How do spinal cord injuries at different levels affect ejaculation and orgasm outcomes?
Executive summary
Spinal cord injury (SCI) changes ejaculation and orgasm in ways that depend on the injury level (where the cord is damaged) and completeness (whether connections remain), with higher (supraconal) lesions tending to preserve reflex ejaculation and orgasm via spinal circuits while lower sacral or conus/cauda equina injuries more often abolish these reflexes and genital sensation . Men and women can still experience orgasm after SCI, but rates and the sensory quality differ by lesion pattern: roughly 40–50% of men and about half of women retain orgasmic ability overall, with markedly lower rates when sacral segments S2–S4 are damaged [1].
1. The anatomy that decides sex: which spinal segments matter
Three spinal segment groups are central to sexual responses: the thoracolumbar sympathetic T11–L2 segments mediate emission, the sacral parasympathetic S2–S4 segments and pudendal somatic neurons mediate erection, lubrication and the expulsion phase of ejaculation, and lumbosacral interneuronal networks serve as spinal pattern generators for ejaculation and orgasmic-like responses . Damage above the sacral cord disconnects brain input but can leave these spinal reflex circuits intact; damage to the sacral segments themselves (or to peripheral nerves — conus/cauda equina) disrupts the local reflexes and genital sensation critical for reflexive ejaculation and many orgasmic experiences .
2. High (supraconal) lesions: reflexes survive, but sensation changes
When the lesion is above the sacral level (supraconal), descending brain control is lost yet spinal reflex pathways remain able to generate erections, emission and even ejaculation in response to direct genital or vibratory stimulation; men with upper motor neuron (UMN) patterns often have reflex erections and are more likely to produce projectile ejaculation with preserved orgasmic signs despite altered sensation . This explains why techniques like penile vibratory stimulation or electroejaculation can reliably induce ejaculation in many men with injuries above T9–T12 .
3. Sacral, conus and cauda equina injuries: greatest disruption to ejaculation and orgasm
Injuries that damage sacral segments or the conus/cauda equina — the nerve roots that carry genital sensation and motor output — most often produce anejaculation, loss of reflex erections or lubrication, and severely reduced ability to experience orgasm, with studies reporting orgasm rates as low as 17% in women with complete lower motor neuron S2–S5 dysfunction and poor ejaculation outcomes in men with lower motor neuron syndromes . Men with lower motor neuron (LMN) patterns are less responsive to penile vibratory stimulation and pharmacologic erection therapies and have poorer prognosis for natural ejaculation .
4. Completeness matters: complete versus incomplete injuries
Whether the cord lesion is complete or incomplete predicts outcomes: incomplete injuries preserve some ascending or descending pathways and are associated with higher rates of genital sensation, psychogenic arousal, and ability to ejaculate or orgasm compared with complete injuries where pathways are severed . Even in complete injuries, however, orgasmic experiences are reported — sometimes as “phantom” or spinally generated orgasms — indicating that subjective orgasm can occur without full conscious genital sensation [1].
5. Sex differences and clinical numbers
Across reviews and cohort studies, about 40–45% of men with SCI retain the ability to orgasm (often linked to ejaculation) and roughly 50% of women do so, though wide variation exists by lesion type and study methods; women with suprasacral injuries are more likely to orgasm with clitoral stimulation than those with sacral lesions (59% vs 17% in one pooled report) [1]. Men report that orgasm can occur with or without ejaculation, and genital sensation strongly correlates with orgasmic reports — roughly 73% of those reporting orgasm also retained genital sensation in one review .
6. Caveats, rehabilitation and unanswered questions
Findings are limited by varied definitions of “orgasm,” small and heterogeneous study cohorts, and differing lab protocols; researchers call for standardized physiologic markers and more work on retraining or rerouting ejaculatory and orgasmic responses, and clinicians use tools like vibratory stimulation, PDE5 inhibitors, sperm retrieval techniques, and counseling tailored to lesion pattern to restore function and fertility . Alternative viewpoints include emphasizing psychosocial adaptation and partnered techniques that exploit residual pathways; sources note both physiological plasticity and persistent gaps in evidence about optimal rehabilitation strategies .