What Is Penile Vibratory Stimulation and What Does It Do?

While boating with friends on Memorial Day weekend 2009 in Palm Beach County, Florida, Eric Rosemary fell into shallow water. The fall shattered his vertebrae and rendered him a quadriplegic. After two years of physical therapy, he was able to regain the use of both of his arms and one hand.

Rosemary met a woman named Christian through online dating. The couple hit it off, moved in together and married three years later. When it came time to try to have a child, Rosemary wasn't confident. After all, about 90 percent of men with spinal cord injuries develop ejaculatory dysfunction, and only 10 percent can ejaculate during sex or masturbation.

Penile vibratory stimulation offered hope

Determined to conceive, Rosemary visited urologist Emad Ibrahim, M.D., the director of the Male Fertility Research Program at the University of Miami in Coral Gables, Florida. Ibrahim was able to help Rosemary overcome his ejaculatory dysfunction, in part through the use of penile vibratory stimulation (PVS).

This noninvasive, nonsurgical treatment involves placing a special mechanical vibrator on the glans, or head, of the penis, to produce ejaculate. PVS is a primary method of obtaining sperm for fertility assessment and fertilization purposes in men with spinal cord injuries.

"I couldn't believe it actually all worked out and happened," Rosemary, who's now the father of a toddler, told The UHealth Collective. "It was just surreal."

PVS is effective up to 86 percent of the time in men who have suffered a spinal cord injury, according to Ibrahim.

"It's simple and safe," he explained. "Then, at the end, they're going to yield the most natural ways of home insemination, or even in vitro insemination."

How does penile vibratory stimulation work?

When PVS is used, ejaculation typically occurs quickly, anywhere from seconds to a couple of minutes. During stimulation, the vibrator is placed at the head of the penis, at either the top (the dorsum) or the bottom (the frenulum).

"We put that vibrator in there, and this mechanical action recruits what we call the ejaculatory reflex," Ibrahim said.

"PVS is a really cool exploitation of what we call a spinal reflex arc, where guys, even if they've had a full spinal cord injury, that feedback arc can still be intact," said Jesse Mills, M.D., a urologist and the director of the Men's Clinic at UCLA in Los Angeles.

PVS is more effective for men who suffered an injury higher on the spinal cord, in the thoracic or cervical area, rather than the lumbar or sacrum.

"If they have a cervical or thoracic injury, there's a really good chance that we'd be able to get an ejaculation with a PVS and be able to institute a pregnancy," Mills said.

A vast majority of PVS cases are for spinal cord injury victims, but men with severe diabetes who don't have the nerve function to ejaculate and men with medication-induced anejaculation (lack of ejaculation) may also benefit.

What are potential side effects?

The one potential risk of PVS is autonomic dysreflexia, an overreaction of the autonomic nervous system to stimulation. This can cause a patient's blood pressure to reach dangerously high levels and may even lead to a stroke.

This is due to the lack of communication between the brain and the lower parts of the body when PVS is performed below the level of the spinal cord injury, Ibrahim said. For example, a patient had a cervical injury, and the PVS is done at the level of the penis, which is in the sacral region.

"This would trigger the sympathetic system to produce some chemicals that will cause the blood pressure to go very high, and the heart rate would even be below or high," Ibrahim said. "And that can cause some serious effects, leading even to stroke."

In the clinic, Ibrahim treats these patients and monitors their blood pressure before they undergo PVS. Autonomic dysreflexia is a possibility for men whose injury is located around T6 or T7 in the thoracic area of the spine and above.

At-home penile vibratory stimulation

"Anybody who's below that level can easily purchase this vibrator and do it at home," Ibrahim said. "We train them very well before we say that you can use a vibrator at home, and we also prescribe medications that they can take at home before overstimulation so that they can be able to manage the autonomic dysreflexia and don't get the side effects."

Mills said he will teach patients how to give themselves a blood pressure agent if they start to experience symptoms of autonomic dysreflexia.

"Most of the time, I'll do a PVS in the clinic," Mills said. "I do a sperm test at the same time because I can use my lab to give them an idea of how their numbers are and how good it's going to be. But [we] need to monitor them with blood pressure and symptom control. Usually, what will happen is you'll start this [PVS], and they'll get this crushing headache, and we'll know.

"All of a sudden, their blood pressure goes from normal to 200 over 100. That's the only downside to doing a home PVS."

PVS saves money

Ibrahim stressed that other methods of sperm retrieval, such as surgical sperm extraction, should represent a last resort.

"When you do surgical sperm extraction, you're going to get the lowest number of sperm that most of the time are not motile, not moving," he said.

PVS yields more total motile sperm. Surgical extraction automatically puts the couple into in vitro fertilization (IVF) cycles, which can cost between $15,000 and $20,000 per cycle.

"When it comes to spinal cord injury, because of the lack of knowledge, most of the practitioners would tell them, 'No, you cannot ejaculate. We have to go to the testis.'"

They go to the testis for sperm extraction and then on to IVF.

"We can get an ejaculate from them using the simple method of penile vibratory stimulation," Ibrahim said. "A lot of times, it's home insemination. And we have many, many examples of people who were successful using home insemination.

"Or you can even go for intrauterine insemination, which is basically about a $2,000 cycle. So that's why we say surgical sperm extraction is the last resort when all these fail."

PVS is easier for the female partner

If you can get an ejaculate with sperm out of a guy, Mills explained, you not only save tens of thousands of dollars, but a lot of injections and overstimulation on the female partner.

"For the couples where she has normal ovulatory function and with him it's just a matter of getting sperm out, they can actually use ejaculated sperm from a PVS and just do an at-home insemination," Mills said.

He added that he has had a few couples he has helped by doing the vibration and the stimulation in the office, and then they do their own sperm insertion. It's a money-saving option, and Mills called it as close to spontaneous intercourse as you can get.

"I always instill the hope in couples that as long as I get sperm, we have a really good chance of finding a way to get them pregnant, whether it's through PVS or through sperm extraction," he said. "Just the idea that you can be able to establish a biologic pregnancy is so gratifying both to me as well as those couples. They're some of my most grateful patients."