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Question:
I am a physically fit 21 year old Caucasian. I have never orgasmed in my
whole life, I also have never ejaculated (through masterbation or by
stimulation by another) but I do have wet dreams every six months in my
sleep. Right before i ejaculate in wet dreams, I wake up and I release, but
i feel nothing and i don't have an erection when it happens either. I get
plenty of erections during the day and I do get erections in my sleep.
My penis has very little sensitivity but touching does increase hardness like
my body somehow senses it. I get "shoots"/twitches of feeling in the head of
my penis when I am soft, sometimes lasting about a second long. After
erections, the head of my penis sometimes hurts and when that hurts, also
the area slightly above and behind my pubic bone hurts (around the general
prostate/bladder area i think). Also after erections, I sometimes get
twitching in my kegel muscle area.
My history:
1. No spinal cord/broken bones/or major injuries or even minor ones
involving sexual areas. Circumsion had no complications.
2. Prostate/testicular cancer checks(digital exams) CT scan of abdomen and
ultrasound of testicles showed no problem.
3.Urine tests and blood tests normal, no hormone tests as of yet.
4. Nerve testing of leg nerves was normal.
5. Went to two sex therapists who agreed (and with whom I agree) that this
problem isn't in my mind. My parents are very understanding and never told
me sex or sexual feelings were bad when I was growing up.
6. I was found to be over reflexive, bulbo cavernus reflex arch test was
normal.
7. Not on any medication/supplements and not depressed-life is going good
right now except for this problem.
8. MRI's of brain and whole spinal cord showed nothing, except I have a disk
herniation at the L5-S1 "with no evidence of nerve impingement"
Conculsion:
The only thing that the docs and me have come up with to try next is
autonomic testing at the Cleveland Clinic in Ohio. Any advice/suggestions
and why you think that that may be worth trying, would be greatly
appreciated.
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Answer:
by Hussein Ghanem: (05/31/2004)
To assess anorgasmia one must understand the 5 phases of the sexual response cycle. These phases are:
1) Desire Phase: As mentioned in our sexual health page, without the desire to be sexually active, men are not going to get excited or have orgasms.
2) Excitement: Manifesting by penile erection in men and vaginal lubrication in women
3) Plateau: Full sexual excitement during intercourse.
4) Orgasm: A highly pleasurable sensation occurring at the peak of sexual excitement. It is associated with ejaculation in men and rhythmic contraction of pelvic floor muscles in women.
5) Resolution: Relief of sexual excitement and a feeling of relaxation after orgasm.
The inability to reach orgasm and ejaculation during any kind of sexual activity, in spite of normal erections and night emissions, is known as 'Primary absolute anorgasmia'.
Several factors might interfere with reaching full sexual excitement and thus failure to reach orgasm. Suggested psychological factors include obsessive-compulsive personality, interpersonal factors and various fears. However, in many cases there is no clear cut cause, and anorgasmia may puzzle both the patient and physician. Patients might fall into a performance anxiety trap. Instead of relaxing and enjoying the sexual experience they might focus on their performance and on reaching orgasm. Performance anxiety would thus inhibit sexual excitement and orgasm.
Suggested physical factors include hypnotic abuse, narcotic & alcohol abuse and nerve disorders or spinal cord injuries. An absent glandipudendal ('bulbocavernosus') reflex has been correlated with treatment failure. However, many healthy men have an absent 'bulbocavernosus' reflex.
Various treatment approaches have been used with varying success. Reduction of performance anxiety and providing a high level of stimulation might be achieved through the sensate focus exercises (relaxed sensual massage). These exercises are prescribed by a sex therapist and include both partners taking turns at giving and receiving stimulation while forbidding genital touching, vaginal penetration and orgasm.
If the patient is able to ejaculate outside the vagina, sex therapists attempt desensitization by prescribing a series of exercises where the patient masturbates up to ejaculation on his own first, then with his wife, then outside the vagina, and finally intravaginally. Electrovibratory stimulation and sexual fantasies might also be helpful.
The other aspect of the Anorgasmia problem is infertility. Several approaches for sperm retrieval and assisted reproduction have been successful. These include electrovibratory stimulation, transrectal electroejaculation, and testicular sperm retrieval. Patients who occasionally ejaculate outside the vagina may collect sperm after night emissions and deliver it to the Andrology laboratory for freezing.
The general advice given to patients with primary or secondary failure of reaching orgasm is not to concentrate on the outcome of the sexual experience but rather to relax and enjoy giving and receiving stimulation.
Reviewed by Sexual Health Editorial Team
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