ejaculatoryanhedonia.com

General Category => General Discussion => Topic started by: Chris on April 18, 2013, 04:47:27 PM

Title: My Theory
Post by: Chris on April 18, 2013, 04:47:27 PM
I am an EA sufferer for 30+ years.  I am also an MD, so I have a unique perspective on what may be going on.  I'm going to keep this succinct, because I think the cause is rather simple.  First off, I do believe the post SSRI group of sufferers are following a different mechanism altogether whose origin must be central (i.e. in the central nervous system pleasure pathways).   But for the rest of us, my observations and experiences have resulted in the following paradigm. For me, there is some sensation during the build up but what is most interesting is how the involuntary muscle contractions that define male orgasm coincide with an obliteration of sensation.  I do not think this is a coincidence.  Moreover, my EA started extremely early in my sexual development, like shortly after discovering what self pleasure was all about.  It also happened instantly.  I still recall the day that the pleasure stopped and my abject surprise.  Also, it was a little painful in the beginning.  But after the pain wore off, the orgasms just were without feeling.  And the build ups while not absent were muted.  I also remember a short time period of sharp, brief stabs of pain centered in the anal area, which also subsided.  Taking all this information collectively, this is what I think is going on:

The pudendal nerve, like all nerves, probably takes various courses between the penis and spinal cord.  All anatomical structures in our body have extreme variability in terms of their locations, divisions, size, symmetry, etc.  Why should this structure be any different?  I believe the vast majority of EA sufferers have some variant in the trajectory of this nerve, which by the way, must weave its way through layers of perineal muscles and various protective canals before it reaches the sacral nerve roots.  I believe EA is a COMPRESSIVE NEUROPATHY (like carpal syndrome) which is caused by an anatomical variant in PD nerve course which results in severe nerve compression when the perineal muscles tonically then clonically contract duriing male orgasm.  I believe the exact anatomical variant may result in nerve compression and damage very early in sexual life or perhaps later if the compression is not as severe, hence different times of onset. 

I do not believe my PD nerve is totally shot, and I have some pleasure during buildup, but the involuntary muscles contractions that occur simply choke the nerve at the exact moment of orgasm....which leads me to my next important point.  Will reaching orgasm cause any pleasure without some nerve stimulation?  I think not, there must be some nerve stimulation from the genitalia to transmit to the pleasure centers to cause pleasure.  Without it, even though arousal is high, nothing integrates in the pleasure center to cause the feeling.

If my theory is correct, the only treatment that I see working is 1) pharmacologically enhacing afferent neuro transmission from gentialia with various neurotropic drugs  2) relieving the compression with surgery  3) bypassing the compression with electrical stimulation, either via the skin or implanted close to sacral nerve roots

That's it...I don't think it's complicated, just a stupid compressive neuropathy.  Virtually any nerve in the human body can be compressed, and if look at the structure of the human perineum you'll appreciate quickly that there are many opportunities to compress this nerve.
Title: Re: My Theory
Post by: sensation on April 19, 2013, 01:24:35 AM

Hi,

I think there may be different conditions that lead to stop feeling physical sexual pleasure. I never took SSRI medication, but I think my problem must also be in the central nervous system. There is something that I will repeat once and again: pleasure not only 'happens'* (more on this at the end) 'in the sexual organs'. There are lots of erogenous zones in the body which, when stimulated, feel very pleasant. My body was an overall party just six years ago. Sex was an overwhelming experience, either on my own or in the company of other men. Sensations started to fade out gradually but I only realised when they suddenly stopped, maybe from 50 percent of sensation level to almost zero. If I didn't have SSRI meds, which was the cause? Other medications? Where does my case fit?

I do feel other types of pleasure (I mean I don't suffer general anhedonia), and I do even feel some physical pleasure from certain activities. But I don't feel the sexual pleasure, the electric sensation on the erogenous zones. It is very difficult for me to explain it, given that English is not my mother language and that this is a very personal experience. But I'm surprised and very upset that it is so specific. I think I still have all my other sensations intact. Like most of us, I've tried to explain my case to many doctors but I didn't get much help. I'm still trying, though.

The mind is an amazing machine and I've learnt to derive pleasure from other activities, but it isn't enough, maybe because I know how I should feel. It has really put my life upside down. I want to engage in sexual activities and in a romantic relationship if possible, but I feel unable to do it anymore. I can do little on my own to solve this. I need somebody to help me investigate, use logic, try things, etc. I know my sensations but I have no medicine or chemistry knowledge, except for what I can read. But I can't extract many conclusions from it, because I have a lack of basic knowledge to understand it.

I know I must not reopen Pandora's Box, but if the guy who said was a guinea pig for Think Fast Research was a real case, I think somebody else would have found a solution. It would be very selfish of him to keep the solution for himself only. We never ever knew anything else from them and I repeat I'd never pay for something like that. All I want is to establish a conversation with somebody who can translate my sensations to medical science...

* For instance, how is pain transmitted in the body? Electrically? Chemically? Both? Is there any chance that pleasure is transmitted in a similar way? Why do analgesics work? Do analog substances exist for blocking other sensations?

I'm sorry to be a pain in the ass with my posts.
Title: Re: My Theory
Post by: needhelpage31 on April 19, 2013, 09:06:29 PM
Chris - I am intrigued by your theory. It's simple, and it seems like it could account for our problem. I have a few questions for you that I hope you can take the time to answer.

1) Would the compression that you describe be progressive? For example, for me, the anhedonia crept up on my over the years. It began as diminished orgasms. Later, I found that intercourse itself was pleasurable, but the climax was totally pleasureless. Today, even intercourse can be very lacking in pleasure. Would this fit your theory?

2) Are you saying that the compression is caused by muscles or muscle tension? Is that why the contractions normally associated with orgasm would cause discomfort, or make feeling leave entirely?

3) How could we test this theory?

4) What would be some specific drugs that might assist if your theory is right?

5) Are there any tests, scans, or methods to physically see whether there is nerve compression?

6) Where, anatomically, would you suppose the compression is happening? In the spine itself?

7) And finally, you are a doctor. What will you do to seek improvement? (Or have you given up after so long?

Thank you so much for answering these. I'm eager to learn your thoughts.
Title: Re: My Theory
Post by: Chris on April 20, 2013, 01:57:35 PM
Certainly, compressive neuropathies can be progressive if the underlying problem is not addressed.  If you compress any nerve long enough, it will wither and failed to conduct electrical impulses.  It can even cause chronic pain, so called pudendal neuralgia.  Do you have any dull ache in the perineum?  i.e. scrota/anal/sacral area?

The compression I am surmising is do muscles and tendinous attachments in the perineum.  Traversing this muscle layer is a long, circuitous path and if the path of the nerve is not "ideal", meaning an anatomic aberration, the strain on the nerve can be damaging.  Certainly, tension in the muscles, if chronic, can add to it, which some people believe is the primary problem.  You are spot on about the contractions:  they are strong, involuntary and a normal part of orgasm but they can also impinge the nerve more.  A fascinating concept, the actual orgasm itself damages the nerve!  This also explains why, for me, a second sexual encounter, after the initial one, is actually uncomfortable and less pleasurable than the first, as the nerve has had no time to recover.

Testing the theory is key and I have thought about this alot.  One ideal is electrical stimulation with a TENS unit.  Placing electrodes first on the penis then gradually more proximal along the perineum, then finally over the sacral nerve roots.  If electrical stimulation can be delivered "upstream" to the lesion, assuming all other spinal and central pathways are functioning normally (which is the assumption of my theory), orgasm should turn on and work. Other ways to test it would involve nerve conduction studies to see if the pudendal nerve shows signs of slow conduction.  I have not done any of this yet, but want to. 

Specific drugs would be ANY drug that enhances synaptic transmission from these fibers where they connect to higher order neurons in the CNS.  If dopamine is the major neurotransmitter for this system, that would explain why drugs like adderall work.

Imaging the perineum probably won't yield much, as peripheral nerves in general are not very resolvable structures.  I cannot discount an MRI scan which would be best bet to discern the structures.  But the radiologist would need to know exactly what you're looking for and would have to know the normal anatomy of the pudendal nerve very well.  I am not so sure this is practical every day request.  It would need to be done in context of a research study.

The anatomic site of compression is not in the spine or nerve roots.  It is in the course of pudendal nerve as it traverses the pelvic floor.  Read up on "alcock's canal" for more info. 

I am still deciding where to go with all this.  It is a uncommon and unusual symptom and I surmise that most fellow physicians would immediately assume it is psychological which I feel it is most definitely not.  If I pursue it further, I feel best MD to discuss it with is a neurosurgeon with specific expertise in pudendal neuropathies.
Title: Re: My Theory
Post by: collin1963 on April 23, 2013, 09:59:29 AM
Good heavens. And the rest of us must sit here and wonder if surgical intervention could possibly result in a 7/10 sensation result or maybe we should just go ahead and prolong the gorge on GABA, Vit B6/12, Lecithin, Niacin and God knows what else. Methinks... What the hell else is there?
Title: Re: My Theory
Post by: searchingforcure11 on April 23, 2013, 02:33:01 PM
Focalin works for me:)  No one seems to try it.
Title: Re: My Theory
Post by: Saul on April 24, 2013, 03:43:48 PM
You propose a very interesting theory and I was particularly intrigued by your following statement " I also remember a short time period of sharp, brief stabs of pain centered in the anal area, which also subsided"

I would describe my condition similarly to yours and these pains are something I periodically experience. The only difference I would note is that I never noticed a sudden change. However this may be because the problem arose earlier in my sexual development or at least in some way prior to my learning to masturbate (but after wet dreams in which I think I used to experience orgasm).
Title: Re: My Theory
Post by: Chris on April 24, 2013, 07:48:27 PM
Yes, I think that is an interesting clue that strongly points to the disorder being centered in the peripheral nervous system, not the central nervous system.  Various branches of the pudendal nerve provide sensory input to the entire perineum, including the anal area, explaining why there may be some "neuralgia" in this area.

I'm not sure people know this, but this nerve is susceptible to compression from long periods of sitting, or even cycling, and injury can often result in disabling chronic pain.  What perplexes me is why some people may develop crippling chronic pain, and others simply lose sexual sensation.  Remember the sexual sensation relates to afferent nerve fibers that also carry simple tactile (touch) stimuli.  So, if touch sensation is weak, sexual sensation will be weak (when one is sexually aroused).

My theory is focused on chronic compression from pelvic floor muscles, particularly contractions that occur naturally during ejaculation.  I think a very important clue lies in the fact that sensations may go from mild-moderate to zero at the precise onset of orgasm (i.e. that brief period when muscles tonically contract before starting to rhythmically contract).  This strongly supports the idea that pelvic floor muscle contractions literally impinge the nerve.  Only problem is these contractions are NORMAL.  Which then suggests that the nerve is somehow more vulnerable than it should be in men with EA, i.e. in normal people the nerve is protected, even during orgasm.  Which then supports the notion that men with EA are somehow anatomically different than normal men, i.e. we are born with an anatomical variant in nerve length/course that predisposes to EA.  This is the essence of my theory.

A rather sobering and depressing theory, albeit a physical explanation that makes medical sense.  I don't think it's some weird coincidence that I developed this early in male puberty and stand here some 30+ years with no improvement.  The pudendal nerve is simply not going to conduct if it's strangulated.  Perhaps amphetamines are the answer as one forum member asserts, but I am quite reluctant to put myself on a highly addictive substance for the rest of my sexually active life.  Another forum member mentioned lamictal some time ago, but I've never heard of any follow up in this regard. 


Title: Re: My Theory
Post by: AlBrown on April 26, 2013, 10:19:50 PM
My thoughts have been the same as your theory Chris and that is the path I have gone down in my treatment and research over the years.  My symptoms and previous traumas certainly indicate this is plausible for my case.  Further evidence was also seen with some of my results of the nerve testing (PNTML).

Unfortunately as you have stated, it is a complex region and the medical research and tools in this area are scarce.  I have tried TENS but not in the manner you have suggested so I may give it a shot.  Thanks for the tip.
 
Title: Re: My Theory
Post by: lostmojo on April 27, 2013, 05:42:33 AM
Thank you for your theory Chris. My physical symptoms are very similar to needhelpage31 except that I also have this weird inverse relationship between intensity of genital stimulation and ejaculation.

It can be summed up thus, the lighter the stimulation the more likely I am to ejaculate. I am normal in the sense that the stronger the stimulation (within reason) the more pleasurable it feels, but I also have some sense of being able to hold back ejaculation. Normally this should be the other way round, more pleasure should equal harder to hold back.

In response to extremely light touch or most sexual positions I have almost no ability to prevent myself from ejaculating. Unfortunately this means I can't even pretend to enjoy intercourse because almost as soon as it starts I'm feeling the contractions about to start. Of course whether I can last or not I feel no sexual pleasure during intercourse or at the point of so called orgasm.

When I was younger I could hold off for quite a while in missionary but had a great deal of difficulty with doggy, now I can hardly find any position at all where I don't have to keep stopping to hold off ejaculation. Note also that when I was younger I could at least feel some sense of physical pleasure albeit very greatly diminished compared to before EA, now it's as close to feeling nothing as it possibly could be. The only way I can experience any pleasure now is via fairly strong stimulation from hand and/or fingers, during oral sex I also feel nothing.

When I say nothing I'm referring to sexual sensations only, I'm not numb but all I get is a sense of touch much like I do on any other part of my body.

How do these symptoms fit in with your theory Chris? Do you think prone masturbation could result in the type of compression you are suggesting? Stimulating the prostrate does not produce any sexual sensations either, could this be linked?
Title: Re: My Theory
Post by: Chris on April 27, 2013, 10:03:33 AM
Interesting.  My personal view of how this whole thing works is the ejaculatory and pleasure pathways are distinct.  I believe the ejaculatory threshold depends more on level of arousal and is under some conscious control, as most of us can attest.  The pleasure pathway needs sensory fiber input.  Since sensory neurotransmission is impeded, I believe, in AE, it should require more tactile input to generate pleasure.  I personally find that I have the most pleasure, albeit quite muted, in the few seconds leading up to orgasm, than it simply turns off like a light switch (so not alot of time to respond and relax).  On the other hand, when you feel pleasure throughout, you have some feedback from which to control your conscious arousal.  When you are mostly numb, you have no physical feedback, and do not adjust conscious arousal, and therefore suffer premature ejaculation more often. 

I do recall an experience I had shortly after discovering masturbation in my early teens, I believe.  When I first discovered ejaculation, I stopped stimulating myself when it happened and did not feel much (just out of sheer surprise!).  The next time I continued stimulating through the whole ejaculatory reflex and felt what I still recall as my one and only true orgasm.  30+ years ago I still remember a whole body experience and intense pleasure emanating from genital region.  It was shortly after this experience that I suffered a painful orgasm, and then never more.  This experience supports my notion that some physical touch is required to integrate with the arousal inputs that then lead to pleasure and ultimately orgasm.  Instead of guessing about this, all one has to do is ask a man without EA if he feels anything at all when reaching orgasm if he does not stimulate himself physically at all. 

This is all consistent with my theory that sensory (tactile) afferent fibers are damaged in EA, and impede the neurotransmission needed to integrate and form conscious pleasure.  Prone masturbation should have no affect on the pudendal nerve which is a deep structure that should not be compressed by this position.  If anything, as I stated earlier, prolonged sitting or cycling does and can compress the pudendal nerve.  The prostate is innervated by branches of the pudendal nerve, and probably upstream of any lesion, so I would expect this organ to be relatively insensate as well.
Title: Re: My Theory
Post by: lostmojo on April 27, 2013, 03:39:38 PM
Here's something else for you Chris to add to your knowledge bank.

Paralyzed man has learned how to achieve a thumb orgasm:
http://www.ibtimes.co.uk/articles/459635/20130421/rafe-biggs-orgasm-thumb-disabled-sex.htm
Title: Re: My Theory
Post by: fireman on May 01, 2013, 02:20:36 PM
chris
thanks for your fascinating posts. please continue to do so. whilst my gp is  most helpfull and considerate, he is unwilling to prescribe medication that is unlicensed ih the uk. and im not sure i would want to take them anyway. im about to have testosterone levels tested, and if that proves to be normal we have been advised to contact a specialist in london.
my case is as follows... im 55, white male, and have had ea for about 28 years. in that time i have had perhaps 2 or 3 genuine pleasurable orgasms. otherwise they are pleasureless and sometimes painfull with an unbearable tenderness on the glans of the penis. i have no sensations in the prostate area. the term ' numbnuts' could have been invented for me i think.  i have had partial feelings from small anal vibrators during masturbation, which enhance the climax, but digital stimulation of the prostate has no effect. i also have proctalgia, which can be intensley painful and is sometimes brought on by orgasm and is basically cramp of the back passage muscles. the lack of feeling means that i had been able to 'perform' with my partners for a long time, but i feel that i am being robbed of something very important to me.
in the past i have had back muscle tears, i once fell from a bike landing on my coxcyx rendering me deaf and blind for about 30 seconds, i had an operation on my cruciate ligament which has left my right shin area numb. other things have happened to me medically but all took place after the onset of ea. one of the 'normal' orgasms i had was after pelvic realignment treatment from a physio who had actually heard of the proctalgia condition( many people havent ). but i was unable to repeat the success again. at the moment im trying with a physio who also practises acupuncture. no success so far. i would give a lot to solve this. it depresses me greatly not to be able to share the sexual sensations of my partners.
chris, i think you are a major area of hope for us here. a medical man with the same condition as us lay people.
Title: Re: My Theory
Post by: Chris on May 01, 2013, 04:15:01 PM
Hi Fireman,
Your study sounds fairly consistent with my theory.  You actually have alot of the pain that go along with pudendal nerve compression.  It's a long nerve and has several branches.  Where and how the compression is sets up what will dictate the symptoms.  In my case, pain is a negligible feature as I surmise is true for many on this board.  In fact, my theory has been revised from recent research I have undertaken and now I can say I believe I understand the precise point of compression in those of us who simply have "genital anesthesia".  There is a distal branch referred to as the "dorsal nerve of the penis" which of course comes in a pair (left and right).  What perplexed me for years is how a compression occurs in two nerves simultaneously?  I mean what's the chance of developing carpal tunnel syndrome, for example, in both your hands at the exact same time.  The answer lies in this branch nerve in which the pair of nerves ride very close to one another in a ligamentous canal right below the inferior pubic ramus (thats the bone right in front of your bladder in the midline).  What happens to one happens to another since they are so close.  Next question is what happened?  What caused the space to get compressed?  The answer is in my case, I am not sure.  I simply cannot recall a major blunt traumatic injury in my life when I was 10-12 years old.  Could there have been a nasty fall from a bicycle or something that I simply don't remember?  Sure, that's possible.  Even a fall on the coccyx could impinge the nerve, albeit probably at a more proximal site where the pair of nerves is not so close.  Another possibilty is still simply genetic/congential predisposition, as I alluded to earlier, based on how the nerve was laid down during development.  Perhaps it's a little too high and close to pubic bone, perhaps it went under a tendon rather than thru it.  These are real possibilities and there are myriad examples from human anatomy where the course of a blood vessel or nerve is simply atypical/deviant which can then lead to some real clinically important consequences like compression.  So perhaps no blunt injury is required, but rather just dumb luck. 

Finally, I'd like to announce that I stumbled upon a surgeon from Baltimore whose name is Dr. Dellon and I have already contacted him.  He is one of the few people in the world with expertise in this nerve and has performed microsurgery involving "nerve release" on many patients.  The indication for surgery in most folks is chronic, severe, debilitating pelvic pain - pain that cannot be managed with strong meds or nerve blocks.  He contends that nerve compression in this area can and does cause genital anesthesia.  And he has helped some people so far.  What really interests me is the obvious splay between the "pain patient" and the "EA" patient.  What sets them apart?  Clearly, the patients with pain have stroked the medical system and have found answers simply because their lives were intolerable and they were desperate.  EA is a different syndrome.  Although I acknowledge that loss of sexual sensations is a huge, life altering event, it's not quite the same thing as someone who can't sit down without developing 10 out of 10 life disabling pain.  My point is his expertise evolved mainly from the travails of the pain patients.  The EA patients I believe are flying under the radar so to speak.  Urologists and neurologists alike are not going to have a clue about compression of this nerve, especially if all it largely causes is EA.  What I want to reinforce to him is that EA is probably alot more common than chronic pelvic pain disorders (which result largely from traumatic injury).  I believe this is truly an unchartered frontier in medicine and the only folks who will have some real results in making scientific progress are those docs/surgeons who already know the pudendal nerve from their experience in treating pain patients.  What I am ultimately telling every one is that if you're not in the SSRI group, you most probably have a compressive neuropathy and the only "cure" will involve some relatively minor surgery (with no guarantees of course).  I believe EA is a surgical disease at its core and to expect some pill to turn it around, is like saying that acute appendicitis can be treated with Advil.  I'll keep everyone posted to future insights.
Title: Re: My Theory
Post by: fireman on May 02, 2013, 12:08:11 AM
chris
again, that is all fascinating stuff. in addition to my earlier post, other possible factors in my case might be as follows;
i have a very slow urinary rate for which a urologist suggested performing an operation he had developed to cut away at the bladder neck muscle. that sounded scary to me so i refused. and a VERY tender and painful urethra, which was proven during a cystoscopy. ( even though the ''expert'' performing this told me i was imagining the pain as there are ''no nerve endings in the urethra'' ). i also suffered a bad blunt trauma to my outer right thigh which resulted in heavy bruising of the complete area from hip to knee.
i have taken anti depressants but only many years after the onset of these symptoms. the same can be said of a heart attack 7 years ago, and the subsequent  panic attacks and anxiety depression.
the compression theory would seem to fit in with the one-off relief from the ea i found after one pelvic realignment. if only i could repeat that success......
Title: Re: My Theory
Post by: lostmojo on May 02, 2013, 05:01:41 AM
I was hit by a car when I was about 10 or 11. The point of impact was the abdomen so I have a trauma injury. Everything was functioning fine before the onset of EA about 17 but perhaps the trauma injury made me vulnerable to something going wrong?

I know this is all theory at this point in time but I am heartened by your statement the only "cure" will involve some relatively minor surgery.
Title: Re: My Theory
Post by: needhelpage31 on May 02, 2013, 06:07:13 AM
Chris - I appreciate your continued insight.

Over the past week I've been reading message boards of people suffering from pudendal nerve entrapment or neuralgia. As you said, most of them experience pain. There are only a few posts about lack of sensation.

Please let us know how your conversation goes with this surgeon. You might direct him to this message board, and also to the original one on hisandherhealth.com. That might give him an idea of the scope and reality of this problem.
Title: Re: My Theory
Post by: lostmojo on May 04, 2013, 04:58:45 AM
Just out of curiosity Chris, how would a surgeon access the area of pudenal nerve entrapment? Where would the incision be?
Title: Re: My Theory
Post by: Chris on May 05, 2013, 03:41:22 PM
If the point of compression is the dorsal nerve of the penis, the incision would be about 2", horizontal, right over the symphysis pubis, which is directly above where the penis enters the perineum.  If it's more proximal, then we're looking at incisions over lower buttock.  I personally think the former is more common site.  The emails with him are still ongoing.  I will report outcome when we are finished conversing and exchanging ideas.

BTW, I'd like to state that I think whomever termed this condition "EA" did us a disservice.  Anhedonia is a psychological term which is not an appropriate description for I what I believe is definitively a physical disorder.  When people hear this term for the first time, it conjures up all sorts of attributes that have no bearing on our situation.

I also would like to formally ask the forum for more specific insight from across cases.  How many people have some sort of discomfort/pain associated with EA, however slight.  I'd like to get a better sense for what proportion of us have pain of any degree in addition to analgesia (which is more descriptive of our situation).  And also, how many of us have some pleasurable feelings, however mild, during build up, that then extinguish at the onset of what would be normal orgasm.


Title: Re: My Theory
Post by: fireman on May 06, 2013, 12:09:51 PM
If the point of compression is the dorsal nerve of the penis, the incision would be about 2", horizontal, right over the symphysis pubis, which is directly above where the penis enters the perineum.  If it's more proximal, then we're looking at incisions over lower buttock.  I personally think the former is more common site.  The emails with him are still ongoing.  I will report outcome when we are finished conversing and exchanging ideas.

BTW, I'd like to state that I think whomever termed this condition "EA" did us a disservice.  Anhedonia is a psychological term which is not an appropriate description for I what I believe is definitively a physical disorder.  When people hear this term for the first time, it conjures up all sorts of attributes that have no bearing on our situation.

I also would like to formally ask the forum for more specific insight from across cases.  How many people have some sort of discomfort/pain associated with EA, however slight.  I'd like to get a better sense for what proportion of us have pain of any degree in addition to analgesia (which is more descriptive of our situation).  And also, how many of us have some pleasurable feelings, however mild, during build up, that then extinguish at the onset of what would be normal orgasm.

hi chris
to start the ball rolling....i do suffer from pain but i dont think its connected with ea. i have chronic proctalgia, which , in my opinion, is cramping of the muscles in the back passage. having said that, i ( and nobody else either apparantly ) have no idea what  causes it. it occurs randomly although most often now it is during the night when im asleep. naturally this wakes me as the pain can be unbearably intense.
regarding the analgesia, that seems to be centred on the perineal , testicular and prostate areas. the penis glans do have sensation but unfortunately not of a pleasant type. even oral  sex can make me wince with discomfort.  it can be very - overly - sensitive in a tenderness kind of way, particularly at orgasm. and the climax gives me no pleasure in the prostate area. unless i stimulate it directly with a small anal vibrator. which i dont do often due to fear of setting of a proctalgia. its a lose - lose situation.
all of this has made me understandably slightly anxious about wht is going on, and therefore i guess i try too hard to find some sensation and pleasure. i can live with the proctalgia - just. the pain can cause me to pass out - but the ea is really getting me down. i have a blood test booked for tomorrow for hormone level checks. i THINK my gp is taking this seriously. unfortunately i had have periods of anxiety and depression ( the ea began way before i took any medication ) which was brought on largely by a heart attack and business stresses. but as i have said to the gp, this ea would give ANYONE depression.
your help is much appreciated

Title: Re: My Theory
Post by: fireman on May 06, 2013, 12:25:38 PM
another couple of thoughts as to possible cause. round about the time of ea appearing i took a short course of minoxidil, to try to stop my oncoming baldness. in the end i gave up and shaved my head!
also, and i know this sounds offbeat, but, i have many fillings in my teeth.
anybody else share these factors?
Title: Re: My Theory
Post by: lostmojo on May 06, 2013, 05:57:33 PM
I also would like to formally ask the forum for more specific insight from across cases.  How many people have some sort of discomfort/pain associated with EA, however slight.  I'd like to get a better sense for what proportion of us have pain of any degree in addition to analgesia (which is more descriptive of our situation).  And also, how many of us have some pleasurable feelings, however mild, during build up, that then extinguish at the onset of what would be normal orgasm.

The best thing to do would be to put some very specific questions in the http://ejaculatoryanhedonia.com/index.php/board,5.0.html section of this forum.
Title: Re: My Theory
Post by: needhelpage31 on May 11, 2013, 11:22:39 AM
Chris, you asked about pain. On occasion, over the past 12 years or so that I've had this problem, I've had intermittent pain with ejaculation. This hasn't been the case for a long time. But when it was happening, it would feel like a constriction in the prostate.

Fireman's comment inspires an interesting aside. I've PM'd a few members of this board over the years. Three of us exchanged photos. We all have a similar look. Slim build, and receding/thinning hair. (It may not mean anything, but I was surprised by the similarity in likeness.)
Title: Re: My Theory
Post by: michaelsad on May 12, 2013, 06:13:00 AM
I am very thin and slim too.
Title: Re: My Theory
Post by: deaconblues on May 12, 2013, 05:15:17 PM
Glad to see such a site like this is here but too bad for all of us that it IS here also.  I've been researching this for like 1/2 year and before that
I just lived with it and felt alone.  Until I found this site last night, I had this problem longer by far then anyone I'd ever seen but I see Chris has had it longer.  I am almost 39 and I've had this problem for a minimum of 23 years and max of 25 years and I've experienced absolutely nothing!  To this day I still remember how good it did feel when orgasms felt good and it sure felt great!  I've been married for almost 7 years but have never told my wife about it, I sorta fake like it feels good unfortunately.  Hearing from friends about how much they want and get sex sorta sucks too because I think how nice it must be to be normal and to have something that virtually all guys get to feel. 

Thanks for sharing Chris, you and I are the longest people I have seen suffering from this wretched problem that I have seen so far.
Title: Re: My Theory
Post by: lostmojo on May 13, 2013, 05:31:20 AM
I've had EA for 30 years and I think there are other members here who have had it for longer. I told my wife about 14 years ago and I tried to explain it as fully as I possibly could but apparently it didn't sink in. If I don't ejaculate during sex she gets quite down on herself because she thinks I'm missing out on something but I definitely told her I feel close to nothing, that was 14 years ago, now it's even worse as I definitely feel nothing.

In relation to physical build as raised by needhelpage31, I also have a slim build. I'm not skinny as I've worked very hard at building myself up over the years but I have extreme difficulty in gaining weight. I wonder if narrow hips is a factor, could that mean that the pudenal nerve is less protected?
Title: Re: My Theory
Post by: Chris on May 13, 2013, 01:16:12 PM
Another interesting observation.  BTW, the way things are discovered in science is first via simple observations, which then lead to hypotheses that can be tested.  The slim build is an interesting observation because it lays the foundation for anatomical similarities in men with EA and the heart of my theory is anatomical variation.  I happen to have a slim build as well and only recently have started to gain weight.  I am 5'11", 180# but in my younger years I was 20-30# lighter.

What can a slim build predispose towards?  First off, less lean and fat weight on the buttock can certainly make it more likely for the pudendal nerve to become entrapped from long hours sitting or cycling.  Secondly, I have often wondered if "tension" on the dorsal nerve of the penis plays a role in men whose penis size differential (flaccid vs. erect) is significantly above average, i.e. if the penis length increases by more than 3X for example from erection, one would expect more tension on the nerve in the erect state, this can predispose towards compression.  Finally, slim build may impact the pelvic bones themselves, perhaps contributing to compression where the nerve comes close to the pubic bone.  These are some examples of how body shape and size could play a role.
Title: Re: My Theory
Post by: JPH on May 13, 2013, 03:08:32 PM


I also would like to formally ask the forum for more specific insight from across cases.  How many people have some sort of discomfort/pain associated with EA, however slight.  I'd like to get a better sense for what proportion of us have pain of any degree in addition to analgesia (which is more descriptive of our situation).  And also, how many of us have some pleasurable feelings, however mild, during build up, that then extinguish at the onset of what would be normal orgasm.



I am able to feel some pleasure during build up that then subsides once I orgasm. During orgasm I do feel some tension. Also, I have a slightly larger buttocks than other slim guys and I have spent many hours at a time playing PC games.
Title: Re: My Theory
Post by: deaconblues on May 13, 2013, 06:47:35 PM
I do not fit nor have ever fit in the skinny range.  I am 5'11", 240 lbs and have always been between 230-280 for pretty much my whole
adult life.
Title: Re: My Theory
Post by: Kstat on May 15, 2013, 05:10:37 PM
Hi everyone, I'm new to this forum. I didn't see an introduce yourself area so I thought I'd post here. Anyway, I'm a woman who suffers from the female form of this. Is it alright if I post on this forum? I have yet to see a similar group of females talking about this on the internet. I've actually been lurking here for a while, but have finally got the courage to post.  :P

This thread was what got me to post. It's nice to know there might be a simple physiological answer for some people with this issue, even if it's not the case for me. I'll post again to write more detail of my specific situation but just wanted to make sure it was ok if i talked on here.
Title: Re: My Theory
Post by: lostmojo on May 16, 2013, 02:12:52 AM
Anyway, I'm a woman who suffers from the female form of this. Is it alright if I post on this forum? I have yet to see a similar group of females talking about this on the internet. I've actually been lurking here for a while, but have finally got the courage to post.  :P

Welcome Kstat, good for you for posting.

There was a female on this forum at the very beginning of it's life (a link to her posts is below) and she also posted on hisandherhealth.com:
http://ejaculatoryanhedonia.com/index.php?action=profile;u=12;sa=showPosts
Title: Re: My Theory
Post by: gdop on May 16, 2013, 10:20:16 AM
Anyway, I'm a woman who suffers from the female form of this. Is it alright if I post on this forum?
Hi Kstat!
Don't mean to be rude, but this forum is about ejaculatory anhedonia, a male condition (i know there is some discussion about female eyaculation, but I think it is not related to male ejaculation). If we are talking about female anorgasmia, it's a common and very studied sexual dysfunction. Dont want to spoil this interesting thread, if you want some explanation it is better to open your own thread.

Thanks,
Gdp
Title: Re: My Theory
Post by: Chris on May 16, 2013, 02:30:17 PM
I have completed by discussions with the aforementioned surgeon and I'm afraid I hit a wall with him.  He seems perplexed by my discussion of the entire syndrome and even intimated that it may be due to child abuse (which does not apply to me).  I do object to the term 'anhedonia' as I stated earlier as it implies a psychological issue which I am confident it is not.  I think anesthesia may be more descriptive, albeit an incomplete description.  Getting the medical profession to address this problem is not going to be easy, as my early efforts have already attested.

I'm a point where I need to test this theory some more, and in order to do that I have a few ideas.  My time in general is limited, so I apologize if things move at a snail's pace, but I intend to continue researching this problem till I get a satisfactory explanation.  For starters I plan to develop a fairly extensive questionnaire which I will post on the appropriate forum because I think describing this condition is critical to solving its mechanism or pathogenesis.  And I feel like it has not been described in enough detail at this point.  I repeat again that the post SSRI cases likely follow a different course, so while they may shed some insight into paths of causality, I do think this is a separate group. 

One intriguing experiment which I look forward to trying is neuro-electrical stimulation.  (I still have not purchased a TENS unit because I am not really inclined to expose this whole affair to my wife, YET).   But when I get my hands on one, I do believe it may yield some really interesting results.  To any or all of you that have a TENS unit, you may message me and I will discuss what I propose to try. 

Whether I want to go down the whole path of MRI nerve imaging or nerve conduction studies I am not sure.  It will be a financial investment (since insurance won't cover it).  I did locate a qualified radiologist in NYC who does pudendal MRI, but as I said, I am not quite ready to dive into this area at this time. 

On the general matters of my theory, I still remain somewhat perplexed why pain would not be a more common finding in men with EA.  I'm also intrigued as to how many men develop it very early in their sexual life (for me, around 13-14).  This has to have some significance I would think.   I have also started to think about circumcision and how this may contribute, but not directly cause the syndrome.  As far as the woman on the forum, there is no good reason I can think of, a priori, that a woman could not develop this syndrome.  She also has a pudendal nerve like all of us as well as a dorsal nerve of the clitoris (in lieu of penis).  So I think it's possible.

Well, that's it for now...keep the discussion going.

Title: Re: My Theory
Post by: needhelpage31 on May 16, 2013, 04:20:22 PM
Chris, I appreciate that you're with us and posting your thoughts.

I can see how the term 'anesthesia' could be more appropriate if your theory is right.

I'm also sorry to hear that your surgeon couldn't see past what he "knows" to realize that you may be on to something. And it may be more common than anyone suspects.

Did you read the posts from a year or so ago about the urologist in Michigan who was looking for people to try a spinal implant in? It seems like it could be a way to test your idea. The trouble is that it would cost $11,000 or so to try it out.
Title: Re: My Theory
Post by: NoFun on May 17, 2013, 02:30:10 AM
Hi everyone, I'm new to this forum. I didn't see an introduce yourself area so I thought I'd post here. Anyway, I'm a woman who suffers from the female form of this. Is it alright if I post on this forum?
More than alright with me. I saw someone else object, but you can't please all the people all the time.

I look forward to your post.
Title: Re: My Theory
Post by: NoFun on May 17, 2013, 02:54:16 AM
I don't think the contractions at the moment of ejaculation could supply significant extra compression in general, and in particular for me, because the force of my contractions are particularly weak. But even for most people, isn't nerve entrapment cause more by constricted space around bones and tendons that would be more affected by position than muscle tension.

On the flip side, that would be something to test. Maybe you could find an acute position that momentarily released the compression. You should be able to move the bones around to release the compression. Also, relaxing and preventing muscles tension should.

But if it is some kind of compression, it has probably weakened the nerve and it's firing, given the decades of the problem. Just not a healthy nerve at this point.

Your case sounds a little similar to mine. I've had maybe two orgasms, and am now approaching 50. With the one orgasm I have a clearer memory of, there was something of a sharp pain in the head of my within maybe 20 seconds of my orgasm.

You mentioned an interest in a poll. I tried a number here, but got little response. One of the forum sections is dedicated to polls. The software isn't great, however, and that may be limiting response.

I tend to think it's a neurotransmitter thing, or a DHT issue. My DHT was at the very bottom of the reference range, last I tested.
Title: Re: My Theory
Post by: lostmojo on May 18, 2013, 12:59:58 AM
I tend to think it's a neurotransmitter thing, or a DHT issue. My DHT was at the very bottom of the reference range, last I tested.

I had many orgasms before the onset of EA, both the buildup and the actual orgasm always felt fantastic. Then one day it just didn't feel as good but I thought little of it. Within a year or so I had little feeling left at the point of orgasm and significantly less intense feeling during the buildup. Over the years it has continued to diminish for both and I've never felt any improvement temporary or otherwise, that is it has been a 100% consistent decline.

I know neurotransmitters are involved in the orgasm itself but could they also influence the buildup as well? If a neurotransmitter deficiency is a factor in my case then it sure seems like it is impossible to refill the bucket despite different eating patterns and trying every natural supplement I could think of, even low dose naltrexone had zero effect.
Title: Re: My Theory
Post by: alias on May 18, 2013, 01:49:35 PM
I definitely agree it has something to do with the pudendal nerve at least for some of us.  I had a MRI neurography study done (not cheap by the way) that showed irritation of the pudendal nerve just distal to the level of the ischial spine.  The findings were consistent with the presence of a subtype of pudendal nerve entrapment syndrome.  The pain from the nerve irritation has been controlled with muscle relaxants and medication aimed at reducing nerve pain.   

I have talked to Dr. Kenneth Peters in Michigan about his pioneering work with an interstim device.   He is able to place leads near the pudendal nerve versus the typical sacral nerves to control pelvic pain.   There is a testing period to see if it works prior to implanting the device.    Whether or not it will help with the situation that concerns us on this site is a good question.  His office is able to check on insurance coverage for the testing period.  I'm letting my checkbook cool off after the MRI bill.
Title: Re: My Theory
Post by: lostmojo on May 18, 2013, 07:16:07 PM
I definitely agree it has something to do with the pudendal nerve at least for some of us.  I had a MRI neurography study done (not cheap by the way) that showed irritation of the pudendal nerve just distal to the level of the ischial spine.  The findings were consistent with the presence of a subtype of pudendal nerve entrapment syndrome.  The pain from the nerve irritation has been controlled with muscle relaxants and medication aimed at reducing nerve pain.

Hi alias, sorry you're here if you know what I mean.

Does this mean you have both pelvic pain and lack of sexual sensation? And little or no sensation at the point of orgasm?

If yes I believe you're the first person on this forum (that I know of) that has both pain and diminished sexual function. Bad as that is your presence and potential treatment could be very enlightening for a number of us, that is the people with EA that is not linked to SSRI or any other medications.
Title: Re: My Theory
Post by: Radium on May 18, 2013, 10:28:52 PM
Chris, I think this is a good theory. I personally do not feel any pleasure at all, none during build up nor orgasm. This seems to be different than what others on this board experience where there is some pleasure during build up but none during orgasm.

Your theory would make sense in my case. When I was in my teens for some reason I thought that if I clenched my PC muscles during masturbation it would enhance the pleasure. I think I did that frequently enough that now whenever my penis is touched I involuntarily clench my PC muscles. It is a completely involuntary reaction and I do not know how to stop it. This could explain why I have absolutely no pleasure. As soon as my penis is touched the PC muscles contract and block off any pleasure sensations.

It seems from the stories on this board that many people lost their feeling in their later teens, maybe because of masturbation practices such as clenching? For me it was a gradual thing that I didn't really notice. Just one day I noticed that my orgasm wasn't nearly as good as other people describe it.

I wonder if there is some way to prevent my muscle clenching? If there was then I could see if my feeling would return.

Title: Re: My Theory
Post by: IwantMyMojoBack on May 19, 2013, 05:51:06 PM
Chris,

I've been very quiet on here for a very long time. I was one of the original participants that migrated from the hisandherhealth forum a few years back.
A long time ago, we participated with some simple self sensitivity tests, and despite a unanimous result (6 out of 6) ie the few of us that did the test were all clearly, way off where we should be in terms of penile sensitivity, but no matter how much I tried I couldn't progress the subject.
To carry out the tests, I had found a website that detailed a map of the human body in terms of sensitivity on a scale of 1 to 10, and using a pointed object, we touched the various parts of our anatomy, and compared the results with the aforementioned map. I found that my penis was literally the least sensitive part of my body.
Interestingly, the head of my penis is almost completely numb on one side, with almost all feeling restricted to the frenulum area.
I can retrieve some of this information, and post it on here, if you think it may be of help in finding a solution for all of us?
Title: Re: My Theory
Post by: alias on May 19, 2013, 08:48:17 PM
Yes, I have pelvic pain and loss of sensation.  The fact that I have received a recent diagnosis of pudendal neuralgia gives this theory some merit.

Title: Re: My Theory
Post by: Chris on May 20, 2013, 01:36:09 PM
I do think the muscle contractions are not inconsequential.  The area along the pubic symphysis is essentially a canal shaped structure which holds the blood vessels and nerves in direct opposition to bone, with tendinous sheaths around it and finally muscles.  When these muscles contract pressure in the compartment is likely to increase and the nerves may even shift.  I'm not a great proponent of the idea that self learned, voluntary contractions of these muscles somehow do in the nerve.  I think there has to be a "susceptibility factor" vis a vis the anatomy to start off with, probably something we're born with.

Another idea I have been ruminating has to do with the tension on the dorsal nerve as nerve compressions can be due more to tension than entrapment.  The dorsal nerve of the penis necessarily has to lengthen as the penis becomes erect and it has evolved to be kind of like an accordion, capable of stretching and unstretching.  Could some men be more prone to extra tension on this nerve during erection? Who might these men be?  It would be those whose penis length during erection/penis length in flaccid state is significantly above average, perhaps by a factor of 2-3 X.  This is consistent with the injury being early in sexual life, i.e. the erection and perhaps orgasm actually is a "stress test" on the nerve.  The more you have, the more stretch, the more stretch, eventually a breaking point is reached, at which point there may be pain and then EA sets in.  Perhaps some circumcisions that are too "generous" could be another susceptibility factor.  Those of us who lose more foreskin may be more prone to this. 

Just another angle.  I'm certain its nerve injury.  I'm just considering other nerve locations and mechanisms.  Stretch may be an important factor.

Title: Re: My Theory
Post by: lostmojo on May 22, 2013, 06:05:54 AM
Perhaps some circumcisions that are too "generous" could be another susceptibility factor.  Those of us who lose more foreskin may be more prone to this.

My very first theory about my lack of sensation was that it may have been due to being circumcised. I set about trying to stretch my existing skin as set out on various "restoration" sites. This did not go well as my skin would start to hurt soon after applying tension. Although no-one claims it will be a quick process my own progress was much much slower than even the most pessimistic estimates. Eventually I gave up having achieved only a minimal amount of "slack", not even a hint of what you could call a foreskin.

Starting this process made me more aware of my skin being very very tight during an erection, this is in line with your theory. Even now with that little bit of extra skin it is still very tight.
Title: Re: My Theory
Post by: fireman on June 04, 2013, 01:09:10 PM
blood test came back as normal testosterone. am now very down about the whole situation. getting nowhere. urologist basically said nothing to be done, but my gp is trying to get me referred to a specialist at UCL . also, had another proctalgia attack last night. the older i get, the more i feel im missing out. acupuncture hasnt worked - i'll try most things - nor physio, hypno, etc etc etc. there MUST be someone out there who has solved this
Title: Re: My Theory
Post by: Saul on June 04, 2013, 02:31:36 PM
This theory seems to hold promise and I will be talking to my 'psychiatrist' whome I was refered to by my gp regarding this condition and have an appointment with every three months to inquire of my progress.

RADIUM: I was in a very similar situation just a year and a bit ago where I would automatically tense my PC muscle with any stimulation of my penis. Furthermore when I was approaching ejaculation I would also tense the entire region. Since then I have controlled and largely eliminated the involuntary PC muscle tensing and I have been focusing on just stimulating my penis in a pleasurable way. This has brought me to the point having some pleasurable feeling during masturbation, but as the original poster here describes it at the point of rythmic contraction any feeling dissapears.
To improve your situation a little and get to the point I am at I would suggest the following:
Stop masturbating to ejaculate and start holding and rubbing your penis without any goal or target other than focussing on the feeling and noticing if there's anything that could be described as better than nothing. Train yourself, as I have done, to stop tensing the pc muscle just by relaxing your whole body in bed focussing on relaxing the pelvic region and just lightly touching, then grabbing your penis or rubbing it then slapping it about a bit. This will take some time but you will find you can do more and more with it before you get that annoying involuntary contraction. Slowly develop this behaviour into masturbation keeping that focus on both the relaxation of the pelvic region and the sensation in your penis.
THis has taken me several months but I would say that it has allowed me to stop the involuntary contractions, experience a pleasurable feeling when rubbing a certain area (below the lip of the glans usually covered by the foreskin) and achieve ejaculation sooner (where previously it woulld take anywhere between 10 minutes and an hour, now down to around 7 minutes) and most of the time without the strong tensing of the pelvic region.

Hope this helps
Title: Re: My Theory
Post by: lostmojo on July 18, 2013, 06:12:52 AM
needhelpage31, on a bit of a retro research whim I decided to go back at look at your original thread on hisandherhealth. I did read it a few years ago and was struck by the similarities between you and I. But there were 3 things you mentioned that I didn't notice and/or pay much attention to the first time reading but I'm drawn to now.


I wonder if there is a linkage between these symptoms and EA.
Title: Re: My Theory
Post by: Saul on July 18, 2013, 06:43:19 AM
lostmojo:

Interesting points you mention though I'm not sure I can see a link in a couple of them
Motion sickness: I've always had it
Adrenalin: I went skydiving in the hopes of getting an adrenalin rush and never really felt one
Allergies/intolerance: I have also had an increased intollerence of certain foods though my alergies (horse hair and hayfever) have remained constant.

The adrenalin is certainly an interesting issue because it can play a part in sexual arousal eg. doing something 'naughty,' fear of being caught/watched by a disaproving authority....etc
Title: Re: My Theory
Post by: lostmojo on July 21, 2013, 12:09:15 AM
I'm not saying you need to have those conditions to be in danger of getting EA.

However I do find it interesting that amongst quite a few things that needhelp31 and I have in common there are also issues with motion sickness, adrenaline and allergies. These issues may be a result of some underlying weakness that also contributes to EA.
Title: Re: My Theory
Post by: Chris on July 29, 2013, 05:17:35 PM
An update for group members:
I've had some time to do some testing with a TENS unit and the results were disappointing but at the same time confirmatory of my general theory.  The sensations from a TENS unit are akin to a soft electrical pulse on your skin and were quite noticeable (and even painful if you dial up the intensity enough) on other parts of my body such as thigh, calf, etc.  The penile area was completely without sensation even at intensity levels which could hurt and/or burn other skin areas.  Placing the electrodes over the path of the pudendal nerve or even over the sacral area had no impact whatsoever.  So what does this mean?

I believe it is virtually confirmatory that EA is a type of NEUROPATHY in which the critical nerve(s) have been damaged, probably from compression (but I can't prove the mechanism) and it is of such a severe degree that there is no return of nerve function over time.  I'm not sure if decompressive surgery could even restore nerve function in those of us who have been affected for 20+ years.  I would surmise that early detection/diagnosis would be key to restore nerve function. 

The results of this testing show NO evidence of a central (i.e. brain) root cause.  Even a vascular stroke would never cause a limited sensory gap in just the genital region.  The cause has to be PERIPHERAL.  Getting back to treatments, I still feel only hope would be an implantable nerve stimulator (in sacral spinal region) or perhaps some amphetamine drugs really do work to enhance neurotranmission, but don't seem practical because they are addictive and a controlled substance.

All in all, a depressing conclusion for all of us affected.  Seems like such a cruel trick to remove us of all or most sexual pleasure.  I think the medical establishment will be slow to acknowledge or even research this condition and it will always be regarded by many to be psychological in nature.  I firmly believe if there are pscyhological underpinnings they are most likely to be the result, not the cause of EA.  Perhaps those of us most fortunate on the board are the ones that never had orgasmic pleasure, since we will never know what we are missing.


Title: Re: My Theory
Post by: xduskyx99 on July 30, 2013, 12:01:15 PM
Chris, I experienced the same thing. No sensation when I placed the tens unit pad on my penis. I already surmised it was nerve damage because I feel zero sensation when stroking my penis when masturbating or engaging in sex. The only part of my penis which has sensation is my glans, it's actually quite sensitive. It still doesn't result in any pleasurable feelings though when stimulated. How could my glans still be sensitive to touch though if the entire region is affected?
Title: Re: My Theory
Post by: Chris on July 30, 2013, 03:09:10 PM
Good question.  I actually have the exact opposite: my glans is the most insensate and the shaft has some sensation, though I am beginning to rethink what I mean by the word "sensation".  I think the skin is very insensitive (as the TENS unit showed), but any mild pleasure I get is more from pressure of stroking which is probably recorded by pressure sensitive nerve fibers deeper inside the structure, not the sensory nerve endings in the foreskin, which to my knowledge, are really where all the action is from a sexual pleasure POV.

I think these variabilities probably relate to different types and degrees of nerve compression.  Most fibers which travel to the glans, for example, may be deep inside the nerve bundle and foreskin fibers could be more peripheral.  This is well known for other parts of the body.  The fibers are arranged according to location.  So depending on exact nature of compression, some fibers may be more compromised than others.  The end result is the same:  marked attenuation of nerve stimulation reaching sacral spine cord and brain.  The pleasure center in the brain is not receving any stimuli, so although arousal and the mechanics of sex are working perfectly, pleasure is not transduced. 
Title: Re: My Theory
Post by: xduskyx99 on July 30, 2013, 05:59:51 PM
I believe my EA is a form of premature ejaculation, because I practically force myself to ejaculate before any buildup to normal orgasm has occurred. This buildup however is impossible because I feel no sensation or pleasure while masturbating or engaging in sexual intercourse. I basically tense up my muscles, forcing myself to ejaculate. If I didn't do this I think I could masturbate forever with no buildup or ejaculation. I'm going to try this sometime though, lying down completely relaxed, and see if after an hour of masturbating any buildup occurs. When the nerves are fully functioning it's supposed to be a natural, involuntary buildup until it can no longer be contained. I have never felt any sense of release.

Another argument in favor of pudendal nerve entrapment is that one of the listed symptoms is lower back pain. I have had issues with my lower back for years now, especially when lying down unless the bedding is extremely soft and perfect. On most beds I need to place something under my lower back, like a rolled up towel, in order to support it to prevent discomfort. This when I'm only 22.

Do you know if various stretches could help with compressed pudendal nerves?
Title: Re: My Theory
Post by: TriumphForks on August 02, 2013, 09:27:41 PM
May I just ask, Chris, how can one lose so much sensitivity from pudendal crush without any loss in continence?
Loss of sensation and loss of muscle function go hand in hand, can you really have one without the other?
Title: Re: My Theory
Post by: Chris on August 03, 2013, 12:35:57 PM
Good question.  And you've managed to point out one of the weaknesses of my theory.  I have thought about the other fibers in the pudendal nerve, which are motor as well as autonomic.  One would expect deficits in other departments as you presume if the compression were early on in the course of the nerve, when its still in Alcock's canal, for example.  One possible explanation is the compression is quite distal, meaning just as the nerve makes its final branch to the "dorsal nerve of the penis".  If the compression is here, continence would remain intact since its controlled by branches which have already divided.  One issue which I cannot readily explain by my theory is that penile erection seems to remain intact.  I would expect compression of autonomic fibers in the dorsal nerve to impair control of vascular tone which prompts penile engorgement or erection.  I, for one, have no trouble achieving or maintaining erection, so these fibers must be intact.  I also have normal sensation to temperature (hot or cold) and I seem to feel pain if my foreskin is pinched.  What is lacking is tactile or touch stimulation.  It is bizarre, I agree...and not readily explained by a pudendal crush syndrome.  I have not completely discounted the likelihood that it may be a central/brain problem in the limbic system.  I just think it is less likely.  Certainly, the SSRI group have proven to me that biochemical modification in the brain can change the brain (i.e. the brain is more plastic than I had imagined), opening up the possibility that EA could be the result of perhaps behavioral issues that we all share in common?
Title: Re: My Theory
Post by: NoFun on August 03, 2013, 08:57:59 PM
I believe my EA is a form of premature ejaculation, because I practically force myself to ejaculate before any buildup to normal orgasm has occurred. This buildup however is impossible because I feel no sensation or pleasure while masturbating or engaging in sexual intercourse. I basically tense up my muscles, forcing myself to ejaculate. If I didn't do this I think I could masturbate forever with no buildup or ejaculation.

I think I'm similar. I don't think the fundamental problem is in the tensing up, that's just my reaction to the same lack of buildup and release. Like you, I last forever without the tensing up. I'm sure that learned behaviour isn't helpful, and the ejaculations aren't enjoyable, but at least they end the arousal.
Title: Re: My Theory
Post by: sensation on August 04, 2013, 09:01:03 AM
Good question.  And you've managed to point out one of the weaknesses of my theory.  I have thought about the other fibers in the pudendal nerve, which are motor as well as autonomic.  One would expect deficits in other departments as you presume if the compression were early on in the course of the nerve, when its still in Alcock's canal, for example.  One possible explanation is the compression is quite distal, meaning just as the nerve makes its final branch to the "dorsal nerve of the penis".  If the compression is here, continence would remain intact since its controlled by branches which have already divided.  One issue which I cannot readily explain by my theory is that penile erection seems to remain intact.  I would expect compression of autonomic fibers in the dorsal nerve to impair control of vascular tone which prompts penile engorgement or erection.  I, for one, have no trouble achieving or maintaining erection, so these fibers must be intact.  I also have normal sensation to temperature (hot or cold) and I seem to feel pain if my foreskin is pinched.  What is lacking is tactile or touch stimulation.  It is bizarre, I agree...and not readily explained by a pudendal crush syndrome.  I have not completely discounted the likelihood that it may be a central/brain problem in the limbic system.  I just think it is less likely.  Certainly, the SSRI group have proven to me that biochemical modification in the brain can change the brain (i.e. the brain is more plastic than I had imagined), opening up the possibility that EA could be the result of perhaps behavioral issues that we all share in common?

I'm not ruling out a nerve entrapment as a problem... And I'm sorry to repeat myself, but I lost sexual sensations in my whole body simultaneously, not only in my penis. I still get erections and can ejaculate, but only with some effort (tensing the muscles inside, trying to sqeeze my prostate). If I didn't do that, it would take me a lot of time to ejaculate, as my body doesn't enter the natural circuit of sensations leading to build up sexual tension and release. It is becoming harder for me to cope with this situation as time goes by, and getting to ejaculate is much more difficult than in the beginning.

The problem is, no matter how many doctos I can contact, they run the usual tests, then either dismiss my symptoms, say that it's psychological or just don't know what to do, and they do nothing. Until now I found nobody who wants to test something new, just try things out or anything. Whatever, except doing nothing. I don't think this is psychological (I'm lacking a physical sensation I knew well), but this has already affected my mind. For me, abstinence is almost the only thing to do, and it's hard because I have a strong desire.

Is there any chance that you as a doctor, or any colleages can spread the word? Just mention the case to colleages and they do the same. I wish I could try stimulants or any other things mentioned in this forum, but I'm just hitting a wall. It's frustrating.
Title: Re: My Theory
Post by: searchingforcure11 on August 04, 2013, 07:19:20 PM
Stimulants are awesome.  Too bad you cant get a doc to prescribe.  Its a shame people abuse things and ruin it for others.  I take the pills when I need them and I have had no addiction at all to them.  I actually have too many pills because I dont need to take them every day.  Not only does the pills help with sex and feeling again it helps with other things such as music and just having more emotion and feeling more.  I find a good song gives me goosebumps a lot more when I am taking the pills as opposed to not taking the pills.  With getting off I feel goosebumps a lot too and my whole body feels pleasure.   
Title: Re: My Theory
Post by: Kstat on August 16, 2013, 08:49:00 AM
Wow, it's been months since my first post. If I remember right, the reason I didn't respond right away was because I saw Chris's post about how the surgeon suggested his issues were psychological and it really bummed me out. Surely we'd remember if we'd been sexually abused or weren't attracted to our partners or something else that could be psychological? I was really disappointed since that Dr. sounded like he could help.

So I tried to put it out of my mind for a while, but my mind always comes back to it. Your story reminded me of myself, Chris, in that I (I'm female) had a couple orgasms as an adolescent (between 10-12), and then the pleasure in masturbating just went completely away. Well, not overnight like I think was the case with Chris, but more slowly over the course of two years until it was completely gone at around age 14. The one thing that's different from most of you though is I never actually get to the point of orgasm, so I don't get those "ghost" orgasms that many of you describe. I'm not sure if it's the same pathology, or if I have nerve entrapment, I just think I essentially have the same problem you all have.

I'm 21 now. Chris's recent experiment with the TENs has me feeling kind of disappointed. I like to hope that even if there's been some damage, things can still be improved even if it's never back to normal. Even though it seems so random to have anatomical differences that compress your nerves, this condition in itself is rare so I'm not ruling it out as a cause. My family was big on going on super long, family bike rides as a child and I wonder if that could contribute- at least in someone that's already predisposed.

Do you have plans as far as what you're going to do with your results, Chris? I find this fascinating even though it's disappointing.
Title: Re: My Theory
Post by: Yanni on August 19, 2013, 06:45:55 AM
I was watching a documentary on female orgasm recently and they suggested that the nerve bundles which leave the clitoris and run parallel to the vagina are stimulated by being forced outwards rhythmically by a thrusting penis and contribute to development of the orgasm.

I'm guessing that men have similar nerve bundles running the length of the penile shaft and, whilst they can't be rhythmically forced outwards, they can be rhythmically forced inwards.  I would suggest that this type of pressure is not necessarily felt as pleasurable in itself, but can act as a kind of stimulus towards orgasm in conjunction with other stimuli.  There is also anecdotal evidence that men like a "tight" space to thrust into, so maybe this is part of that shaft pressure thing.

The reason I mention it, is because I watched another program where a woman was telling other women how to give a blow job.  Her technique involved using the mouth to give a warm moist environment to the glans and an encircling hand to provide pressure to the shaft.

I find this interesting, because I never received any education about this dual stimulation technique and it never occurred to me to try the combination:  pressure to the shaft plus warm/moist/slippery stimulation of the glans.

I'm wondering whether part of the problem is that with EA, we have lost some of the natural sensitivity to triggers (or else they have become out of sync) and perhaps require a more specific combination of sensations to overcome the orgasmic threshold.  That combo might be somewhat difficult to achieve in normal circumstances or without a supportive partner.

For myself, I noticed a major libido reduction when I developed chronic fatigue and myalgia and the subsequent loss of most of the orgasmic sensation that I did have (not that it was that great anyway).  I put this down to the constant low level muscle pain competing with orgasmic triggers, but also the fact that my penile skin emits tearing pain signals when even slightly stretched, even though the skin is not initially tight or stretched.  I think anyone who has had a headache has generally experienced a loss of desire and potential to orgasm.  Pain is a danger signal and I believe our bodies are designed to give pain attention over pleasure.  I have experienced this pain for so long that I'm not sure if it consciously registers anymore, but I am sure that it is somehow blocking orgasms.

As a final comment, there is anecdotal evidence that some women do not experience orgasms and require specific training to facilitate its development, yet every man is supposed to naturally perform and experience orgasms.  I put it to you that some men also require "training" and not the type of self-help that we are accustomed to.  I believe it is quite possible that we learn poor techniques because we don't know any better, (no-one ever told us the right approach) and if we do hit on something that feels good, we may not explore it to its full potential because we are unaware how far we actually can go.  Then when something robs us of what we are used to, we have no idea that anything else is possible and we add despair to our misery.

I'm convinced that more is known about the female orgasm and its impediments than the male orgasm and this is because men are just supposed to work like machines and no-one questions it:  dysfunction has been, until recently, incomprehensible.

I was trying to make some coherent statement with this post, but it seems to have got away from me.
Title: Re: My Theory
Post by: Chris on August 27, 2013, 04:00:11 PM
Kstat,
Your situation may be different.  Of course, since women lack a frank ejaculatory reflex it may be difficult to discern if you're having a physical orgasm without the pleasurable sensation.  Some women do have muscular contractions involving vaginal and perineal muscles, so it is possible, just not as clear cut as with men.  So, you could have the female equivalent of EA.  It certainly sounds like it from the early childhood chronology.  I'm always intrigued by the number of people who report its onset so early in adolescence. 
I'm not sure what's next for me.  I continue to think about my theory and refine it, and I always consider alternative explanations.  I was reading on some men's sexual health forum the other day stories of young men who lost orgasmic sensation after certain "exercises" involving excessive penile pressure.  I thought that was interesting.  Perhaps it can be iatrogenic?  Perhaps I did something in my early life that I can't remember that damaged/compressed the dorsal nerve of the penis?  Memories are so faint, I just can't recall.
I keep on coming back to the fact that, for me, the EA started at the onset of what was supposed to be orgasm.  This supports the notion that the physical orgasm itself (i.e. muscle contractions) damaged the nerve...strange idea...how can the nerve be irrevocably damaged from one brief compressive event??  or is it cumulative compressive events?? but maybe it's not the anatomy, but rather a defect in the way nerve fibers are "protected" by layers of connective and fatty tissue.  Maybe we're susceptible to compressions of all sorts.  The dorsal nerve of the penis is just a very unusual nerve in that it's susceptible to extreme pressures in an erectile organ repetitively with each sexual act.  I still feel somewhat unsatisfied with the theory.  I feel I'm missing something.  In any event, I highly doubt it's fixable at this point....
Title: Re: My Theory
Post by: lostmojo on August 28, 2013, 05:30:33 AM
I was reading on some men's sexual health forum the other day stories of young men who lost orgasmic sensation after certain "exercises" involving excessive penile pressure.  I thought that was interesting.  Perhaps it can be iatrogenic?  Perhaps I did something in my early life that I can't remember that damaged/compressed the dorsal nerve of the penis?

In my teen years I often masturbated in the prone position and was not very gentle in doing it either. How does this fit in with this theory? Could this possibly damage the dorsal nerve?
Title: Re: My Theory
Post by: Yanni on August 29, 2013, 07:13:31 AM
I'm becoming more confident that my issue is caused by pain signals preferentially blocking pleasure signal pathways rather than nerve damage.  The difficulty is that I don't know of an analgesic that doesn't also block pleasure pathways.  It is interesting that one of the posters mentions chronic back pain at an early age and I wonder if that is also the mechanism of his EA:  pain overwhelming the nerve pathways to the exclusion of pleasure.

This doesn't readily explain my perception of poor orgasmic pleasure before the onset of chronic pain, although my history has been one of constant fear and anxiety which means potentially continual energisation of danger signals (adrenaline?), which presumably would also trump pleasure.  Once again, how would one decrease anxiety without also decreasing the pleasure pathways?

I also experience something odd when taking codeine:  as I understand it, the codeine gets converted in the body into morphine and should give a high, however I just experience relief of pain symptoms and a floating feeling but nothing that I would consider a high.  Perhaps when one experiences chronic pain, the natural endorphins produced over a long time period desensitise the brain to the euphoric release of chemicals normally produced during orgasm.

I recently experienced something unusual for me whilst my penis was being stimulated:  normally if my penis is stimulated too vigorously or for too long, I experience discomfort bordering on pain that is like a milder form of post-ejaculatory sensitivity;  on this occasion when the stimulation was for too long and generating discomfort, I tried to endure it and after a while I felt the buildup to ejaculation, but it was much slower than usual and eventually I went over the edge and actually felt something that was closer to an orgasmic feeling.  It was as if the orgasm was determined to overwhelm the pain block this time but was barely succeeding.  I can't say that it was particularly pleasurable as it was competing with the pain, but it was certainly more than I have experienced for some time and has renewed hope that the orgasmic potential exists but is being impeded by other factors that the body takes more notice of because it represents danger and danger trumps pleasure.

The other thing I will say is that for those of us who may have never experienced a proper orgasm, we have no baseline against which to measure our experiences.  Speaking for myself, I'm not sure what an orgasm is supposed to feel like, but I gather it is primarily a brain thing with additional sensations from muscle contractions.  It is strange that the medical profession does not have a comparative chart of orgasmic experience.  This is similar to their approach to pain:  it infuriates me when a Doctor asks me to rate pain on a scale of 1-10 without providing some objective measure of what a 10 is supposed to be (like, think of the worst pain you have experienced before as a 10 and what would that be?).
Title: Re: My Theory
Post by: Kstat on August 29, 2013, 02:07:26 PM
Yanni, what kinds of pain symptoms do you have? Is it localized to the genitals? I'm thinking pain in that area may likely be a symptom of some kind of damage to the tissue/nerves. I'm assuming by "chronic pain" you mean in other parts of your body as well, so could you please clarify?
Title: Re: My Theory
Post by: Yanni on August 29, 2013, 09:42:40 PM
Yanni, what kinds of pain symptoms do you have? Is it localized to the genitals? I'm thinking pain in that area may likely be a symptom of some kind of damage to the tissue/nerves. I'm assuming by "chronic pain" you mean in other parts of your body as well, so could you please clarify?

My chronic pain is mainly in the muscles down my back and across the shoulders, but sometimes extends to arm/leg muscles:  it's like having a variable version of flu constantly but without the respiratory or congestion symptoms.  I believe it is an offshoot of the chronic fatigue I experience.

I get a mild tearing pain when the penile shaft/foreskin is stretched even slightly, despite the skin itself not being taught;  yet I do not get the pain through erection.  It seems as though sexual excitement somehow changes the perception of pain or which nerves become more sensitive and which become dulled.

If the penis is stimulated too vigorously, I get a milder form of post-ejaculatory sensitivity pain (the type that makes you cringe away from it when the penis is stimulated immediately after ejaculation).

The chronic pain is more deep muscle, whilst the genital pain (when it occurs) feels more surface.
Title: Re: My Theory
Post by: Kstat on September 01, 2013, 11:29:04 AM
This is a selfish question, but do you think it's fixable for me? I know it's hard to discern this from posts online, but I've had this for 7 years if that helps. I'll probably take what you say with a grain of salt because I don't like to give up easily, but I'd still like to get your opinion since as a doctor you have quite a bit of knowledge about human anatomy.
Title: Re: My Theory
Post by: Chris on September 02, 2013, 05:03:33 PM
Kstat,
Seven years is a long time.  What impresses me most about my own course and alot of the forum's members is how the syndrome is so unforgiving.  The course is not stuttering, it does not wax and wane, there has never been a hint of return.  It's almost like a bad stroke:  one bad hit and loss of function FOREVER.  So, historically speaking, if it has not returned in 7 years, it's not likely to return in 8 or 10 or 20.  I am 30 years on and counting.
This natural history is odd to me...I would not expect a compressive neuropathy to behave this way.  The most common compressive neuropathies stutter for months to years before causing permanent neurologic damage.  So, perhaps EA is a compressive neuropathy of a different flavor and I am still studying various possibilities.
I am sorry I am not hopeful for your case.  If my theory is correct, the sufferers with the most chance of return of function would be the early birds (< 1 year) who seek and get corrective surgery in a hasty manner.  Problem is this syndrome starts so young:  I surely wasn't thinking through my options when I was 13 years old!
Chris


 
Title: Re: My Theory
Post by: andrew_b on September 04, 2013, 09:06:00 AM
But if the nerves are being compressed by chronically tight muscles this must surely be reversible. I have seriously tight muscles in a number of areas one of which being the gluteals and surrounding area and I'm sure these could be impacting on the penile nerves. I had a good deep tissue massage yesterday and she did a bit of work on my glute muscles and this morning in the shower I felt some good sensations on the area served by the dorsal nerve, so much so that if I'd had time I think the shower spray would have resulted in ejaculation, it was that strong. The guy who cured himself with foam rolling had the same issues going on so I really think all is not lost Chris. I've had this for 7 years like kstat and I'm still very optimistic that its curable. We really appreciate your medical insights by the way Chris.
Title: Re: My Theory
Post by: TriumphForks on September 05, 2013, 11:47:31 AM
I still feel that theories involving nerve compression/damage don't hold water. Personally, I've had an MRI scan and a few nerve conduction tests and everything turned out to be normal. In addition, the presence of normal ejaculation and contraction indicate that the problem does not lie in the penis.
The penis is not the only erogenous zone on the body, yet sufferers often say that they have lost *all* erotic feeling in the body.
So my conclusions come to this probably being a problem with receptors in the brain, as opposed to transmitters in the genitals.
Title: Re: My Theory
Post by: Chris on September 05, 2013, 03:16:23 PM
The presence of normal ejaculation and penile contractions does not rule out a peripheral neuropathy.  The final branch of the pudendal nerve (dorsale nerve of penis/clitoris) is a 100% sensory nerve fiber.  It does not carry any motor or autonomic fibers.  So, compression of this part of the nerve would have NO impact on ejaculatory mechanics.

I am beginning to think that the the so called term "ejaculatory anhedonia" and our general obsession with orgasm in particular has distracted both myself and others on this forum from the fact that the OVERALL sensory experience (whether it be to touch, electrical stimulation or erogenous pleasure during the entire sexual response cycle) is greatly impaired in this syndrome.  It is not just a disease of orgasm or ejaculation!  The fact that sensations drop off even more during orgasm in particular I now believe to be simply a sign of a very damaged nerve that is simply choked by the normal contractions that occur in the pelvic floor muscles.  Normal, healthy men also contract these muscles involuntarily and experience sexual pleasure just fine.  We are somehow different.

MRI scans and nerve conduction studies may be useful, but the person interpreting them must know exactly what to look for and where.  Moreso, routine MRI protocols aren't designed to resolved fine structures like the pudendal nerve, and must be specifically protocoled as a MR neurogram if you want to have a chance of seeing any pathology.

I am now more focused on external events that could have damaged our pudendal nerves (or the final branch, dorsal nerve of the penis).  I am recalling more memories from my early adolescence that is pertinent.  I have memories of a heavy, dull ache in the scrotum, penis, and perineum in general following mastubatory episodes.  I also recollect that sitting down made it worse, and standing better.  I also recollect at least one instance in my early twenties of severe scrotal pain that was confused with epididymitis that followed a LONG CAR RIDE.  To this day, I don't like sitting for long periods of time, and often change position, not because of intolerable pain, but just MILD discomfort, and perhaps partly a subconcious reflex I have acquired since adolesence. 

Ask yourself this question:  did you ride a bicycle alot during your childhood/adolescence or any period of time leading up to your acquisition of EA?  Did you sit alot on hard surfaces?  Did you suffer extreme pressure in your perineum for any reason(s)? 

Perhaps the reason EA comes on and never seems to remit is that there is ISCHEMIC (i.e. no blood flow) damage to nerve fibers from severe external compressive events.  This sort of injury is often irreversible or very slow to recover (much like a bad stroke).  Once the nerve is inflamed from compression, pain would likely be an early feature, but maybe not a late feature.  The late feature may be simply genital anesthesia or so called EA.    Food for thought.


Title: Re: My Theory
Post by: andrew_b on September 07, 2013, 02:13:32 PM
Great insights Chris. The only trauma I suffered prior to the onset of my symptoms was a massive emotional one which seemed to lead to my endocrine system going into melt down. I got hot flushes, weight loss, fatigue, loss of social skills, depression etc plus the sexual dysfunction. Which makes me think for me at least, there's a clear hormonal etiology evident perhaps a bit like low grade chronic fatigue syndrome. The chain of events being something like:  emotional insult leads to loss of energy, body enters survival mode and shuts down non essential services which in turn leads to weak tense muscles, libido and stamina loss etc. Alan cured himself with a supplement and nutrition regime and searchingforacure (I think) has been cured with the stimulant focalin, then there's those who've benefited from cannabis so there's definitely some aspect to this syndrome that's more than just peripheral neuropathy. There would seem to be some endocrine system involvement too. Certainly for me there are good days and bad days and I'm at last starting to see a trend towards more good days than bad so I remain optimistic.
Title: Re: My Theory
Post by: IwantMyMojoBack on September 08, 2013, 12:51:06 PM
I've spent decades looking for a cure and I've tried hundreds of different things, some at great cost.
The only scientific article that I have ever found that details a cure for ejaculatory anhedonia is Journal of Sex and Marital Therapy Volume 20, Vol 1 Spring 1994 by Philip A Garippa. I know that this probably won't go down well, but the treatment was psycholgical/ integrative therapy based. I have a pdf copy of it, if there is any way of distributing it? 
Title: Re: My Theory
Post by: NoFun on September 08, 2013, 09:45:43 PM
The presence of normal ejaculation and penile contractions does not rule out a peripheral neuropathy.  The final branch of the pudendal nerve (dorsale nerve of penis/clitoris) is a 100% sensory nerve fiber.  It does not carry any motor or autonomic fibers.  So, compression of this part of the nerve would have NO impact on ejaculatory mechanics.
...
I am beginning to think that the the so called term "ejaculatory anhedonia" and our general obsession with orgasm in particular has distracted both myself and others on this forum from the fact that the OVERALL sensory experience (whether it be to touch, electrical stimulation or erogenous pleasure during the entire sexual response cycle) is greatly impaired in this syndrome.

I like the theory in terms of a generalized inability to feel sensory pleasure, particularly in the penis.  I know that many of us have talked about penis stimulation being no more stimulating than rubbing your elbow. The level of pleasure from stroking definitely varies at different times, with it often being little more than stroking my elbow. Sometimes less.

Nerve compression would be one possible cause, but I don't think in my case.

I've had nerve conduction tests done by urologists. They detected no anomalies in both the left and right dorsal nerve. But it could be that it's the various vibration sensors and not nerve conduction that is the problem.
Title: Re: My Theory
Post by: Yanni on September 10, 2013, 09:07:39 PM
The most orgasmic pleasure I can remember is during a wet dream when I was about 19yo:  nothing before or since has compared.

I'm intrigued by this, since I believe there is no physical nerve stimulation:  it's all done in the brain.  In fact, I have always understood that an orgasm was principally a brain thing, primarily triggered by physical stimuli but augmented by imagination and other stimuli.  That being the case, I have hope that a way can be found to trigger an orgasm without the involvement of potentially compromised nerves.

I remember when I was younger, bringing myself someway towards the point of ejaculation by imagining genital stimulation and the feelings that produced, but without any physical stimulation.  I'm sure an orgasm could be achieved by this method, although I found it hard work to imagine the sensations sufficiently to exceed the threshold.

A group of men found their way to heightened pleasure by experimenting with prostate massage.  It seems that they can re-train their brain to experience the stimulation of the prostate as an orgasmic-type trigger.  They recommend no penile stimulation involvement during this training process.  Pre-requisites to progress include relaxation and fantasization/imagination, augmented by pleasure vocalisation and other aural material.  An interesting element of this technique is that ejaculation does not happen and the men can experience multiple serial whole-body orgasms.  I have not been able to get this technique to work for me, possibly because my nerves are compromised (by constant pain) which interferes with the process of orgasmic threshold excess.

I have heard of spinal injury cases that have lost sensation below the waist and thus orgasmic potential, finding that other parts of their bodies take over the stimulation sensory role and permit them to experience an orgasm.

The reason I mention the above is that there are other ways of experiencing pleasure that don't rely on the traditional penile stimulation process and I wonder if we are spending too much time focusing on fixing an impediment to the only pleasure trigger most of us have attempted, instead of looking at other approaches to generating orgasmic feeling.  I don't think there has been enough research into all the possible ways that an orgasm can be triggered in a man, to offer us options.  Then there will be the necessity of de-programming ourselves that the only way to be a functional man is to experience a penile-triggered orgasm.  I think women have had a taste of this in the past with the failure to understand that their orgasm trigger may involve something other than penetration.

Maybe our particular impediment means that many other techniques are similarly compromised, but I'm not sure many of us have an understanding that there are other techniques available.  Certainly I don't recall other options being tried in discussions on this forum.

I'm particularly interested in how a wet dream might be created during a waking state.

Title: Re: My Theory
Post by: NoFun on September 11, 2013, 02:55:00 AM

I'm intrigued by this, since I believe there is no physical nerve stimulation:  it's all done in the brain.  In fact, I have always understood that an orgasm was principally a brain thing, primarily triggered by physical stimuli but augmented by imagination and other stimuli.  That being the case, I have hope that a way can be found to trigger an orgasm without the involvement of potentially compromised nerves.

I went to a University researcher on penile nerve issues. She tested me out and concluded that the nerves were fine. Her conclusion about the problem was that it was a supraspinal (brain) issue, with "a threshold set too high".

Not to be Debbie Downer here, but the fault may actually be in the brain, and can't be bypassed.

Interesting that you had your one and only in a wet dream, though.

I had a poll on that, and found that the group as a whole had much fewer wet dreams than average.
Title: Re: My Theory
Post by: dark023 on September 11, 2013, 03:11:07 AM
In that case there may still be a way to reset the threshold though right?  If some of us have had orgasms in the past, the threshold has obviously change, we just need to figure out how to change it back?
Title: Re: My Theory
Post by: Yanni on September 14, 2013, 07:28:30 AM
From everything that I have experienced, it feels like something has raised the orgasmic trigger threshold in my body above the normal that most men experience and it is only extreme situations (eg illness, bypassing the usual triggers in wet dreams to activate at the source, etc) that lower the threshold or raise my body up to the new threshold and permit a semblance of a normal orgasm.  In my case I think it is pain that raises the threshold.

However, I had a recent experience which challenges this idea:  my penis was being stimulated quite vigorously and it was becoming uncomfortable and painful (this is often the point at which ejaculation will suddenly be triggered just to "get it over with") but this time I bore down on the pain somehow (possibly with clenching of abdominal muscles) to endure it and after a short while I started to feel a buildup to ejaculation, but it was much slower than usual and had a different feeling and when it reached a peak I think I experienced some orgasmic sensation as well as ejaculation.  It was certainly better than anything I have experienced in some time, but internally I'm in conflict because of the attendant pain and reluctant to try again, even though it was somewhat pleasurable at the end (the pain sort of offsets the pleasure).  I can only imagine what I might feel if I didn't have the pain.  So now I'm confused about the role the pain is playing.
Title: Re: My Theory
Post by: NoFun on September 21, 2013, 06:12:08 PM
However, I had a recent experience which challenges this idea:  my penis was being stimulated quite vigorously and it was becoming uncomfortable and painful (this is often the point at which ejaculation will suddenly be triggered just to "get it over with")...  So now I'm confused about the role the pain is playing.
Interesting. On the one and only orgasm I can recall, sensation really started with what I would call a sharp, painful itch in the head of the penis. Definitely not pleasurable, but I felt more driven to continue that usual, and maybe within 30 seconds had an orgasm.
Title: Re: My Theory
Post by: Yanni on September 22, 2013, 08:11:58 AM
I wish I understood biology better, to get a greater handle on what is happening with pain and sensation and how it relates to the orgasmic/ejaculatory process.  Do we have separate pain and pressure sensors?  Are there separate nerves for pain, pleasure and pressure or is it a shared highway that gives priority to pain signals versus pressure and it is the pressure signals that actually get translated into pleasure when happening at the correct tempo, location, strength and duration?

I'm not sure the medical profession understand the true process of ejaculation and orgasm as it relates to the symphony of triggers required for it to happen and what can interfere with them.  Is there a learning process involved or is it intrinsically hardwired, which can undergo "amnesia" in certain circumstances?

I am aware that some women need to be taught how to have an orgasm.  Perhaps that can apply to men as well, but we mostly tend to think "it just works" so when it stops we don't have the tools to get it restarted.
Title: Re: My Theory
Post by: Bill on November 04, 2013, 01:52:33 PM
Your theory is fascinating, Chris, and from a medical perspective it's certainly the most persuasive explanation I've ever heard for this "EA" problem. Like you, I've long racked my brain to try and recall any at least moderately traumatic injury to the pelvic area that I may have suffered in my youth, but nothing arises. I do feel that perhaps general pelvic muscle tension may have been present, due in particular to anxiety I had in my earliest youth about bowel movements -- frequently clenching the pelvic muscles to avoid having to go the bathroom at school, etc., etc.

My own version of this EA issue is a little different than most of the accounts I've thus far read on this forum. I've shared it elsewhere, but I'll do so here again and in a slightly different way in case it may perhaps help shed some light on some of the remaining conundrums in your theory. It's difficult to describe all of this without getting into some embarrassingly specific things about my early practices of masturbation, but so be it. Here's the deal: when I first experienced sexual sensation/release at about the age of 9 or 10, I didn't even realize specifically that that is what I was doing. I basically was dry humping a pillow, and in my mind the focus of the stimulation was more that I was pushing against my bladder area. I was definitely fantasizing in a sexual way, but I didn't actually think that this was masturbation since I wasn't overtly handling my penis. Anyway, the feeling that I experienced was a kind of itching/burning sensation, not overtly pleasurable but not exactly painful, that gradually increased and peaked during orgasm. It vaguely felt related to the feeling of a full bladder or bowels, but not exactly. At this early pre-puberty stage, I did not ejaculate semen, so this further contributed to my false notion that somehow what I was doing was not in fact masturbating/stimulating my penis. Regardless, I came to enjoy this whole experience as described above, and I did it often. I don't remember the exact chronology here, but perhaps six months later or so, I first tried masturbating in a "traditional" manner. I'll never forget the first moments of touching my penis with a lubricated hand. The sensation was entirely different than the one I describe above. Instead, I felt a kind of warm, tingling sensation, one that then and now I am certain is the "correct," normal sensation of sexual pleasure. The feeling grew as I continued, but shortly before orgasm it subsided and once again I felt the itching/burning sensation during orgasm. Soon, perhaps after one or two more experiences like the one I just described, the extremely pleasurable sensation (warm and tingly) went away entirely, and basically normal direct penile stimulation masturbation came to feel just like the initial thing I'd experienced when humping the pillow. I experienced the warm/tingling sensation maybe a handful of other times during the course of the next several years, always in the context of some new masturbation experience: the jet in a swimming pool, a vibrating massager. Never, though, did the sensation last through orgasm, but always the itching/burning feeling would take over. At the time, all this was a maddening mystery to me, but in looking back on this in the past 10 years or so (I am now 37), I believe that what characterized each of the experiences in which I felt the very pleasurable, "normal" sensation was that my pelvic muscles were more relaxed than usual during stimulation. Then, as they naturally contracted during climax, the old "abnormal" sensation would reappear.

Eventually, the "abnormal" sensation eventually became my de facto sexual sensation, and it has been for many years. Occasionally now I feel the more pleasurable sensation briefly during stimulation of other erogenous zones, but never during penile stimulation. Like most others in this forum, everything seems to work fine on the surface -- I am happily married and ostensibly all is normal about my sexual experience, except for the fact that I experience an itching/burning sensation during sex.

In recent years I've become hopeful about the root cause of my problem being pelvic tension, and at the moment I'm embarking upon a course of stretching/relaxing etc., as discussed in other places on this forum. However, certainly your notion of nerve compression makes perfect sense as well and obviously far from being mutually exclusive with pelvic tension is precisely a result of it (well, and also of the idiosyncratic vagaries of nerve formation, as you discuss). I guess what has always given me a glimmer of hope that my situation may be reversible is this: I had experienced the "abnormal" sensation probably hundreds of times and utterly consistently before out of the blue the more pleasurable sensation was discovered. In other words, at least in roughly those first three to four years of my sexual awakening from 10-14 or so, the "abnormal" sensation did not progressively arise and eventually dominate my experience, but quite the contrary. So, it seemed that at least then it wasn't a matter of a nerve becoming univocally damaged once and for all -- i.e., there was some obvious overlap in my ability to experience "normal" sexual sensation (albeit not during orgasm), and my experience of the itching/burning sensation. This has always been a puzzle to me.

I hope some of the above makes sense and isn't too convoluted. In simple terms, what is different for me is that rather than a pure absence of sensation I've always experienced an "abnormal" sensation. The more I think about it, I'd say that it is precisely the feeling of a sore muscle in my pelvic area, focused in my penis. It's not painful, and obviously my brain has learned to associate it with sexual release and to a certain extent to enjoy it. It is pleasurable enough, in other words, that I don't find sex completely devoid of satisfaction, even though I wouldn't describe the pure sensation per se as overtly pleasurable. The reason I share all of this is I'm wondering if my particular variant on this EA experience may shed some light on it in general. I think with me it had a lot to do with muscle tension and how this interacted with masturbation technique and how it all played out in my earliest years as a sexual being. While I have some hope that doing stretches and trigger point massage, etc., in the pelvic area may perhaps reawaken my ability to experience deep sexual pleasure, I also fear after reading your posts that perhaps the more direct cause of my experience is nerve compression of the pudendal nerve. Perhaps somewhere along the way my brain learned to interpret some experience of muscle tension that could be triggered during sexual stimulation as normal, and that's why instead of simply feeling nothing, I experience a kind of alternate, not all that pleasurable feeling during sex. It's a puzzle.
Title: Re: My Theory
Post by: Ralding on November 04, 2013, 04:57:29 PM
I am an EA sufferer for 30+ years.  I am also an MD, so I have a unique perspective on what may be going on.  I'm going to keep this succinct, because I think the cause is rather simple.  First off, I do believe the post SSRI group of sufferers are following a different mechanism altogether whose origin must be central (i.e. in the central nervous system pleasure pathways).   But for the rest of us, my observations and experiences have resulted in the following paradigm. For me, there is some sensation during the build up but what is most interesting is how the involuntary muscle contractions that define male orgasm coincide with an obliteration of sensation.  I do not think this is a coincidence.  Moreover, my EA started extremely early in my sexual development, like shortly after discovering what self pleasure was all about.  It also happened instantly.  I still recall the day that the pleasure stopped and my abject surprise.  Also, it was a little painful in the beginning.  But after the pain wore off, the orgasms just were without feeling.  And the build ups while not absent were muted.  I also remember a short time period of sharp, brief stabs of pain centered in the anal area, which also subsided.  Taking all this information collectively, this is what I think is going on:

The pudendal nerve, like all nerves, probably takes various courses between the penis and spinal cord.  All anatomical structures in our body have extreme variability in terms of their locations, divisions, size, symmetry, etc.  Why should this structure be any different?  I believe the vast majority of EA sufferers have some variant in the trajectory of this nerve, which by the way, must weave its way through layers of perineal muscles and various protective canals before it reaches the sacral nerve roots.  I believe EA is a COMPRESSIVE NEUROPATHY (like carpal syndrome) which is caused by an anatomical variant in PD nerve course which results in severe nerve compression when the perineal muscles tonically then clonically contract duriing male orgasm.  I believe the exact anatomical variant may result in nerve compression and damage very early in sexual life or perhaps later if the compression is not as severe, hence different times of onset. 

I do not believe my PD nerve is totally shot, and I have some pleasure during buildup, but the involuntary muscles contractions that occur simply choke the nerve at the exact moment of orgasm....which leads me to my next important point.  Will reaching orgasm cause any pleasure without some nerve stimulation?  I think not, there must be some nerve stimulation from the genitalia to transmit to the pleasure centers to cause pleasure.  Without it, even though arousal is high, nothing integrates in the pleasure center to cause the feeling.

If my theory is correct, the only treatment that I see working is 1) pharmacologically enhacing afferent neuro transmission from gentialia with various neurotropic drugs  2) relieving the compression with surgery  3) bypassing the compression with electrical stimulation, either via the skin or implanted close to sacral nerve roots

That's it...I don't think it's complicated, just a stupid compressive neuropathy.  Virtually any nerve in the human body can be compressed, and if look at the structure of the human perineum you'll appreciate quickly that there are many opportunities to compress this nerve.

Hi Chris,

I found that a very interesting read. I think you are right about some things and possibly wrong with others. I believe that it is similar to carpel tunnel syndrome (which is another tension disorder) and tension disorders are causes by the nervous system being set into a fairly constant hyperactive state causing increased muscles tension. The root of these hyperactive state though is less clearly defined. It could be from poor muscle use and patterns of behaviour over many years which is causing muscles to stay on and compounding that surrounding muscles could tightening to try and balance the situation causing even more tension. It can also be caused by stress and just our bodies response to it. I feel like the pudendal nerve is one of many nerves that contribute to the pleasure feelings we have during orgasm. But there are many more nerves and in guys we also have the very important dorsal nerve of the penis the deep perennial nerves and even more that run through the obturator muscles. Additionally so much pleasure from orgasm is also felt deep in the anus around the prostate which is a nexus of nerve ending and in the lowest part of the abdominal muscles just above the penis - build up seems particularly concentrated around there. But all of the nerves are only part of the story The muscles seem to be so important as well and they really need to be relaxed strong balanced and at their correct length. Not only will this cause nerves to be less compressed but it also allows synergy in the movement of all the muscles which allows the pleasure to flow through the abdomen pelvis and even lower back. Lets face it orgasm is as much about movement of muscles as it is about neurotransmitters activity and dopamine as it is about the nerves. I think addressing the musculature of the pelvis is the most important step that anybody suffering from this condition can take it's also the most holistic and rewarding. I strongly would recommend adopting this course of action for at least three months before attempting any kind of drug therapy or surgery. I'm sorry but I completely hate the mindset that drugs and surgery are good options. They are end game options and last resorts.

People who take SSRI drugs also cause muscle problems. Those drugs cause stress in the bodies muscles. They also make it difficult to cum because the increase in seretonin is imbalanced with with regards to dopamine. What then happens is people tend to masturbate furiously for hours on end and end up putting muscles into involuntary muscle spasms. This however is a theory of mine but I have discussed it at length with people who take psychoactive pharmaceuticals all of which seem to have side effects.   
Title: Re: My Theory
Post by: ChasingIt on November 08, 2013, 11:59:43 AM
To Chris(if you are still reading this form), or anyone who could help, my symptoms are almost exactly like Chris's. Had full blown orgasms in my early years up untill the age of 11 (started early, I'm 17 now). It was a shift in the matter of one day going from 10/10 to 0-1/10 orgasms. I've been masturbating ever since then off and on never experiencing anything over a 1. I can remember an event that was at least in the same year, possibly the same day, where I was walking on a bar on a play set and fell landing directly on my scrotum & anus area (avoided the testicles) the only problem is it was a very long time ago and can't remember if it was related. Before even considering it a nervous or muscular problem I started testing different supplements the past month and feel like they have maybe gotten me to a 2/10 but it is possibly just an increase in buildup pleasure. The supplements include l-theanine, inositol, phosphatidylserine, cdp choline, and piracetam. I'm now at a loss of what to even have checked, I'm going to a chiropractor tomorrow specifically for pelvic re-alignment so I will document anything that comes from that. I have a tens unit and have been using it in multiple places on my pelvis area but am willing to experiment with anything that anyone can direct me to. My biggest question is what type of doctor am I searching for that can do an MRI and nerve conduction test of the specific pelvic areas. If I can get some insight on these thing I promise I will report any of my findings and results.
Title: Re: My Theory
Post by: Chris on November 08, 2013, 02:05:18 PM
Ralding,
You may be on to something.  I do agree with some of your tenets and disagree with others.  What you are proposing is that the pelvic floor muscles are the root cause of the problem.  The pudendal nerve and its branches traverse the pelvic floor, therefore if these muscles are in a constant state of inappropriate tension, then we get nerve compression and EA.  However, I do not believe muscles are the source of sensory perception, peripheral nerves and the brain ultimately are.  Now, can rhythmic muscle contraction titillate  nerve endings, yes...and to that extent this could be a source of pleasure.  I like your explanation of how SSRI use may cause persistent EA...very interesting link that supports your theory.  I have a question then:  if pelvic floor muscle tension is the cause of EA, then why don't more EA sufferers have other deficits?  The pelvic floor at its heart is the arbiter of fecal and urinary continence.  Why don't we have more issues in this area if these muscles are always inappropriately  tense? 
Title: Re: My Theory
Post by: Chris on November 08, 2013, 02:15:36 PM
Chasing It,
Your story mirrors mine and I can't help but think that any time loss of sensation happens so acutely and appears permanent, the mechanism must be nerve injury...probably by severe rapid compression and loss of O2/blood supply.  As I have stated earlier this sort of clinical presentation is akin to stroke.  No other neurologic processes, be they degenerative or autoimmune happen that quickly and follow a course of permanent, non-variable loss of sensation over years.
It is very interesting that you have a vague memory of a fall with trauma to the perineum.  It would be very useful to figure out if there was a 1:1 correlation between the injury and your EA.  For me, 30 years of time have elapsed and I cannot possibly recall any event that preceded my EA.  I have raised the possiblility in the past that excessive bicycling could injure our pudendal nerves.
As far as work up I would focus on the following:  try to get a MR NEUROGRAM of your pudendal nerve, this is very specialized and is not performed just anywhere.  I believe there is a website that focuses on pudendal neuropathy and it lists various sites across the country.  I'll try to get it for you but try a google search.  Secondly, I would consider seeing a neurologist, be frank with him and explain you have no sensation in your penis, and perhaps he can do nerve conduction studies on your dorsal nerves of the penis.  Finally, do you have any baseline sensation to your penis (touch, pin prick, cold, hot, vibration, etc)?  Do you feel anything when TENS electrodes are placed there? Since you are relatively early in the course of EA, you would make a good subject to investigate.  Keep us posted.
Chris


Title: Re: My Theory
Post by: ChasingIt on November 10, 2013, 02:56:20 AM
Thanks for the response! I will work on trying to get a better approximation on the dates of the time I lost orgasm and my fall. Tomorrow I'll start searching for someone to perform a mr neurogram! The sensation in my penis is the only thing that differs from us, perhaps because I am a little earlier. A pinch feels like a pinch to the wrist, it doesn't really hurt like one to the neck would, but I can tell I'm being pinched. Also when touching on the skin directly behind the gland I can feel the slightest feeling of pleasure although nothin compared to what was. When masturbating, I feel like everything is working on the buildup and slowly gets better an better untill the point of orgasm where it just leaves immediately. No muscle contractions, chills, vocalization, or anything. I tested the dorsal nerves of my penis with the tens unit and was surprised that i could definitely feel it more sensitively than other parts of my body. Another interesting thing was that after using it for about 2-3 minutes at different settings, I could still feel stimulation in the dorsal nerves for about 4 minutes after.
Title: Re: My Theory
Post by: Yanni on November 16, 2013, 05:47:48 AM
Chris,

How would you explain a single wet dream as being the most intense orgasmic experience ever, if it is mediated mainly by nerves, since these don't get activated in the same way in a dream?

I have a theory that the brain can "imagine" sensation where no sensation exists, as long as it has had a previous experience of those sensations to build on:  thus from a memory of what rhythmical stimulation feels like, a brain can imagine it happening completely under its own control as to tempo and intensity and basically orchestrate a symphony of orgasmic trigger feelings.  However, I think this can only work if one has already experienced an orgasm in the past, sort of like once learning to ride it is easy to pick it up again at a later stage as the memory pathways are still there.

I'm not sure how this theory can be used, even if correct, because I don't believe it is possible to readily enter a dream state but still under conscious control, although I have a suspicion the Tantrics can approximate it.

Having said that, some men can trigger a hands-free orgasm without any overt stimulation, which is kind of interesting and suggests that either it doesn't take much sensation for them or they are imagining a buildup that isn't actually happening physically.

When I was much younger, I could imagine rhythmic stimulation of my penis when no such action was occurring and I could achieve quite a high level of excitement, although not enough to ever tip me over the edge, but I think it confirms an ability to think oneself to an orgasm in the absence of stimulation.
Title: Re: My Theory
Post by: NoFun on November 18, 2013, 12:23:54 AM
How would you explain a single wet dream as being the most intense orgasmic experience ever, if it is mediated mainly by nerves, since these don't get activated in the same way in a dream?

Mediated mostly by nerves *when you're awake*. All sorts of experience can be generated without actual sensory input while dreaming, but it's quite a trick to train yourself to do that on command while awake.