Male Sexual Conditions

In some men the penis becomes so sensitive it is impossible to wear clothes without several condoms to provide a layer of protection between the genital tissue and clothing.  This may be caused by a problem in the cauda equina.

Orgasm is a neurologic response to sexual stimulation. Sensory input from smell, touch (in Ejaculatory dysfunction is common and can be classified into anejaculation, delayed, retrograde, premature, and painful ejaculation. Among these disorders, painful ejaculation is the only ejaculatory condition where pain is the main complaint. The incidence of painful ejaculation among men age 50 years and older ranges from 1 to 6.7 percent.  Painful ejaculation can have a significant impact on a man’s quality of life, negatively impacting self-esteem and reducing desire for sexual intercourse. Among men who report painful ejaculation, 90 percent considered this condition to be a serious problem.
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Common presentations of painful ejaculation can include penile pain, perineal ache, or suprapubic discomfort occurring during or after the ejaculatory period. Pain is sometimes experienced in the testicular or glans area of the penis immediately after ejaculation, or may result from perineal muscle spasm. Atypical pain with ejaculation can also occur in the abdomen, urethral meatus, or rectum.  There are multiple causes of painful ejaculation. Painful ejaculation can occur in many instances from ejaculatory duct obstruction. Intense perineal discomfort immediately after ejaculation can occur without evidence of infection or trauma, and may be attributed to a problem in the cauda equina.

Instead of pain, sometimes the genitalia and/or thighs are itchy despite there being no evident pathology to cause this to occur.  This area is innervated by nerves that may e sending the wrong signal to the brain which interprets a feeling of itchiness or priuritis, causing you to want to scratch, even though there is no actual irritation on the itchy surface.

Persistent genital arousal disorder (PGAD) is associated with unrelenting, unwanted, persistent, intrusive, and spontaneous sensations such as pressure/discomfort, engorgement, pulsating, pounding and/or throbbing in the genital tissues and/or in the perineum and/or anus in the absence of conscious thoughts of sexual desire or sexual interest. Persistent genital arousal disorder is often associated with significant personal bother and distress. Men and women with PGAD are often ashamed for having inappropriate genital feelings and often having suicidal thoughts.

Prostatitis is a frequently painful condition that involves inflammation of the prostate and sometimes the areas around the prostate.

Restless legs is similar to persistent genital arousal disorder in that movements are taking place with no control, spontaneously at specific times or throughout the day.

Lack of genital sensation may feel like a man is wearing 10 condoms.  Nerve testing can help determine where the injury is located.

Anorgasmia is a sexual orgasmic disorder in which there is persistent and consistent inability to achieve orgasm, after adequate stimulation that causes personal distress. Anorgasmia can be caused by psychologic problems or medical problems such as diabetic neuropathy, multiple sclerosis, or complications from spinal cord injury, genital surgery, radical prostatectomy, pelvic trauma, hormonal issues such as low testosterone and low thyroid. A common cause of anorgasmia is the use of anti-depressants, particularly selective serotonin reuptake inhibitors (SSRIs).  Anorgasmia may also be caused by lack of genital sensation due to injury in the cauda equina.

Men with pleasure dissociative orgasmic disorder or orgasmic anhedonia can achieve orgasm but derive no pleasure from it.  It is thought that they have a dysfunction in regulation of the brain neurochemical dopamine in the region of the brain’s reward center, the nucleus accumbens. This region of the brain is thought to play an important role in reward, laughter, pleasure, addiction, and music.  It may be caused by psychologic issues such as depression or drug addiction, or by physiologic issues such as high levels of prolactin, low levels of testosterone, use of medications such as SSRI antidepressants, chronic medical problems such as spinal cord injury, and chronic fatigue syndrome.  For some men it may associated with lack of genital sensation leading to lack of pleasure.