Participants included 41 SCI men with C2 to C8 and T3 to T6 lesions, tested with PVS with or without midodrine. Blood pressure and heart rate were recorded before, at, and after ejaculation, and each test (positive or negative) was followed by a questionnaire on physiological and orgasmic sensations. The results showed that systolic blood pressure (SBP) in tetraplegic men increased by up to 51mmHg (113 to 164mmHg) at ejaculation, with little difference between subjects requiring and not requiring midodrine. SBP variations differed from paraplegics using midodrine (increase of 39mmHg) and not using it (increase of 13mmHg). Hear rate decreased in all subjects (from 8 to 24 b/min) at ejaculation but more so in paraplegics using midodrine. Physiological sensations were perceived more often at ejaculation compared to sexual stimulation and were reported more often with PVS than with midodrine. Physiologic sensations (cardiovascular, muscular, autonomic) were reported more often than orgasmic sensations (relaxing, pleasurable, intimate sensations). Conclusion: Ejaculation in SCI men is associated with sensations related to physiological variations rather than subjective feelings of climax. Midodrine does not affect tetraplegics as much as paraplegics (possibly because sympathetic activity is already maximal during autonomic dysreflexia) and ejaculation sensations are more generalized with PVS and are not a pharmacological side effect of midodrine.
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