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Anyone know how to treat ejaculatory anhedonia?

Hi all

I've had longstanding ejaculatory anhedonia. I used to have phymosis - an overtightness of the foreskin which I think has caused some harm.

I have since been circumcised.

Anybody know how do go about treating such an issue?

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20620809 tn?1504362969
Sorry to hear you are dealing with this.  This is a fairly common form of sexual dysfunction.  This article is really long and technical. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6127532/  But it does have a lot of info in it.  Your doctor has not been informative at all? One thing I know comes up when you are being assessed is your emotional state.  Have you been depressed?  Are you anxious?  That can impact this.  To clarify, you have ejaculation but not orgasm with it? I'd also get your prolactin level checked.  There also seems to be some association when someone has a neurological condition.  Get your testosterone checked and do kegel exercises.  But mostly, talk to your doctor.
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Avatar universal
Thanks for the response.
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Does prolactin have an effect you say?
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You don't say exactly how this is manifested.  Are you saying you can ejaculate but it doesn't feel good?  There are many reasons this can exist.  One is caused by medication, including medication often used to treat some of these problems like SSRI antidepressants.  So one thing to look at is if you're taking medication or if you were when the problem started.  I was on SSRIs for a long time, and it caused me to take a really long time to ejaculate.  I did have the pleasure of it, but it could take forever.  But the problem didn't go away when I stopped taking those drugs, so what I'm suggesting here is one place to look is medication as effects can outlast the taking of them.  This is because of another possible reason, which is the brain to genitalia connection isn't working right.  Medication can cause this, but it can be caused by unknown factors.  I would assume a neurologist would be the person to see about it, but you doc should be able to direct you to the right specialist.  This by no means replaces what was said above, it's great info.  
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I was on SSRIs but a very long time ago. I don't think that is the cause but its possible.

I think that the cause was damage caused by phimosis which was since treated with circumcision but perhaps the damage remains.

Supposing it is nerve damage any idea how to treat that?
You still haven't said if you orgasm but it doesn't feel good or you can't orgasm at all.  If you can orgasm but you don't enjoy it, that's probably not nerve damage in the sense we think of it because stuff is working, it's the connection to your brain neurotransmitters that is messed up and we really don't know much about that or how to fix it since I don't know how you'd know which neurotransmitter was messed up.  This would be more in the line of mental illness, where we take drugs that affect our neurotransmitters but not because they're causing the problem but because it tamps down our symptoms.  If you can't orgasm at all, that might be a nerve problem, in which case you see a neurologist, but don't expect much.  I was said to have a nerve problem, though I don't know if it's true or not, by a surgeon after my prostate enlargement surgery left me with lots of problems, but he had no real treatment for it other than taking meds for nerve pain.  The question would be, is there a surgery that can rewire you (or me).  I didn't go back to see because my surgeon was a moron, but maybe there is such a thing and again, that's what neurosurgeons or urologists would do, I suppose.  But again, you haven't said how your problem is manifested.
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Sometimes it happens and sometimes it doesn't and when it does happen it is very delayed relative to ejaculation leading be to believe it is a nerve issue. Thanks for your response.
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I'm still unsure but it sounds like you can ejaculate, but it often takes a long time.  You kind of describe what happens often following surgeries on the prostate, which is odd because you don't report that.  My advice is, engage in a lot of foreplay assuming you're young and don't have any problem getting and keeping an erection -- if you have a problem getting an erection due to surgery or other reason this won't work -- but again if you're getting and maintaining an erection but it takes too long to ejaculate, this is a common problem faced by people on antidepressants, both men and women, and one way to deal with it is to do a lot of foreplay first so that by the time you enter into intercourse you're ready to ejaculate.  It's also fun.  Another way is to discover what really really turns you on and find a partner willing to do that.  The more turned on one is, the more likely it is to ejaculate.  Neither of these things gets rid of the physiological problem but they can help to minimize the negative effects of having it.
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