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Suggest Treatment For Ejaculatory Anhedonia

Posted on Mon, 21 Apr 2014

Question: I'm a 42 year old male who has been suffering from ejaculatory anhedonia since my early teens. When I first discovered masturbation (probably around the age of 12-13) I had strong full body orgasms, however by the time I lost my virginity at 16, the strength of the orgasms had petered out to that of a very pleasurable sneeze. Today, I get more pleasure out of sneezing than an orgasm. I have no problem in getting sexually aroused, getting and holding an erection, and the sexual act itself is very pleasurable until the onset of a very sudden and disappointing (in terms of pleasure) ejaculation, generally 1-2 minutes into intercourse. I cannot think of any psychological reasons for the problem. In other areas of my life i do not suffer anhedonia of any kind. I'm happily married, have absolutely wonderful kids and lots of good friends and a close relationship to my parents and siblings. I'm originally from the Nordic region where sexuality is not really seen as sinfull, or something to be repressed. I also have no history of being abused etc. I'd thus be interested in hearing what physical causes the may be for my condition may be and what type of expert to approach. The only possible physical clue that I can think of is the cramps that I sometimes got through my teens and early 20s after masturbation or intercourse. The cramps, which were quite painful, happened behind my scrotum up to about the anus and would last for a few seconds.

Answered by Dr. Jonas Sundarakumar (1 hour later)

Brief Answer: To see an XXXXXXX & have a detailed evaluation Detailed Answer: Hello and welcome to Healthcare Magic. Thanks for your query. I understand that you must be quite distressed by your sexual problem. From the detailed description of your problem, it appears that you are indeed suffering from an ejaculatory anhedonia, also known as "pleasure dissociative orgasmic disorder". Now, there can be both psychological as well as medical causes for this condition. In my experience, in a majority of cases, the cause is partly or entirely psychological. But in you case, as you have clearly mentioned, there doesn't appear to be any obvious underlying pychological causes. So, we need to look at possible medical causes which could be resulting in this condition. One of the most likely medical causes is a hormonal imbalance. Prolactin and Testosterone are the two hormones mostly implicated as causative factors. An excess of Prolactin or low levels of Testosterone can both lead to orgasmic disorders. Another probable causative factor is an insufficiency in a neuro-transmitter (brain chemical) called Dopamine. Rarer causes include nervous problems - such as a "neuropathy" or spinal cord problems or sometimes even certain urological conditions. Certain medication like SSRI anti-depressants or certain anti-hypertensive medication can also have a side effect of causing this problem. So, in your case, what I would recommend is a thorough and targetted medical evaluation to ascertain the correct diagnosis. The most appropriate specialist who can address your problem would be an XXXXXXX or a Sexologist. You will need to undergo a thorough physical examination, including a urological examination as well as hormonal tests as part of the evaluation. Further management of your problem would depend on the cause identified. I hope this information has been helpful to you... Wish you all the best. Regards, Dr. Jonas Sundarakumar Consultant Psychiatrist & Sexologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Jonas Sundarakumar (22 hours later)

Thank you for your quick an thorough response. XXXXXXX and (English speaking) sexologist seem to rather thin on the ground where I live (Luxembourg). Now I did find mention of one XXXXXXX online, but that was on the website of the local hospitals maternity clinic and seemed to speak mostly about male infertility issues. If I cannot get hold of an XXXXXXX or sexologist, who do you suggest I approach? Should I simply get in touch with my regular GP and see if he will agree to prescribe e.g. the prolactin and testosterone test, or perhaps refer me to specialists that he may know? There are many urologist here, but how do I know if they are specialised issues related to male sexual performance.. rather than say urinary infections? And finally a short addition to my original post... I have never been on any medication, had any major medical issues etc.

Answered by Dr. Jonas Sundarakumar (19 hours later)

Brief Answer: You can ask your GP for a specialist referral... Detailed Answer: Hello again, Usually, GPs may not prescribe such specialized tests themselves. So, I think it's better that you ask your GP to refer you to an appropriate specialist. Also, a specialist referral is necessary not only for the tests, but also to decide on the further plan of management. If there is no access to an XXXXXXX or Sexologist, you can ask your GP to refer you to a Urologist who deals with male sexual disorders. Best wishes, Dr. Jonas Sundarakumar Consultant Psychiatrist & Sexologist

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar