From the Research
Pregabalin is not effective for treating retrograde ejaculation caused by spinal cord injury or BPH, and alternative non-surgical options should be considered. The most recent and highest quality study 1 suggests that electroejaculation is a safe and reliable method for induction of ejaculation in men with spinal cord injury who fail a trial of penile vibratory stimulation, with a success rate of 95%. Other non-surgical options include alpha-adrenergic agonists like pseudoephedrine, ephedrine, or imipramine, which work by increasing bladder neck tone and promoting antegrade ejaculation 2, 3.
Causes of Retrograde Ejaculation
To determine the cause of retrograde ejaculation, it is essential to consider both spinal cord injury and BPH as potential underlying factors. The study by 2 suggests that spinal cord injury can lead to dyssynergic ejaculation, resulting in retrograde ejaculation. On the other hand, BPH can also cause retrograde ejaculation, particularly if alpha-blockers like tamsulosin are being used. Discontinuing these medications may help alleviate the condition.
Non-Surgical Treatment Options
Non-surgical treatment options for retrograde ejaculation include:
- Alpha-adrenergic agonists like pseudoephedrine (60-120mg taken 1-2 hours before sexual activity), ephedrine (25-50mg before intercourse), or imipramine (25-75mg daily)
- Penile vibratory stimulation or electroejaculation performed by specialists
- Adjusting the timing of medications, maintaining proper hydration, and urinating before sexual activity
Predicting Successful Outcome of Penile Vibratory Stimulation
The study by 4 reports that clinical predictors such as neurological level, superficial abdominal reflex, cremasteric reflex, bulbocavernosus reflex, plantar reflex, ankle jerk, knee jerk, lower abdominal sensation, and hip flexor response can help predict the outcome of penile vibratory stimulation. The presence of somatic responses during penile vibratory stimulation also showed statistical significance in predicting successful ejaculation.
Treatment Success and Side Effects
Treatment success varies based on the underlying cause and severity, with spinal cord injury cases generally being more challenging to treat than BPH-related cases. These medications may have side effects, including increased blood pressure and heart rate, so patients with cardiovascular conditions should use them cautiously and consult their healthcare provider before starting any treatment.