Digest of recent discussions on ISSM mail (May 2009 - Aug 2009)

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CAROL FEATHERSTONE

Ejaculation without Orgasmic Sensation                                                 

17 August 2009: 10 Messages

1

I have a patient who functions up to climax and ejaculates, but with little or no orgasmic sensation.  He's done some book and internet research but apart from eliminating physical (neurological) causes or suggesting Kegel’s to strengthen pelvic floor tone there is little practical help. He’s had a lot of physical and hormonal checks too. Any thoughts or ideas?

Carol Featherstone (carol.featherstone@BTINTERNET.COM)

2

Check serum testosterone.

Abraham Morgentaler (amorgent@YAHOO.COM)

3

I suggest a thorough neurological workup. Does he have sensory losses? Does he have dorsal column symptoms and signs? Medications? Food fads?

David M. Ferguson (ferguson@BOREAL.ORG)

4

Apart from eliminating physical causes that have been mentioned, I would think of psychological etiology, such as dissociation of function and sensation. This may be similar to subjective female arousal disorder: while she may respond to stimulation with lubrication, the woman lacks subjective perception or feeling of arousal. For this client I suggest evaluating also the possibility of a traumatic event. 

Gila Bronner (gilab@netvision.net.il)

5

I think we’ve all seen this most commonly with SSRI or SNRI medications.  Aside from medications, I think the most important medical conditions to consider are hypogonadism, diabetes, and MS.  Dr Perelman’s model of idiosyncratic sexual or masturbatory techniques is important to consider in these cases. Some strategies that may be helpful are Wellbutrin or a high-speed vibrator such as the Ferticare.

 W  Brant (dr.w.brant@GMAIL.COM)

6

Many years ago I had a patient like that. The clinical team that evaluated his case referred to him as suffering from orgasmic anhedonia. He underwent all sorts of physical examination including urological, neurological and hormonal, but no physical evidence was found. I treated him with many sexual therapy techniques including the participation of his wife, but the problem remained intact. I tried some individual psychological dynamics and obtained a detailed history since childhood. I found that, beside being a religious minister and a full time theological professional, his father was also a religious minister. He grew up with strict religious values. Nevertheless, during his early adolescence (ages 11-13) he used to masturbate rubbing his genitals with his sheets and mattress. According to his recollection, besides ejaculating, he felt orgasmic sensations. Near his 14th birthday he went with a few friends to swim in a river. All of them took their clothes off and swam in the nude. He did the same thing, surprised seeing other adolescents in the nude for the first time. After they swam, all of them started to masturbate in front of each other and started a competition of who will ejaculate first. At first he did not know what to do, since he had never masturbated using his hands. He imitated his friends, and finally all of them circled him because he took a long time to ejaculate. He felt so nervous that he did not feel his orgasm when he finally ejaculated. Subsequently, he never felt orgasmic sensations during ejaculation; whether he ejaculated by different forms of masturbation or by having sex with wife. 

For a couple of years I was seeing this patient in individual psychotherapy, he felt all kinds of guilt and shame about his sexual expression; which he was able to overcome. Finally, he was able to feel much better about his sexual problem. He was able to follow my instruction of faking orgasmic sensations while ejaculating. At first, he was somewhat resistant with the method, but after a while he became so comfortable with it that towards the end of therapy, he said that he felt like he had already solved the problem. But he never experienced the same orgasmic sensations as he did before the traumatic experience with his friends in the river.

I never knew if his problem was totally psychological or if it had some organic components. Nevertheless, to my own satisfaction he felt much better after treatment.

I hope this experience, in which I learned so much, could be of benefit to the understanding of your case.       

José R. Pando (pando7870@AOL.COM)

7

As his anhedonic ejaculations seem to stem from the traumatic/humiliating group masturbation experience I wonder if EMDR would have been helpful?

Margaret Redelman (redels@MEDEMAIL.COM.AU)

8

Ejaculation without orgasmic sensation is a huge issue on my medical website bulletin board.  There are thousands of posts on this issue, with men describing the varied medical and psychological treatments that have failed. I invite you to visit the board.  There are so many, it is now part of Wikipedia on the issue of sexual anhedonia. Many of the posters discuss the tests and meds that have been prescribed. They go on for 55 pages. Scroll down the first page to get started. They are most enlightening and show the pangs and pain of the men who suffer this problem.

Stan Felder (stan.felder@VIBRANCEASSOCIATES.COM)

9

Carol should definitely inquire about the frequency of orgasmic experience, totaling both masturbation and partnered sexual activity. Generally, there will be a trend observed that the quality of a man's orgasmic experience diminishes, when his frequency of orgasm increases beyond his ‘threshold' for optimum function. This assertion presumes there is a range of response that is optimal for any given individual for any given time in his life.  For instance, a 17 year old man might comfortably experience 8 ‘good orgasms’ in a week of sexual activity, while that same man will probably report very limited orgasmic sensation, if he attempted to duplicate that experience when he is 44 years old. A number of men who masturbated at high frequency while also having additional partnered experiences in their 20s and 30s, find they cannot continue to do so in their 40s and 50s, etc. 

Orgasmic frequency per week would represent only one of a number of biopyschosocial-cultural etiological factors which might explain etiology, as per the ‘Sexual Tipping Point’ model. The other medical and psychosocial factors (identified in e-mails from others on this list, e.g. David, Alan, etc.) need to be ruled in or out and there could certainly be a multi-determined etiology.  However, the orgasmic frequency factor can be easily assessed by asking the patient to substantially reduce his frequency of orgasm between office visits and reassessing when he reports back at the next visit. Such a strategy provides considerable diagnostic information benefit, with no additional cost or safety risk!

Anyone interested in receiving pdfs of publications supporting the above may e-mail me a request.

Michael A. Perelman (perelman@earthlink.net)

10

Poor sensation = nerve damage, disease, drugs or deterioration e.g. neuropathy. Love. Ruth.

Ruth Hallam-Jones (ruth.hallam-jones@VIRGIN.NET)