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Conversely, premature or spontaneous ejaculation can be a problem for men with injuries at levels T12âL1. In general, the higher the level of injury, the more physical stimulation the man needs to ejaculate. Even men with complete injuries may be able to ejaculate, because other nerves involved in ejaculation can effect the response without input from the spinal cord. Erection, orgasm, and ejaculation can each occur independently, although the ability to ejaculate seems linked to the quality of the erection, and the ability to orgasm is linked to the ejaculation facility. As many as 95% of men with SCI have problems with ejaculation (anejaculation), possibly due to impaired coordination of input from different parts of the nervous system. As with other types of sexual response, ejaculation can be psychogenic or reflexogenic, and the level of injury affects a man's ability to experience each type. Male fertility is reduced after SCI, due to a combination of problems with erections, ejaculation, and quality of the semen. Men with SCI rank the ability to father children among their highest concerns relating to sexuality. It can be severe enough that ejaculation is provoked by thinking a sexual thought, or for no reason at all, and is not accompanied by orgasm.
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