the amplitude was increased to 4.0 mm (100 Hz) and the device similarly applied. Step 3: If no ejaculation occurred, two devices, each 2.5 mm and 100 Hz were applied to the dorsum and frenulum of the glans penis. Participants at risk for autonomic dysreflexia were pretreated with sublingual nifedipine (20 mg), 15 min prior to stimulation. Blood pressure and other symptoms of autonomic dysreflexia were monitored. Participants answered a questionnaire about their experience with the device. Results
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