Androlog Mail:
Re: anorgasmia with anejaculation in a psychologically normal patient.(Dr
Vasan's query)
You need to examine for subtle neurological abnormalities to rule other
conditions. We have seen rare patients who have undiagnosed multiple
sclerosis and diabetes who presented with secondary anorgasmia, and occult
spinal dysraphism syndromes presenting as primary and secondary anorgasmia.
Cord tethering may lead to a worsening neurological condition with time in
those patients. I trust your patient has not been taking an SSRI, based on
your comments about his mental status. Unfortunately, even though you
believe your patient is "psychologically normal", I remain of the opinion
that most men with anorgasmia in the absence of a neurological diagnosis
suffer from a psychogenic problem, and sex therapy would be indicated.
However, response rates are not terribly great with therapy. You may try
vibratory stimulation of the penis. Failing those options, if fertility is
a consideration, electroejaculation under anesthesia is uniformly successful
in obtaining a semen specimen.
Dana Ohl
dana.ohl@umich.edu
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