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Autonomic Dysreflexia and Vibrostimulation for Men with Spinal Cord Injury
by
Stanley Ducharme, Ph.D.
For some time there has been the realization that autonomic dysreflexia (AD) was one of the dangers associated with sexual activity for men with spinal cord injury. Patients were often taught the warning signs of dysreflexia before hospital discharge and provided with little other information regarding the connection between AD and their sexual activity.
Recently, at the 2006 annual meeting of the American Paraplegia Society, Dr. Stacy Elliott from Strong Rehabilitation Hospital in Vancouver presented a rather informative scientific paper on the dangers of dysreflexia for men who use vibrostimulation. As you may recall, vibrostimulation involves the placement of a strong vibrator (such as the Ferticare Vibrator) on the frenulum of the penis. This is the area along the ridge of the penis just below the head.
Using the vibrator, many men with SCI find that they are able to achieve ejaculation. Although the procedure is generally used in urology and sperm retrieval clinics to produce semen for fertility purposes, the technique is often incorporated into sexual activity in the home. Since only 10% to 15% of men with SCI are able to ejaculate independently, the use of a vibrator is widely accepted as a means to enhance sexual pleasure on a regular basis at home. Over the last decade it has gained widespread acceptance for home use.
Understanding Changes in Blood Pressure
For the able bodied man, changes in blood pressure are common at the time of orgasm. Some studies have demonstrated, for example, that the systolic blood pressure increases to the 170 mmHg range for a few seconds during orgasm. Blood pressure is measured in millimeters of mercury (mmHg) and recorded as two figures-systolic pressure, the pressure in the arteries when the heart contracts, over diastolic pressure, the pressure in the arteries when the heart rests between each heartbeat. High blood pressure is a blood pressure that is 140/90 mmHg or above each time it is taken.
New Evidence Emerging
In the recent Vancouver study of 144 men with various levels of spinal cord injury, their systolic pressure was recorded to be in excess of 220 mmHg. In 226 trials of vibrostimulation with this sample group, 65% of the men met the criteria for AD at the time of ejaculation according the PVA Clinical Practice Guidelines on Autonomic Dysreflexia. Moreover, men with cervical injuries were found to be two to three times more likely to be experiencing dysreflexia during ejaculation than their counterparts with lower level injuries.
What was especially fascinating about this Vancouver study, is the fact that over two thirds of the men with dysreflexia noticed no obvious symptoms associated with dysreflexia. These usually include a pounding headache, heart palpitations and dizziness. However, these were absent in a large group of men who met the criteria for AD. Surprisingly, the men didn't realize that they were having a dysreflexic episode. This condition in which the individual experiences the drastic blood pressure changes associated with dysreflexia without any outward symptoms has been termed "silent dysreflexia". Again, men with cervical level injuries did experience more incidences of silent dysreflexia than did men with lower level injuries.
Implications
Ultimately, the question remains, what does this mean? Should vibrostimulation be discontinued? Is it significant that over 65% of men are experiencing dysreflexia when they ejaculate using a vibrator? Unfortunately, no one currently knows the answer. At this time, we don't know the long-term risks of frequent dysreflexic episodes over a period of years. We don't know the impact of these ongoing spikes in blood pressure on the integrity of the blood vessels and the cardiovascular system. We do know, that the majority of men who use vibrators are having silent episodes of AD each time they ejaculate.
To reduce the adverse side effects of such vibrators, many doctors recommend that the vibrator be removed from the penis as soon as possible following ejaculation. Until further information is available, it may be wise to use these extremely powerful vibrators somewhat sparingly. Ideally, to avoid the potential of long-term health risks, ejaculatory blood pressure should be monitored in the doctor's office before using vibrators for home use. Given this option, people with SCI and their partners can make informed choices as to whether the use of vibrostimulation is worth the potential long-term risk to the cardiovascular system. Clearly, this is an area in which we need more information and research.
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