Drugs that MIGHT work for Delayed Ejaculation OR Delayed Orgasm (low penis sensitivity after erection)

[sammmy]

Keep in mind that this review article does not differentiate between Ejaculation and Orgasm. Some of the proposed drugs stimulate Ejaculation, not Orgasm: ephedra extracts/teas, ephedrine, pseudo-ephedrine. They can cause premature ejaculation without pleasure (orgasm) because they contract some sphincter muscle in the urethra (hence the urinary retention, you may not be able to pee at high doses), which makes ejaculation easier but do not affect the orgasmic nervious circuit - my personal experience with them.

The medical studies in that area are contradictory and pathetic and there is no tested and proven solution like viagra for erectile disfunction. One has to experiment for themselves and all proposed treatments either may not work or work but with unpleasant side effects.

The drug treatment of delayed ejaculation - PMC

Delayed ejaculation (DE) is an uncommon and a challenging disorder to treat. It is often quite concerning to patients and it can affect psychosocial well-being. Here we reviewed how DE is treated pharmacologically .We also highlighted specific ...

www.ncbi.nlm.nih.gov

 

[sammmy]

 

[madman]

Understanding and Managing Men’s Orgasmic Difficulties

INTRODUCTION This review discusses 2 ejaculation disorders that represent disturbances in psychosexual responding, premature ejaculation (PE) and delayed/ inhibited ejaculation (DE). Both disorders are related to the timing/occurrence of ejaculation (ie, ejaculation latency [EL]) during...

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Regarding Delayed Ejaculation

*DE may be either lifelong or acquired; the former is poorly understood

*Treatment options are limited as no approved pharmacologic options are available

*Motivated patients or couples may realize significant benefits from behavioral, cognitive, and relationship strategies under the guidance of a specialist

*These procedures help enhance arousal, remove barriers to arousal, and ensure mutual sexual satisfaction

Male Anorgasmia and Delayed Ejaculation

Alexander Pastuszak, MD, Ph.D., reviews the anatomy and physiology relevant to delayed ejaculation and anorgasmia, as well as the causes and diagnosis of these conditions. He also discusses psychosexual and behavioral coaching treatment approaches for these conditions and evidence for...

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Take home point!

Dumb question regarding ejaculation

So this may sound weird and trolling, but I've noticed I don't shoot anymore, I ejaculate and it just drips It's been happening for a while What causes that? Lack of excitement? Dull orgasms?

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This entry is a long-overdue response to a request that I cover the topics of absent ejaculation and inability to orgasm.

It is important to make the distinction between ejaculation and orgasm: Ejaculation is the physical act of contraction of the pelvic floor muscles and expulsion of semen, whereas orgasm is the associated feeling of pleasure that usually accompanies ejaculation. The two are not the same, although the terms are often used synonymously. Ejaculation takes place in the genitals, orgasm in the mind. It is entirely possible to ejaculate without experiencing an orgasm and to orgasm without ejaculating. The ideal situation is when the two components are perfectly aligned when they go “hand in hand.” (Cute, right?)


Just Right

In the perfect world, ejaculation and orgasm are “just right,” meaning occurring on a timely basis (not too rapidly nor too slowly), nor too meekly, nor absent. Problems with ejaculation and orgasm include the following: rapid ejaculation, delayed ejaculation, absent ejaculation, skimpy ejaculation, weak ejaculation, diminished ejaculatory sensation, lack of orgasm, and post-orgasmic illness syndrome (POIS). Some would refer to these issues as “jizasters.”

Although rapid ejaculation is typically a problem of younger men, many of the other ejaculation issues correlate with aging, weight gain, the presence of lower urinary tract symptoms due to prostate enlargement, and erectile dysfunction. With aging, there is a decline in sensory nerve function, weakening of pelvic floor muscles, and diminished reproductive gland fluid production. Furthermore, medications and surgery used to treat prostate issues may profoundly affect ejaculation.

Disorders of Ejaculation

Disorders of Ejaculation: An AUA/SMSNA Guideline (2022) Alan W. Shindel,* Stanley E. Althof, Serge Carrier, Roger Chou, Chris G. McMahon, John P. Mulhall, Darius A. Paduch, Alexander W. Pastuszak, David Rowland, Ashley H. Tapscott, and Ira D. Sharlip Purpose: Men who ejaculate before or...

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Delayed Ejaculation

16. Lifelong delayed ejaculation is defined as a lifelong, consistent, bothersome inability to achieve ejaculation, or excessive latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion)

17. Acquired delayed ejaculation is defined as an acquired, consistent, bothersome inability to achieve ejaculation, or an increased latency of ejaculation, despite adequate sexual stimulation and the desire to ejaculate. (Expert Opinion)




EVALUATION AND DIAGNOSIS

18. Clinicians should assess the medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with delayed ejaculation. (Clinical Principle)

19. Clinicians may utilize additional testing as clinically indicated for the evaluation of delayed ejaculation. (Conditional Recommendation; Evidence Level: Grade C)




TREATMENTS

20. Clinicians should consider referring men diagnosed with lifelong or acquired delayed ejaculation to a mental health professional with expertise in sexual health. (Expert Opinion)

21. Clinicians should advise men with delayed ejaculation that modifying sexual positions or practices to increase arousal may be of benefit. (Expert Opinion)




PHARMACOTHERAPY

22. Clinicians should suggest a replacement, dose adjustment, staged cessation, or medications that may contribute to delayed ejaculation. (Clinical Principle)

23. Clinicians should inform patients that there is insufficient evidence to assess the risk-benefit ratio of oral pharmacotherapy for the management of delayed ejaculation. (Expert Opinion)

24. Clinicians may offer treatment to normalize serum testosterone levels in patients with delayed ejaculation and testosterone deficiency. (Expert Opinion)

25. Clinicians should treat men who have delayed ejaculation and comorbid erectile dysfunction according to the AUA Guidelines on Erectile Dysfunction. (Expert Opinion)

26. Clinicians should counsel patients with delayed ejaculation that no currently available data indicates that invasive nonpharmacological strategies are of benefit. (Expert Opinion)

Orgasm and Ejaculation Disorders

Orgasm and Ejaculation Disorders (2022) Federico Belladelli, Edoardo Pozzi, Giuseppe Fallara, Paolo Capogrosso, and Andrea Salonia 7.1 Anatomy and Physiology of Orgasm and Ejaculation There is no standard definition of orgasm, although it has been defined as an intense transient peak...

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7.3 Delayed Ejaculation (DE)

7.3.1 Aetiology
There are mainly three aetiological factors that are well-recognized in the context of DE [44].

1. Aging: degeneration of penile afferent nerves inhibits ejaculation.
2. Congenital: Mullerian duct cyst, Wolffian duct abnormalities, Prune Belly Syndrome, imperforate anus, and genetic abnormalities.
3. Anatomic causes: transurethral resection of the prostate, bladder neck incision, circumcision, and ejaculatory duct obstruction (can be congenital or acquired).
4. Neurogenic causes: diabetic autonomic neuropathy, multiple sclerosis, spinal cord injury, radical prostatectomy, proctocolectomy, bilateral sympathectomy, abdominal aortic aneurysmectomy, and para-aortic lymphadenectomy.
5. Infective/inflammatory causes: urethritis, genitourinary tuberculosis, schistosomiasis, prostatitis, and orchitis.
6. Endocrine causes: hypogonadism, hypothyroidism, and prolactin disorders.
7. Medications: antihypertensives, thiazide diuretics, alpha-adrenergic blockers, antipsychotics, antidepressants, alcohol, antiandrogens, ganglion blockers, and SSRIs. 8. Psychological: acute psychological distress, relationship distress, psychosexual skill deficit, disconnect between arousal and sexual situations masturbation style.


7.3.2 Diagnosis of DE


7.3.3 Treatment

1. Psychological support

2. Pharmacotherapy:

many therapeutic options exist in the context of DE. As such, even though neither the European Medicine Agency (EMA) nor the Food and Drug Administration (FDA) approval exists, agents like cabergoline, bupropion, alpha-1- adrenergic agonists, buspirone, oxytocin, testosterone, bethanechol, yohimbine, amantadine, cyproheptadine, and apomorphine have been used to treat DE, with varied success rates [73].

3. Penile vibratory stimulation

 

[madman]

*With aging, there is a decline in sensory nerve function, weakening of pelvic floor muscles, and diminished reproductive gland fluid production

 

[sammmy]

The neurologic causes are missing the likely scenario of an infection causing permanent nervous damage in the nerves / brain circuits responsible for ejaculation or orgasm.

Not only genitourinary tuberculosis can cause that. The probability for such an infection is increasing with aging.