Understanding Common Sexual Difficulties in Men (AMAB)

Each condition involves different aspects of sexual function:

Delayed ejaculation: When ejaculation occurs but is significantly delayed.

Erectile dysfunction: When a man cannot achieve or maintain an erection necessary

for penetrative intercourse.

Anorgasmia: Inability to reach orgasm, regardless of the erection or ejaculation status.

Ejaculatory anhedonia: also referred to as non-orgasmic ejaculation. Condition is

relatively uncommon. While ejaculation and orgasm often occur together, they are

controlled by different physiological mechanisms, so it is possible for one to occur

without the other.

ANEJACULATION

Emission refers to the process in which sperm and fluids from the prostate and seminal vesicles are moved into the urethra during ejaculation. Disruptions to the nerve pathways or muscular function responsible for this process can lead to anejaculation, where semen does not reach the urethra, and hence no ejaculation occurs, even though the man may experience sexual pleasure or the sensation of orgasm.

The following factors can lead to anaejaculation:

Neurological damage: Damage to the sympathetic nerves (from the T10-L2 spinal

cord segments) that control emission can lead to this dysfunction. These nerves control

the muscles responsible for pushing sperm into the urethra. Spinal cord injuries, pelvic

surgery (like prostatectomy), or conditions such as multiple sclerosis can affect these

nerve pathways.

Diabetes: Long-term diabetes can cause diabetic neuropathy, which damages the

autonomic nerves that regulate emission, leading to anejaculation.

Medications: Certain drugs, particularly antidepressants (SSRIs) or alpha-blockers,

can interfere with the normal emission process by either affecting nerve function or

muscle contraction in the vas deferens and seminal vesicles.

Retrograde ejaculation: In some cases, men may experience retrograde ejaculation,

where semen is directed backward into the bladder instead of out of the urethra. This

can result from sphincter dysfunction or after surgical interventions.

ANORGASMIA

Orgasms are a complex experience involving both physical sensations and psychological

factors, regulated by multiple parts of the nervous system, including the parasympathetic and sympathetic systems as well as the brain. Biological factors leading to inhibited ejaculation and anorgasmia can include:

Nerve damage: Nerves from the sacral plexus (S2-S4) control the rhythmic

contractions of the pelvic muscles responsible for ejaculation. Damage to these nerves

can prevent the proper contraction of these muscles, resulting in the inability to ejaculate.

Hormonal imbalances: Low levels of testosterone can affect libido and orgasmic

function, although they do not typically cause ejaculatory failure directly. However,

severe hormonal disturbances may disrupt the entire sexual response cycle.

Prostate issues: Inflammation, infection, or surgical removal of the prostate gland (such

as after a radical prostatectomy) can impact ejaculation due to its role in producing

seminal fluid and its proximity to nerves involved in ejaculation.

Central Nervous System Dysfunction

The central nervous system (CNS) also plays a crucial role in ejaculation and orgasm.

Conditions that affect the CNS, such as Parkinson's disease, stroke, or brain injuries, can lead to anorgasmia or anejaculation. The CNS coordinates the complex interplay between psychological arousal and physical response, and disruptions here can inhibit the ability to achieve orgasm or ejaculate.

REDUCED PENILE SENSITIVITY

Anorgasmia and reduced penile sensitivity may be closely related. A lack of penile sensitivity is usually caused by issues with nerve function, reduced blood flow, hormonal changes, or lifestyle habits.

Nerve compression: Prolonged pressure on the groin such as from long bicycle rides on narrow saddles or excessive sitting can compress the pudendal nerve.

Rough masturbation: Very aggressive friction or a tight grip over time can temporarily dull everyday nerve responsiveness.

TREATMENT CENTERS IN BERLIN

Institute of Sexology and Sexual Medicine at Charité led by Prof. Klaus M. Beier.

This is one of the leading centers for sexual health and offers comprehensive treatment for sexual dysfunctions: https://sexualmedizin.charite.de/en/

.

EXPERTMEDICAL, a private practice in Wilmersdorf that specializes in both urology

and sexual medicine. They offer intimate consultations and sex therapy, covering issues

like erectile dysfunction and orgasmic disorders: https://www.expertmedical.berlin/en/

.

Charité’s Department of Urology, which has clinics at both the Benjamin Franklin and

Mitte campuses, provides specialized care for urological and sexual health issues

WHAT CAN I EXPECT FROM A PHYSICAL EXAMINATION?

A physical examination helps rule out any biological or anatomical issues that could be contributing to any of the conditions described above. The doctor may check for:

Neurological health: Reflexes and sensation in the genital region (e.g., pudendal

nerve function) to ensure that the nerves responsible for sexual function are working

properly.

Genital examination: Assessing for physical issues such as hypogonadism, penile

abnormalities, or signs of prostate disease.

Hormonal evaluation: Low testosterone levels can contribute to reduced libido or

sexual dysfunction, though not directly linked to orgasmic disorders in most cases.

Hormonal imbalances (e.g., low testosterone or elevated prolactin) may need to be

tested.

Laboratory Tests for Anorgasmia

Lab tests may be conducted to evaluate the patient’s overall health and hormonal balance.

These could include:

Testosterone levels: To assess for hypogonadism or other endocrine disorders that

may affect libido or sexual function.

Thyroid function tests: Hypothyroidism or hyperthyroidism can affect sexual health.

Prolactin levels: Elevated prolactin levels (hyperprolactinemia) can be associated with

reduced libido and orgasmic dysfunction.

Laboratory Tests for ED:

Testosterone levels: To detect low hormone levels, which can affect sexual function.

Blood sugar: To screen for diabetes, which can damage nerves and blood vessels

related to sexual performance.

Lipid profile: High cholesterol levels can contribute to blood vessel damage, which may impair erectile function.

Thyroid function tests: Both hypothyroidism and hyperthyroidism can affect sexual

function.

Specialized Testing

If the initial workup doesn’t have any conclusive results, more specialized tests may be necessary:

Nocturnal penile tumescence (NPT) testing: To check for erections during sleep,

which could indicate that the problem is psychological rather than physiological.

Doppler ultrasound: To assess blood flow to the penis, especially in cases where

erectile dysfunction might co-exist with anorgasmia.