In connection with PeniMasterPRO the rod pulling force generator allows for elongating the penis in an axially symmetrical manner without abutment far from the penis (attachment location). This means that no other bodily part or piece of clothing is required to generate the pulling force on the glans chamber and that the pulling force is nearly the same at all positions of the penis. By using the rod expander the penis can be elongated either in an upwards or a downwards direction or diagonally – and this has proven to be unobtrusive, even under normal clothing. Thus, many activities of day-to-day life can be implemented without any problems. Additional physiological effects include progressive rhythmic contraction of the perineal muscles via the bulbocavernosus reflex, which helps in strengthening rigidity of erection. I would share Lyn's concern above about vibrations from a powerful medical vibrator possibly causing more damage, certainly in the early days, and I don't see how it could help nerve recovery. The frequency is more than 10 times higher than you can do with a handjob. If you want to try it for pleasurable reasons such as to try and achieve orgasm and your surgeon says OK, that's fine. Constriction bands are defined as compressive devices that apply pressure at the base of the penile shaft resulting in obstruction of venous blood outflow, thus aiming to increase penile rigidity and, therefore, improving erections ( 60). Their use has been classically indicated for patients with venous leak or those experiencing sexual incontinence. Sweis R, Biller J . Systemic complications of spinal cord injury. Curr Neurol Neurosci Rep 2017; 17: 8.

Medicine CfSC. Sexuality and reproductive health in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2010; 33: 281–336.

Giuliano F, Clement P . Neuroanatomy and physiology of ejaculation. Annu Rev Sex Res 2005; 16: 190–216.

To achieve biologic fatherhood, men with spinal cord injury (SCI) and the clinicians treating them are faced with the following (current) scenario: 1. In general, sperm production is in the normal range although sperm motility is impaired [ 1]. 2. Approximately 90% of men with SCI cannot ejaculate via sexual activity [ 2]. 3. Following a simple and proven protocol, with the application of penile vibratory stimulation (PVS) of an appropriate amplitude and frequency, an ejaculate can be obtained in up to 85% of these men with neurogenic anejaculation [ 3]. The majority of the ejaculates obtained will have >5 million total motile sperm; about half of all ejaculation trials will have >10 million total motile sperm [ 4]. 4. These ejaculated sperm can be used in an assisted reproductive technology protocol such as intrauterine insemination and achieve results similar to those seen using sperm from non-SCI men with male factor infertility. In fact, there are many published reports showing that, with appropriate guidance, patients can be taught to collect sperm at home, and achieve pregnancy via at-home intravaginal insemination [ 5, 6, 7]. 5. Surgical sperm retrieval (SSR) of testicular or epididymal sperm yields adequate numbers of sperm for IVF/ICSI, but SSR essentially eliminates any of the other options mentioned above [ 8, 9, 10]. It is important to mention that many complications have been associated with prolonged use of rings and bands. Prolonged occlusion of venous return may lead to venous thrombosis and progressively leads to lymphatic and arterial obstruction ( 60). Depending on the duration of this process it may result in local irritation and erosion ( 64). In-vitro and in-vivo studies with ischemic priapism have demonstrated that acute hypoxia leads to smooth muscle paralysis ( 65, 66). Ultimately corporal smooth muscle infarction and ischemic necrosis may occur ( 60, 67– 71). Bruising, skin breakdown, and penile pain associated with the application of the constriction band have already been discussed. The tightness of the band may also result in failure to achieve an ejaculation and the development of a temporary penile numbness. One of the other problems with the erection achieved with the vacuum device is that it may hinge at the point of application of the constriction ring. That is, the penis behind the ring is soft and only the portion of the shaft that is beyond the ring has any degree of hardness. Therefore, the ring must be applied as far proximally as possible ( 115).To control for sequencing effects, five subjects received PVS in the following sequence: M1, M2, M3; five subjects received the sequence M2, M3, M1; and five received the sequence M3, M2, M1. For trials with M1 and M2, FertiCare device(s) were set at 2.5 m m amplitude and 100 Hz. For trials with M3, stimulation parameters of the Viberect-X3 were preset by the manufacturer and were not adjustable. PVS and Questionnaire The James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA. Sonksen J, Fode M, Lochner-Ernst D, Ohl DA. Vibratory ejaculation in 140 spinal cord injured men and home insemination of their partners. Spinal Cord 2012;50:63–6. Simultaneous vibratory stimulation of both surfaces of the penis at high frequency (70-110 Hz) for 7-10 minutes can lead to gradual filling of the penis with arterial blood within minutes by activating the pudendo-cavernosal reflex.

Sikka, Suresh, Tajkarimi, Kambiz, Kadhum, Khulood, Mandava, Sree, Trost, Landon, Burnett, Arthur, Hellstrom, Wayne, An objective evaluation of viberect device in comparison to intracavernosal vasoactive injection for penile duplex doppler ultrasound blood flow analysis, abstract International Congress of Andrology, Melbourne, Australia, Feb 23-26, 2013 The pump is to make sure you are still achieving regular erections even when you can't get them naturally, because failure to have erections for a long time will result in further penis shortening when natural erections eventually recover, see https://community.prostatecanceruk.org/posts/t21301-Penis-size#post216227 (although I originally wrote it for hormone therapy, it applies to the recovery period from surgery too). It is not required to orgasm to get this protection, just to get hard. Sonksen J, Biering-Sorensen F, Kristensen JK . Ejaculation induced by penile vibratory stimulation in men with spinal cord injuries. The importance of the vibratory amplitude. Paraplegia. 1994; 32: 651–660. Lubricants are liquids or gels applied to minimize dryness and pain during sexual activity ( 38). According to the 2012 National Survey of Sexual Health and Behavior, Reece et al reported that 70% of men in the United States older than 24 years of age admit to using lubricants for intercourse, masturbation, and partnered sexual play ( 39). Around 90% of men who have sex with men (MSM) reported lifetime lubricant use ( 40). Subsequent orgasm and ejaculation can be very strong and amplified due to stronger contraction of the bulbospongiosus muscle and activation of higher ejaculatory centers.

Afex

MATERIALS AND METHODS: Subjects for this study were five healthy men (mean age 26.4 years) with normal erectile function as measured by responses to the IIEF-EF. The Viberect treatment at 75 Hz with ventral stimulation was initiated without any external visual sexual stimulation. Both objective Rigiscan measurements of rigidity and subjective Erection Hardness Score (EHS) responses were recorded and correlated. Toleration and safety were monitored. Anderson R, Moses R, Lenherr S, Hotaling JM, Myers J. Spinal cord injury and male infertility-a review of current literature, knowledge gaps, and future research. Transl Androl Urol. 2018;7:S373–82.

Vibratory stimulation of genitalia is considered safe by the medical community with important benefits including treatment of orgasmic dysfunction and stress urinary incontinence. PVS is considered the method of first choice for semen retrieval in men who are anejaculatory due to spinal cord injury. 11 Compared to the alternative semen retrieval method of EEJ, 18 PVS results in better semen quality, 19 is preferred more by patients 20 and can be performed by selected couples wishing to attempt home insemination. 8 Consequently, clinicians have sought to optimize the efficiency and success rate of PVS. For example, previous research found that application of two FertiCare devices salvaged 22% of failures to one FertiCare device. 14, 21, 22 The introduction of the Viberect-X3 in 2013 provided another tool for inducing ejaculation in this population. 15 The purpose of the present study was to compare the efficacy and success rate of the three methods of PVS applied to the same patient. Only men with a neurological level of injury at or rostral to T10 were selected for this study because injuries caudal to T10 may interfere with the ejaculatory reflex arc necessary for the success of PVS. 23 There are no scientific reports that vibrator use can cause bothersome physical side effects when used properly. Actually, men who admit to using vibrators regularly have less sexual dysfunctions in comparison to those who have never tried them. Men who reported vibrator use in the past month had slightly higher IIEF scores in comparison to those who had never used them or tried them in the past year ( 81). No attempt was made to control for factors, such as medications, that may affect the semen quality of the participants in this study. For this reason, complete semen analysis data is not presented. It is often important, however, to note if retrograde ejaculation occurred, because sperm obtained from the retrograde fraction may be useful or sometimes necessary in assisted conception procedures. All participants were catheterized after completion of the three protocol steps if necessary, regardless of the outcome, and assessed for the possibility of retrograde ejaculation. Retrograde ejaculation was defined as 10% or more of the combined total sperm count being represented by the retrograde fraction. Questionnaire Kathiresan AS, Ibrahim E, Aballa TC, Attia GR, Ory SJ, Hoffman DI et al. Comparison of in vitro fertilization/intracytoplasmic sperm injection outcomes in male factor infertility patients with and without spinal cord injuries. Fertil Steril 2011; 96: 562–566.The concept of sex aids is very broad, and, judging from the literature on this topic, their medical utility varies greatly. Frequently, but not exclusively, referred to as sex toys, the term sex aids refers to an object or device that is primarily used to facilitate human sexual pleasure. The first attempts to enhance sexual activities through the use of an object date from more than 30,000 years ago where archeologists unearthed a piece of a stone tool which, according to some authors, may have been a sex aid due to its phallic shape, size and smooth surface. ( 1) There are reports suggesting the use of olive oil as a sexual lubricant from around 350 BC ( 2). Moreover, one of the first treatment options for erectile dysfunction (ED) was detailed in the Kama Sutra in India around 300 AD, detailing dildos and penis extensions made of wood or reeds tied to the waist ( 2). The consensus of participants and panel members was that the Ferticare 2.0 device is safe and effective for inducing ejaculation in men with SCI. Thirteen of the 15 participants in this study responded to the Ferticare 2.0. These 13 participants had previously responded to PVS with other devices. Two participants did not respond to the Ferticare 2.0. These two participants (4 and 11) had previously not responded to PVS with other devices. In these PVS failures, it should be noted that their semen was subsequently retrieved by the method of electroejaculation [ 19] using the Seager Model 14 electroejaculation device (Dalzell USA Medical Systems, The Plains, VA). Every year, there are ∼12 000 new cases of spinal cord injury (SCI) in the United States, 1 and thousands more worldwide. Most spinal cord injuries occur in young males. 1 Following SCI, the majority of men become anejaculatory and require medical assistance to procure sperm. 2 Only 10% of men with SCI can ejaculate via masturbation. 3