Physicians and psychologists almost always treat premature emission or
ejaculation as a psychological problem. We report on 6 men who had su
dden 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 penil
e sensation. None of the men had premature ejaculation before injury w
ith average time of intercourse of 10 to 20 minutes before orgasm. Aft
er the injury they noticed emission before or at vaginal entry. Two pa
tients reported emission with any sexual thoughts and 1 had emission w
hen startled in a nonsexual manner. Sexual therapy using squeeze and s
top/start techniques was unsuccessful in all cases. Patients were star
ted on phenoxybenzamine, terazosin or prazosin and reported slight imp
rovement. We believe that injury in the conus area of the spinal cord
may disinhibit the ejaculatory mechanism and allow for premature emiss
ion.