Physicians and psychologists almost always treat premature emission or ejaculation as a psychological problem. We report on 6 men who had sudden onset of severe premature emission after spinal cord injury. All men suffered spinal cord injury related to trauma at the T12-L1 level, and had areflexic bladders after the injury. Two men had normal penile sensation. None of the men had premature ejaculation before injury with average time of intercourse of 10 to 20 minutes before orgasm. After the injury they noticed emission before or at vaginal entry. Two patients reported emission with any sexual thoughts and 1 had emission when startled in a nonsexual manner. Sexual therapy using squeeze and stop/start techniques was unsuccessful in all cases. Patients were started on phenoxybenzamine, terazosin or prazosin and reported slight improvement. We believe that injury in the conus area of the spinal cord may disinhibit the ejaculatory mechanism and allow for premature emission.
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