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CHAPTER 28
those during personal interview, by finding a higher percentage of erections and ejacula
tions recorded by the personal interview technique. However, there is general agreement
amongst all these authors that the percentage of erections varying between 52-94 per cent
were infinitely higher than that of the ejaculations 3-19*7 per cent. Intercourse capability
varied between 23-33 Per cent, orgasm 6-14 per cent, and reproductive results were the
lowest (up to 5 per cent). Bors (1963) stated that while erection is more frequent with
high lesions ejaculation occurs more often in those with low lesions. This is not, as will
be shown later, in accordance with our experience.
(2) Direct examination of the ejaculate obtained
(a)
By prostatic massage.
This technique was used by Home, Paul & Munro (1948). These
authors found that the amount of ejaculate by prostatic massage could be increased with
prior electric rectal stimulation—a method which was previously employed by Dexter,
Lerner & Kaplan (1940) and by Joel (1941). However, Bors and co-workers were not
impressed by the results obtained with this method in their own cases, which was in
accordance with Kuhn's findings (1950).
(b)
By testicular biopsy.
Bors and co-workers studied biopsy specimens from testes in
34 patients with spinal cord injuries. They found that in all but 3 cases the biopsy
revealed tubular atrophy while there was no disturbance of Leydig cells. Furthermore,
with 2 exceptions, they found a correlation between testicular biopsy findings and the
level of the spinal cord lesion. Lesions at or below Ti i showed a lesser degree of testicular
abnormality. The authors also correlated the biopsy findings with the result of sweat
tests, using the Qumizarin method (Guttmann, 1937-47), anc^ tnus were a^le to study the
relationship between testicular function and other components of the autonomic system.
With 4 exceptions, a close relationship was found between testicular biopsy findings and
the result of the sweat test. Lesser testicular changes were associated with normal sweating,
while major testicular abnormalities were associated with impaired sweating. However,
the 4 exceptions showed that there may be dissociation between these two components
of the autonomic system. The disadvantage of testicular biopsy is that, for obvious
reasons, it cannot be considered as a routine method in these patients and, moreover, it
cannot give any indication of the function of the genital organs as a whole, nor does it
give any indication of volume, sperm concentration, sperm motility and percentage of
normal and abnormal forms.
(c)
By the intrathecal prostigmin assessment test.
My own studies on fertility in paraplegics
and tetraplegics started in 1946, when I discovered an amazingly and selectively stimu
lating effect of prostigmine on the function of the reproductive organs following intra
thecal injection. It was previously known from the studies of Kremer & Wright on cerebral
hemiplegia patients (1941) that intrathecal injection of prostigmine has a depressant
effect on the skeletal muscles leading to hypo- or areflexia, unlike its stimulating effect on
these muscles following intramuscular injection—hence generally employed in the
treatment of myasthenia gravis. I, therefore, used intrathecal injection of prostigmine
