His and Her Health

I am 31 years old, happily married for 10 years, with four children. For the first two or three years of our marriage, sex felt great for me. But for the past seven years my experience has deteriorated to the point where I regularly ejaculate without feeling an orgasm - without feeling good at all.

My wife is super-supportive, but it's hard on her too. It's been seven years since things worked right for me. My problem is not ED. Never has been.

I no longer feel the intensity of pleasure that I used too. Too often, I feel next to nothing at all. I no longer get the feeling of euphoria afterward, nor do I feel tired. (I used to get the best sleep after sex.)

I'm 5 ft 8, 154 pounds, I exercise, don't drink, smoke, or do drugs. My wife and I have an excellent relationship. (In fact, sex for her keeps improving.)

I've seen a urologist, endocrinologist, and have worked with my GP too. I even visited a specialist in Boston. (I live in the mid-west) No-one seems to have HEARD of this problem, never mind have a solution to it. And it's killing me.

Over the years I've tried Wellbutrin XL (for its prosexual side-effects), dostinex, several SSRI's, thyroid medication, and several supplements. I've seen only mild improvement, and am very frustrated. I can't face a lifetime of this.

So has anyone experienced this? Can anyone offer help or hope? Thanks in advance.

You have the same experience when you masturbate?

Thankfully, my wife is more than accomodating, so I have no need to masturbate. But to answer your question, whether stimulation is through intercourse, oral, or manually, it all feels the same - very poor.

In case it helps, I've had numerous blood tests done - all in normal ranges. I was becoming slightly hypothyroid, thus the synthroid. My testosterone fluctuates, but even when increased with clomiphene (prescribed by the doctor in Boston - he preferred it to T-gel because it works from the 'top down' in the body) I feel only higher drive. Not in pleasure.

I also had an MRI of my head, and a testicular ultrasound - all normal.

Half of my frustration is that no-one else seems to report having a similar problem.

Finally, I became fully aware of my problem about 5 years ago when, for two weeks, sex and orgasm felt like it had when I was newly married. It was wonderful, and I realized that I had been declining slowly over the years. But then I went back to feeling very little pleasure again.

I found this on "ejaculatory anhedonia" on the internet:

>>In their book, The Sexual Male: Problems and Solutions, Richard Milsten and Julian Slowinski state that, " Orgasm and ejaculation are so closely related that men tend to use the term 'orgasm' to describe the overall experience and sensation, although the two can be desynchronized (i.e., there can be ejaculation without orgasm and orgasm without ejaculation)."

Ejaculatory anhedonia is the term used to describe the condition in which men are able to ejaculate physically but do not have the accompanying feelings of release, pleasure, or orgasm. Sometimes referred to as "anorgasmic ejaculation," it causes no physical harm.

If your boyfriend feels like this is something he would like to address, a health care provider, specifically a urologist, could work with him to find out exactly what is going on. A few simple tests could provide the answer. If the cause is not hormonal or physiological, then the next step may include seeing a sex therapist. You and/or your boyfriend can check out the web site for the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) to find a therapist in your area.<<

Found this too:

>>Sexual anhedonia is known as 'ejaculatory anhedonia'. This rare condition means that the person will ejaculate with no accompanying sense of pleasure. This condition is most frequently found in males, but women can suffer from lack of pleasure when the body goes through the orgasm process as well.

Sexual anhedonia may be caused by:

Hyperprolactinaemia
Hypoactive sexual desire disorder (HSDD), also called inhibited sexual desire
Low levels of the hormone testosterone
Spinal cord injury
Use of SSRI antidepressants
A urological examination and blood tests can determine the cause of a specific case of sexual anhedonia. If no physiological problems are found, one should seek treatment via psychotherapy with a certified sex therapist, or psychotherapist.

Patients may be prescribed sustained-release bupropion to aid in treatment, because bupropion has been shown to increase sexual desire and intensity of orgasm.<<

>>It can happen due to medication, particularly antidepressant side effects, alcohol, stress or depression symptoms or hormonal imbalances.<<

Found this on askphysicians.com:

"If it is Anhedonia it could be from psycogenic penile anesthesia, in other words, decreased sensitivity from the nerves that go to the penis. It may also be psychological."

"Many men who have an obsessive personality or a hysterical personality are often affected with sexual anhedonia. A psychiatric consult is indicated unless you have had a history or spinal cord injury or peripheral neuropathy."

"See your family physician first so he/she can examine you to rule out any physical or neurogenic causes. Then, determining what is found, your physician can then refer you to a urologist or to a psychiatrist that specializes in these disorders."

Thank you for your efforts in looking into this. I've been researching this problem for several years, and like you, have come across this definition of anhedonia. I've been tested for just about everything on the list - including penile nerve sensitivity (normal), prolactin, my desire is certainly high, I'm not on SSRI's, etc.

I have yet to see a neurologist. The only solid thing I have is that I have central sleep apnea (I'm of slim build, so I'm not the typical apnea patient), so it seems I may have some central problem - maybe in my hypothalamus, etc. I guess I'll have to pursue that.

Here's what gets me about those articles though - I've read a few things about anhedonia, but have never come across a real person who has said "I have this" or "I had this and here's how I fixed it." And that frustrates me - I feel so isolated with this problem.

Has anyone out there come across this in real life?

needhelppage31,

I would seriously converse with people who have suffered negative and persistent sexual side effects from SSRIs, even after having been off of them for several months or years.

Apparently, there is a percentage of people who take SSRIs, go off them, and develop "after effects", if you will. The problem for these people is that the medical community does not officially recognize this problem because SSRIs do not normally list these folks' symptoms as being a side effect of taking the medicine.

Take a visit to Yahoo Groups and look up "SSRIsex". Although some of the members and posts there might seem extreme sometimes, these people really believe that the SSRIs they took are the cause of their problems, some of them complaining of symptoms like yours.

"The sexual side effects of Selective Serotonin Reuptake Inhibitors (SSRIs) do not always go away after quitting, and can last a long time after discontinuance. This condition is sometimes called Post SSRI Sexual Dysfunction (PSSD), and can persist indefinitely after stopping the antidepressant.

This support group is for people with sexual side effects that began during SSRI use, but have continued after quitting them. These side effects include low or absent libido, impotence or decreased lubrication, orgasm problems, and genital anesthesia."

Thanks for the idea. Personally, I only tried SSRI's once, for a few weeks, maybe three years ago. So I know it's not the CAUSE of my problem, but you're suggesting that there may be similarities in problems, which I will gladly look into. Anybody else ever experienced this?

Regarding your statement, "I've read a few things about anhedonia, but have never come across a real person who has said "I have this" or 'I had this and here's how I fixed it'"--I'll run your question by Dr. Slowinski and let's see what he's got to say.

In the meantime, to torture you with yet another question--have you had a workup for MS?

Also, given how the orgasms aren't exactly flowing, what if you were to totally give up on orgasms for the next six months? What if you were to try to just enjoy the physical sensations of close physical contact without hoping it will lead to an orgasm?

Perhaps the most pleasurable sensations won't come from between your legs. Maybe there are other parts of your body that your wife can kiss and caress that will feel good in a sexual way. See what happens if you let the more subtle sensations be as important as orgasms.

It might be strange to think of it this way, but it sounds like your penis could be robbing the rest of you from some very satisfying and delightful sensations. Sure--orgasms might be like driving a Porsche, but maybe the other sensations can be like a walk through the woods on a warm summer's day.

I don't believe I've had a workup for MS. What kinds of things would tested, in such a workup?

As for your other suggestion, to some extent I've tried that too. One thing I've noticed, though, is that a back rub doesn't feel nice either, like it used to. It's awfully frustrating.

I'm so sorry to be suggesting you see another specialist. But you'd need a workup from a neurologist.

Hopefully that will turn up negative, and then we'll expend some serious effort on tormenting you with other questions and suggestions!

I will say, with four kids in such a short time, I don't know how I'd even have time to think about sex. You are a better man than I!

I am 39 years old, 5 ft 9, 160 lbs, don't smoke, drink excessively or take any drugs and I am physically very fit. Since the age of 16 I have had exactly the same symptoms of ejaculatory anhedonia as yourself and like you tried to live a normal life. Exactly as it was with you, I only realised that something was very wrong, when I had a one-off relapse. It is unbelievably frustrating that there is just so little knowledge on this subject, especially as to the cause and treatment. I have had some tests, although not as many as yourself, just testosterone levels blood pressure etc. I've tried psychotherapy and just not caring about it anymore, but to no avail. All I have to offer, is to describe the relapse I mentioned before. Basically I was about to ejaculate too early so I deliberately stopped, thought "too late, I've gone too far" and carried on, but I hadn't actually gone too far, suddenly everything was normal. I've tried to repeat this event at least a thousand times without success. I'm convinced that its some kind of early ejaclation problem, I've found that if you focus at 1 inch from the back/ top of your head instead of your penis etc it does improve things to about 1% of the norm. The only other relavent things I can think of were that I took a few severe blows to the head around the time the problems started and had a fairly though not completely traumatic childhood. In the near future, I will be trying Well-butrin, I will keep you posted. Good luck in your quest!

I'm amazed to finally hear from someone else who is having the same experience I am! At the same time, because I know how frustrating it is, I'm sorry to hear it too. Please post if you have any feedback after the Wellbutrin. And remember, for me the XL variety seems to help - the SR type doesn't. I'm still at only 3 of 10 (10 being normal) but it's better than zero. I'd also be curious to hear if dostinex/cabergoline did anything for you. Best of luck.

I'm glad that my experience has made you feel less alone, It's incredibly difficult to live with ejaculatory anhedonia, you're lucky to have an understanding wife. Its wrecked my marriage/life and I'm determined to find a solution before I enter another relationship. I'm sure that there is a common key factor between us. I notice that you mention you suffer from sleep apnea (central), I also have shown symptoms of sleep apnea (I'm told), but I haven't sought any medical help. As well as this I have intermittently suffered from arrythmia, and regularly suffer from insomnia. I have also occasionally had cholinergic urticaria but I know how to avoid the onset so it hasn't been a problem for quite some time. In view of the fact I have otherwise been perfecly healthy, It does all seem to point to the hypothalmus, or at least that region of the brain. I was really surprised to see you're 30% normal, was that because of wellbutrin or dostinex, or a combination of the two. As I mentioned previously, I have a course of Wellbutrin, I'm a bit wary of taking any medications, which is why I haven't tried them yet. Did you experience any side effects? If you have any questions that you feel may be of benefit, feel free to ask. I will keep you informed.

Interesting, to hear of those similarities between us. I've wondered about the hypothalamus - but I'm not sure how to test for normal function there. As for the Wellbutrin, the only side effect I've seen is that I have less of an eppetite. A pretty good side effect, I'd say! And it does seem to help somewhat. Not a cure, but it helps. I had mixed results with dostinex. It seemed to kill my drive sometimes, and yet sometimes it made things better too. I wish I could pin down some kind of cause/effect relationship.

Interesting, too, about the cholinergic urticaria. I can't say that I have that. But once I took L-histadine tabs, and it made things worse for me - made it go very fast with no pleasre. So I take methionine daily, trying to stimulate my body to produce less histamine. And antihistamines seem to have a positive effect on the way it feels. Again, it's hit or miss, but I think it's helped me a bit.

I'm sure you've already put a lot of thought into this, have you considered the events leading up to the time that you temporarily experienced normal sensation during sex, was there anything unusual or significant that happened. For example, did anything emotional happen to you or anything unusual in your diet, did you take any medications? Finally do you believe there is a possibility it is a form of premature ejaculation, as I believe there is a strong possibility that I personally am finishing when I should really be just starting.I will let you know if I have any improvement with my course of Wellbutrin, (at the beginning of next month). I notice you recommend the XL variety, I have the SR! Did you find the SR completely ineffective and how long does it take before you notice any improvement?