Chemical ejaculation using physostigmine in anejaculatory spinal cord injury patients

Kim, Sang Chul; Park, Won Hee

Abstract

We tried subcutaneous physostigmine 31 times in 24 spinal cord injured patients who had lost ejaculatory capacity. Normal semens were obtained in 4 patients(6.7 %), subnormal semen in 1 patient(4.2 %), a few sperms in 5 patients(20.8 %), and no sperm in 14 patients(58.3%). Sperm appearance rate was 41.7%. Patients with injuries in cervical and upper thoracic levels ejaculated successfully mere frequently than those with injuries in lower thoracic and lumbar levels. The results or T, L1, L2 injured patients were not successful. Side effects included nausea and vomiting (91.7%), dizziness(45.8%) and headache(25.0%), but all patients could tolerate them. Significant adverse effects, particularly autonomic dysreflexia, were not found. Artificial uterine inseminations with sperms induced by subcutaneous physostigmine were performed in 3 cases, and all of these attempts were successful. We have 3 live births. In conclusion, subcutaneous physostigmine for provoking ejaculation in anejaculatory spinal cord injury is cheap, easy to be performed and has no significant side effect.