Question
Jerry-
My fiance recently had a motorcycle accident which left him paralyzed from the chest down, t-7 i beleive. He takes viagra, and uses maxaderm cream to maintain an erection during sex. He says that he can sometimes feel a little stimulation on his penis during sex, however he still hasn't orgasmed. What can we do to make him orgasm? and or ejaculate- we would like to be able to start a family together one day....

Answer
Because each spinal cord injury is unique to the individual, so is the capacity for sexual function.  The best thing to do is to consult the SCI doctor that your fiance is working with.  He/she will be able to direct you to the proper therapists for reproductive function.

Having said that, here is some information from the SCI Center at the University of Alabama at Birmingham.  They are one of several SCI centers in the United States that supply great information on a wide range of SCI topics.

FERTILITY
The fertilization process typically begins during sexual intercourse as the sperm is ejaculated into the woman抯 vagina. Motile sperm then move through the cervix, uterus, and into the fallopian tubes. Pregnancy results when the man's sperm fertilizes the woman's egg.

Many men with SCI and their partners want to have children. Although there are some couples who have little or no difficulty with fertility, many men with SCI are unable to father children through sexual intercourse.

Ejaculation problems are the primary issues to be resolved for men who want to become fathers. About 90% of men with SCI experience anejaculation, which is an inability of men to ejaculate on their own during intercourse. Another potential problem is retrograde ejaculation, which is a condition wherein semen is deposited in the bladder instead of exiting the body through the urethra.

Poor semen quality can also make it very difficult for men with SCI to fertilize the egg. Men with SCI make normal numbers of sperm, but the average number of motile sperm in semen from men with SCI is 20% compared to 70% in men in the general population. It is not know why there is abnormally low sperm motility, but it does not seem to be related to level of injury, age, years post injury, or frequency of ejaculation.


FERTILITY TREATMENTS
Men who experience fertility problems must rely on alternative methods to improve their ability to father children. There are potential risks that need to be considered with all treatment options, so men with SCI need to talk to a doctor experienced in fertility issues related to SCI.

Semen quality is varied, but the exact cause of poor semen quality is unknown. Some recent research has shown that normal semen can be obtained for about 6-12 days after in injury. This may allow some men to have their normal semen frozen in an effort to improve fertility rates at a later date. Some men who have a large number of dead sperm (necrospermia) may see improvements through repeated ejaculation. Otherwise, there is little that can be done to improve poor semen quality.

Because of problems with ejaculation, most men with SCI must rely on alternative techniques to achieve parenthood. Penile vibratory stimulation (PVS) can be used to achieve an erection, but its main purpose is to produce an ejaculate for those who wish to become fathers. A variety of vibrators/massagers are available for this purpose. Some are specifically designed with the output power required to induce ejaculation in men with SCI. Estimations are that 55% of all men with SCI can expect to respond to a high amplitude vibrator, and 80% will respond if their injuries are above T10. PVS is usually recommended as a first treatment option because of the low investment of time and money. Although research suggests that the better quality semen is obtained with PVS, Rectal Probe Electroejaculation (RPE) is an option if PVS is not successful. With RPE, a doctor inserts an electrical stimulation probe into the rectum, and the controlled electrical stimulation produces an ejaculation. When sperm cannot be retrieved using PVS or RPE, minor surgery can be performed to remove sperm from the testicle. Collected sperm are used in artificial insemination techniques.

Thank you for your question, Alexia.  I hope that my answer was helpful.