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About Arthur Goldstein, M.D.
Expertise
Any problems or questions related to the field of urology; ie urinary stone disease, urinary cancers (kidney, bladder, prostate, testis, etc.), urinary infections, impotency, etc.
Experience
I am retired from the active practice of urology. My 34 years was totally in the clinical field and involved the entire gamut of genitourinary problems, with special interest in male impotence and endourology.
Organizations
American Medical Association, American Urological Association, American College of Surgeons
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You are here: Experts > Health/Fitness > Urology > Urology > Orgasm
Expert: Arthur Goldstein, M.D.
Date: 10/8/2008
Subject: Orgasm
Question
Dr. Goldstein,
I have had this problem for the past 9 months to a year. Previously, at age 71 I was diagnosed with severe spinal stenosis. Since that time , it has been increasing difficult to achieve orgasm ( there is no ejaculation since the time of a turp procedure eight years ago ) to the point now where it is almost impossible for me to achieve orgasm during intercourse.It occasionally happens - once every month or six weeks , the time length to achieve being 45 minutes- 60 minutes. I am serious about the problem, a depressing situation since previously it was at 10-15 minutes time period . At my age , that is frustratingly exhausting. I remain firm the entire time due to Cialis but can never seem to reach my goal. Do you have any suggestions. I have contemplated spinal laser surgery to relieve the pressure I assume is on nerve endings
Regular spinal surgery is out since I have already had that procedure on my neck and cannot risk a poor response, one which would leave me completely retired and in pain.
Do you have any suggestions as to a procedure that would open the spinal nerve endings that have resulted in the above problem?
Sincerely,
GT
Answer
Gerald, let me first inform you that I have no expertise regarding spinal stenosis although that certainly can cause a variety of sexual problems. You would need to ask your neurosurgeon about the likelihood of regaining climax with surgery. I would, however, like to qualify some points for you.
It is very common after a TUR to experience no apparent ejaculation. The volume of the semen is decreased (but not eliminated) by removing a portion of the prostate as it is this organ which manufactures about 2/3 of he ejaculate. Normally at the time of ejaculation, the bladder neck closes so that the semen takes the path of least resistance in an antegrade fashion out the urethra. After a TURP, the bladder neck may not close completely and retrograde ejaculation occurs into the bladder. The semen is then voided out with the next urination. TIURP does not generally decreases orgasm.
Orgasm is an event physiologically distinct from erection and ejaculation. Orgasm is defined as the intense emotional excitement and release via climax usually accompanying ejaculation in the male. It is perceived and mediated solely by the brain. There are some individuals who can never orgasm and they may have a malfunction of this portion of their brain. There is no specific drug available at this time for difficulty achieving orgasm but research is in being done in this sphere. More common, is those people who can experience orgasm but who may take longer than normal to achieve or they may occasionally fail to climax. After one ejaculates there is a period of time (called the refractory period) during which a man is unable to have successful sexual activity. The latter is defined as the totality of adequate erection, ejaculation and orgasm. This period is different for each person and gradually increases with age. Another possibility is performance anxiety. All men fail occasionally. However, if after a "failure" it is on the mind of a man the next few times he has sex, this will frequently short circuit his ability to climax. A key to this diagnosis is that such a man will always be able to ejaculate with masturbation but occasionally fails in social situations. I understand that this unlikely applies to your case. Stress and other emotional problems often can be etiologic in men who experience difficulty reaching climax.
Certain medications such as antidepressants & certain drugs used to treat high blood pressure may, as a side effect, suppress or significantly delay ejaculation. In fact, several of the antidepressants are often used to treat premature ejaculation because of this action. Some hormonal or pituitary problems may also cause difficulty with climax. In one of these disorders, the hormone prolactin is overproduced by the pituitary and can suppress orgasm. Deficiencies of testosterone & thyroid malfunction may also cause this difficulty. Consultation with an endocrinologist may discover such causes.
In summary, I would not consider spinal surgery for your problem until other potential etiologies are evaluated. Good luck.
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