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Forum Name: Male Sexual Disorders

Question: Anorgasmia [Male] - unable to orgasm


 valleyman - Thu Feb 28, 2008 4:46 am

I'm a 29 yr old male, who hasn't been able to orgasm for the last 3yrs. Just before ejaculation I'm unable to sense any pressure or tension build up and the release of semen happens right away.

I have been able to achieve orgasm before but then it just stopped and I've been miserable since then along with the broken marriage - our initimate life suffered alot due to this fact. I'm unable to achieve orgasm even through masturbation.

My semen analysis is normal and so are my testosterone levels. My urologist mentioned that anatomically everything is fine with me, so did my endocrinologist and my sex therapist who confirmed it's not a psychological thing.

Please help as I'm losing interest and confidence in myself due to this issue and none of the doctors I've visited are able to help me.
 Tim W Latsko - Mon Mar 03, 2008 7:23 am

Hello Valleyman,

There are an infinite number of variables that affect our body and mind's ability to function correctly. Depending on the clinician with whom you consult there are varying approved treatments.

That said and in consideration of you and other professionals having ruled out a medical condition along with your stated degree of comfort in sexual situations, you might want to consider meeting with a licensed psychologist/mental health professional who can assist you in exploring other areas of potential concerns. It is interesting how and what we think, about seemingly unrelated issues, affect our overall functioning.

Keep us posted of your progress. Create and enjoy a great day!

Tim
 Dr. Chan Lowe - Tue Mar 04, 2008 10:16 pm

User avatar Hello Valleyman,

I would agree with Tim's recommendations. I would add, though that if there is nothing wrong physically and there is nothing wrong psychologically that basically eliminates the two areas that are involved in this process. So I would submit that there is either a problem physically (physiologically) or there is an issue psychologically. Given that you are able to ejaculate, the nervous system connections necessary are present and functioning.

I am wondering if there may actually be some unrecognized psychological pressures that are changing your perceptions of the sensations of orgasm. It may also be that your body is now recognizing the sensations of orgasm differently such that you are not perceiving the sensation as an orgasm. Often, these changes find their root in some psychological issues as well.

Follow up with your urologist may be helpful. Also, seeing a therapist may actually be of some benefit. As Tim said, sometimes seeming unrelated things can have significant impact on sexual health.

Best wishes.
 Dr. Tamer Fouad - Wed Mar 05, 2008 4:20 pm

User avatar Hello,

I'd like to add to the fine replies of both Dr. Chan and Tim. As both have clearly stated organic causes are to be excluded first, although psychogenic causes are most common (90% of causes).

Its good to know that your testosterone level is normal.

Alcohol in addition to some medications such as SSRI antidepressants e.g. fluoxetine (Prozac), sertraline (Zoloft) and paroxetine (Paxil).

A list of other conditions that should be considered are neurological diseases such as spinal cord injury, multiple sclerosis, and diabetetic neuropathy.

Its good that you are coming forward with this, since most men don't as Dr. Chan mentioned on the Private Forum when discussing your question. The fact that you are losing interest will only aggrevate the condition.

So the way this is handled is as follows: First exclude all the organic causes mentioned above even the very rare causes. Once that has been done you're left with only one pretty common possibility --> psychological. The problem with psychological causes is they may co-exist with organic causes worsening the condition. The other problem is its hard even for a experienced doctor to make the diagnosis of a psychogenic cause for a condition since its usually done by exclusion. I wouldn't rule it out if I were you. In addition the difficult marriage relationship as well as the divorce are all risk factors for psychological problems. It's tempting to jump right at it.

I hope we have helped to shed some light on your condition. It isn't easy, I know we all researched it and discussed it on the Private Forum.

Please keep us updated and feel free to add to this thread!

Good luck!
 valleyman - Thu Mar 06, 2008 12:11 am

Could there be a connection to masturbating with porn? I read through some of the threads which stated that this could be a reason. Also another thread talked about using a pillow for it. Why would using a pillow cause such issues?

If the above reasons could be the cause of my problems, how do I resolve it? I've stopped this a while ago. Also I haven't taken any SSRI medications.
 Dr. Tamer Fouad - Fri Mar 07, 2008 8:55 am

User avatar Hello again,

To the best of my knowledge masturbation has nothing to do with it. The methods use in masturbating have nothing to do with it either.
 Dr. E. Seigle - Fri Mar 07, 2008 3:19 pm

Dear Valleyman,

A few thoughts to add to those already suggested:

1. Consider seeing a neurologist to rule-out a neurologic condition that can interfere with sexual function (as was mentioned by Dr. Fouad).
2. Many medications, over-the-counter, herbs, prescription drugs, and drugs of abuse can cause sexual dysfunction.
3. Since this seems to be confusing, you may want to consult a psychiatrist to rule-out a psychiatric condition that may be a factor in this.

Good luck, I know this must be very discouraging!

-Dr. Seigle
 Debbie Miller, RN - Fri Mar 07, 2008 4:02 pm

User avatar Hello,
I know how frustrating this must be for you and I am sorry you are struggling in your marriage relationship as a result.

You didn't mention how long you worked with the sex therapist but a disorder like this can take quite a while to overcome but with a good therapist and following instructions for the graduated assignments, success rates are actually quite good. But, it is not a quick fix. Communication and trust in the partner are key factors. If you are not currently in a relationship due to divorce, the techniques will likely not fix the problem since it is interactive.

It is more rare for men to have this disorder (about 8% vs 24% for women) but obviously that means many men suffer this way and you are not alone. It doesn't fix the problem, but can be nice to know when it may feel like you are alone in this.

Hypnosis and electrovibrators are alternative treatment that might be helpful in performance anxiety or inability to orgasm. Your therpaist should be able to guide you in this.

Patience is the one piece of mind I can recommend now.

Goodluck.
 Beverly H. - Fri Mar 07, 2008 5:29 pm

I would agree that all possible medical causes for your problem need to be explored, and it seems that many of them have. Still, the urologist consult sounds like a good next step. Also, you must be vigilant about considering the effect of all medicines and vitamin/herbal preparations you are taking.
You did mention that your inability to achieve orgasm began during your previous marriage and played a role in its demise. So, I am inclined to suspect that this began with a psychological issue (perhaps your self esteem was negatively impacted in the marriage) and is now compounded by the tension of continued failure to overcome the problem.
Please consider finding a therapist with whom you feel comfortable and commit to exploration of your feelings about relationships and sexuality. I have heard that some physicians are willing to prescribe a short course of Viagra or Cialis which sometimes "jumpstarts" the sexual response but that may not be as effective in the long term as good therapy.
Try to stay positive.

Beverly H.
 Marceline F, RN - Sat Mar 08, 2008 12:58 am

User avatar Dear Valleyman,
I sympathize with your current dismay. I also appreciate your efforts to find a definable cause for the anorgasmia. Dr. Fouad mentioned an aspect that I believe is worth your pursuing further. You mentioned you have an endocrinologist. Since many people have diabetes that is managed by their primary doctor, the fact that you have your own endocrinologist suggests you have an ongoing pervasive problem - possibly with diabetes? While many people are aware that diabetic neuropathy can affect the sensorium in regards to hands, feet and pain in the extremeties, not as many people are aware that diabetic neuropathy can be: peripheral, autonomic, proximal, and/or focal. Our bodies are marvelously complicated, and each of these nervous systems work on different areas. The autonomic nervous system is the one responsible for sexual response. While the "plumbing" may be intact, it is still possible that the nervous pathway may be compromised. Have you explored this with your endocrinologist?
I do not know what options there are if indeed this is the basis for your problem, but at the very least, to identify the source may enable you to make decisions for your life that will enhance and protect it.
In any event, I heartily recommend you continue your therapies regarding your relationship concerns. There are wonderful relationships that can be built without the need for sexual activity to be a cement. And sexual fulfillment in a loving communication is still possible, with a partner that appreciates ALL of you - not just your appendage!
 Dr. K. Eisele - Sun Mar 09, 2008 7:13 pm

User avatar Dear ValleyMan:

Wow! The whole team is trying to help you with this. In reviewing the answers, I see a couple of other possibilities, medical and psychological. Has anyone done a complete battery of lab work--not just testosterone levels? If not, I would suggest, in particular, the following:

Lipid panel
Thyroid panel
Corticosteroid levels

If you have a vascular problem (evaluated by lipid panel and blood pressure), it could show up as a sexual function problem in general, although this is less likely since you are able to achieve an erection. A thyroid panel would be useful also. Steroid levels are important, because the sympathetic nervous system is responsible for ejaculation. If you have an adrenal gland problem it could affect this function, because steroids are produced in the adrenal gland.

Since you have seen a urologist, I am assuming that your prostate gland has been evaluated and is normal. If not, that will need attention. It would be unusual, though, for someone of your age to have a prostate gland problem.

How long ago did you see a sex therapist? It could be that the initial problem was not psychological, but that it is now. If you have not seen a sex therapist recently, and all the somatic possibilities have been ruled out, you should consider going back. There is one other possibility: Conversion disorder. This is a problem that is psychological in nature but that presents as a somatic condition for which no physiologic cause can be found. You really need a psychiatrist with experience in consultation-liaison psychiatry to look at this possibility, as it is very difficult to diagnose.

Good luck, and please come back and let us know how things are going.
 valleyman - Sun Mar 09, 2008 7:53 pm

Hello all

Thanks for your responses. I did see a neurologist who suggested that everything was normal after he took a few quick physical tests. I met with a sex therapist for about 3 sessions who said that my problems weren't pshycological and suggested me to check with an endocrinologist or followup with my urologist.

I don't have diabetes and I was able to go to an endocrinologist without a referral. I told him about my condition and he verified from the blood tests that I wasn't suffering from any pituitary or hypothalmic tumors. He suggested I consult a urologist. My urologist mentioned that he couldn't identify any obvious reasons for my problems and asked me to see a therapist.

Earlier I had been to an urologist regarding some pain in my groin area which occurs just after masturbation and about low quantity of semen. He said that he couldn't relate to any of my issues and nothing seemed obviously wrong. He conducted a cystoscopy and he couldn't find anything wrong except for some inflammation. I do recall that my problems started about two months after this incident. I'm not sure if it's related, the same urologist mentioned that it isn't.

So I have been literally running in circles from one doctor to the other.
 valleyman - Sun Mar 09, 2008 7:56 pm

I also had a sonar scan of my testicles and the doctor verified that everything was normal and there was no sign of varicocele related issues.
 Tim W Latsko - Tue Mar 11, 2008 12:56 am

Valleyman,

Let's take a look at what sex therapy is:

Sex therapy is a short-term solution-focused intervention, let's say 6-12, possibily 15 sessions in rare or complicated situations. Solution focused is simply that, in your case it will be to have you reach an unretarded/normal ejaculation/orgasim.

It is necessary to evaluate relationship issues as a part of sex therapy but they are not the primary issue. Sex therapists treat the sexual problem directly as compared to the supposition that that other relationship issues must be resolved prior to reaching an accetable degree of sexual satification with your partner. However research and my professional experiences has shown that couples who share an intimate intellectual conection tend to have few performance issues.

You have two options here to accept, those being: it is not psychological ..therefore it must be physiological---so you need medical treatment or if it is not physiological it must be psychological--so you psychological care... or a combination of both...then you need to start over at square one. Given that you have already ruled both out. Consider it psychological at this point.

I have reviewed ther thread thus far and recommend that you pursue working with a sex therapist to explore satisfying your sexual desires through means other than vaginal sex or masturbation. I believe at this point you have nothing to loose by consulting with your previous sex therapist and asking him/her for referral to someone who uses a differing approach.

You may even want to try an SSRI or SNRI as a paradoxical attempt to experience an orgasim. What is the worst that could come of it? you may experience an orgasim, there is nothing wrong with prescription medication as long as it is prescribed for a specific purpose and is being used for said purpose. You can do it....Let us know how the evaluation goes and the results. Wishing you the bext.

Tim

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