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Difficulty in getting orgasm, low sensation in penis, ED. Had C6 / C7 vretebra fracture, low power in lower limbs.

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General & Family Physician
Practicing since : 2005
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i met with an accident 11 years ago. my c6/c7 vertebra is fractured. But i can walk with the help of crutches. Low power in lower limbs. The problem is when i masturbate i just fall short of orgasm. My muscles can not push to ejaculate, tough some times i am succesful. There is low sensation in my penis. My body is also little spastic. I want easy orgasm/ejaculation. Please suggest methods/ medicines to overcome this problem. I face erectile dysfunction, but can achive errection if i keep stimulating penis.
Posted Fri, 13 Jul 2012 in Sexual Problems
 
 
Answered by Dr. Prasad 24 hours later
Hi,

I am Dr. Prasad, a general physician associated with the department of neurology. I see you have addressed this query to a sexologist. As no doctor have answered it yet (which is a rare occurrence on this website) and as your query partly contains neurological issue, let me take this opportunity to answer it.

Sexual problems are related to erectile dysfunction, problems with ejaculation and sexual arousal. From your query, it's not clear whether the problem is just difficulty to masturbate due to muscle fatigue or if you have some difficulty maintaining erection.

Spine injuries such as cervical spine trauma can cause total or partial erectile dysfunction. Since you are able to initiate masturbation, it implies the nerves are intact to erect your penis. Indeed if the difficulty is maintaining erection, then we have some erection enhancing pills (5 phosphodiasterase inhibitors) such as sildenafil / tadafil and they can help you.

However if the issue is muscular fatigue, then you need to strengthen muscles with physiotherapy. Spastic muscles can be corrected to some extent with physiotherapy. In addition healthy diet will benefit you. Perhaps a different method / technique where there is little muscular efforts may be tried to satisfy yourself.

Let me know if the issue is anything else and I will try my best to help you address it. In the meantime I expect any one of the sexologist to have a look at your concern and inform you if I have missed something. So please be patient for their reply.

Thanks for the query. I am available to answer any follow ups if you have any.

Best Regards
Above answer was peer-reviewed by
 
Follow-up: Difficulty in getting orgasm, low sensation in penis, ED. Had C6 / C7 vretebra fracture, low power in lower limbs. 3 hours later
Thanks for the reply.
As i said i am some times able to achive orgasm by masturbation but it is very time consuming. The problem is that errection is maintained as long as i keep stimulating penis. The moment i stop it starts to drop. I do not experience errection on mental arousal. There is spasticity in my legs & abdominal Muscles. I also have low libido.
What i want is to easily reach orgasm. I said that i reach the peak but just fall short of orgasm. I feel that the muscles needed to push the semen r not working effectively. so i can not reach orgasm.
The technique i developed is to put warm water on penis on reaching the peak point which gives the trigger pulse & this way orgasm is some times achievable
After orgasm i feel very relieved & my muscles feel relaxed.
So what i want is---
1) increased sensation in penis
2) easy way to reach orgasm
3) solution on my partial ED
4) reduce spasticity
5) Increase in libido.
I hope you can suggest medicines or technique for the above.
I have come across L Arginine. can it help. If so What is the dose & the Duration. If i take sildenafil & yet fail to reach orgasm, how long the errection is maintained.
 
 
Answered by Dr. Prasad 12 hours later
Hi and thanks again,

This clarifies lot of doubts which I had earlier.

Erogenic sensations from the penis need to travel through spinal cord to and fro to cause sexual stimulation, penile erection and later ejaculation. Ejaculation / orgasm is the end process of this whole act.

Thus spinal cord injury can explain all your symptoms - reduced sensation, partial erectile dysfunction and retarded ejaculation. The difficulty you face might be causing mental dissatisfaction resulting in loss of libido. Not to forget the lower abdomen and limb spasticity might also be due to the injury.

Since the injury was sustained 11 years ago, treatment and recovery of injured spine and nerves is probably not possible now. Thereby neurological correction at this point of time is a little difficult. However since your complaints are mainly related to sexual problems and spasticity, the symptoms can be correctable to some extent. Since sexual problems are treated differently and beyond the expertise of neurologist, I had to involve in some research and take some curb side consultation from my colleagues associated with sexology to be able to address your concern better. The following is my suggestions to you:

1. Penile Vibratory Stimulation: This is a simple outpatient procedure which uses help of mechanical vibrator designed for specific penile functions. The vibrator is set into action and placed over the glans or foreskin to help achieve maximum penile sensation of intact nerves. Since you are able to have erection, some stimulation and orgasm sometimes, I do not have any doubts that this will work for you.
You may consult an expert urologist / infertility specialist who can help you through the procedure.

If the whole things works you might repeat the procedure or but the instrument from a good surgical store using the help of the doctors.

2. Though erogenic stimulus is mainly from the penile structures, there is a good contribution from other body structures. I would encourage you to explore your body to find those erogenic parts. Stimulating them in addition to penis should intensify orgasm and help in faster ejaculation.

3. Erection enhancing pills are helpful to enhance and maintain erections. However there are lot of reports that they cause reduced sensation, so this may work against you. So I would not suggest you to use them now.

4. A few drugs used specially in the treatment of depression may have negative effects on penis sensation. I am not sure if you are on any such medications. If you are on any regular medications verify the side effect profile of each drug. Changing drug is entailed if any culprit drug is found.

5. Though there have not been many studies to suggest use of any medication specifically for this problem, few drugs which are worth trying are as follows
- Anti serotonergic drugs like cyproheptadine
- Dopamine agonist like amantadine, levodopa, etc.
Since these drugs are associated with various side effects, it is necessary that you take these under supervision of your doctor only.

These drugs may have added benefit in reducing spasticity.

In addition, I will encourage you to start physiotherapy if you are not on in any more. They will go in a long way in treating muscular weakness, spasticity and other neurological deficits.

The most important thing of all would be 'NOT to get depressed' now. You must have come along a long way from the injury and most of your neurological functions are intact. Losing your way now will only worsen problems.

All the best!

Hope you find this discussion useful. Let me know if you need any more information.
If you do not have any other follow ups, please close this discussion. Any feedback is welcome.

Best Regards
Dr. Prasad
Above answer was peer-reviewed by
 
Follow-up: Difficulty in getting orgasm, low sensation in penis, ED. Had C6 / C7 vretebra fracture, low power in lower limbs. 5 hours later
Dear sir,
thanks for the reply. I have tried simple vibrator which increases the stimulation very well. It takes me to the peak point, my muscles start trembleing but still fall short of ejaculation. Today i masturbated to good orgasm using my technique( putting warm water on reaching peak point, with good ejaculation).
I am mentally very healthy and not depressed as i am doing job & have lots of friends to pass time with.
I am willing to try the drugs suggested by you.
1) I would like to know some erogenic points of my body. though i found my nipples to be very sensitive, tell me more erogenic points.
2) if the spasticty in my limbs & abdomen are reduced , will it help reduce time for easy ejaculation.
3) Suggest me some good muscle relaxant so that i can directly buy it myself.
4) Suggest me some exercise to strengthen by bladder control.
Waiting for your reply.

Thank you
 
 
Answered by Dr. Prasad 16 hours later

Hi and thanks again,

I expected vibrator stimulation to work in the same way as warm water works without injuries. But since they don't help in many instances, I wonder if you can consult an urologist and discuss about medical drugs I suggested earlier. It should help you attain easy ejaculation.

Erogenic points vary among individuals. It can only be discovered by exploration either self or by your partner. Common erogenic points are nipple, ear lobule, feet, nape of the neck, etc. You would need to explore and discover those points for yourself.

Spasticity in limbs and abdomen are part of the same condition. Correcting it might play a role in treating sexual problems too.

Please understand that spasticity is a different condition associated with spinal cord injuries. I do not feel muscle relaxants will benefit you either in correcting spasticity or improving ejaculation. Do not be embarrassed to visit an urologist and talk about your problem. Though patients with delayed ejaculation and reduced penile sensation are less, I am sure your urologist will be patient and helpful.

4. I am not sure what you meant by bladder control - if you meant how to control dribbling urine pelvic muscle strengthening exercise named as keegel's exercise can be useful. The exercise involves voluntary contraction of muscles as done while trying to stop urine during urination.

Fix an appointment with a nearest urologist and I am sure you will learn plenty other treatment options from them.

Hope this answers your query.
Do close this discussion and review it if all your queries are addressed. Yet, if you have any more queries, I will be happy to address them.

Best Regards
Above answer was peer-reviewed by
 
Follow-up: Difficulty in getting orgasm, low sensation in penis, ED. Had C6 / C7 vretebra fracture, low power in lower limbs. 13 hours later
Dear sir,
learned a lot from the previous discussions. As suggested by you i am soon going to see a urologist. LAST QUESTIONs & i am done.--
1) I like to know what do the drugs you suggested i.e - Anti serotonergic drugs like cyproheptadine & - Dopamine agonist like amantadine, levodopa, etc. do. I mean do these help to reach orgasm easily in less time. or are they muscle relaxant. or do they increase sensitivity.
2) Can a women get pregnant with my quality of sperms, i mean can a man with spine injury produce good quality sperms.
3) Should i try actually having sex with my girlfriend.

These are my last questions, hope you understand my condition & reply accordingly.
I found your suggestions very valuable & looking forward positively.

Thank you very very much.
 
 
Answered by Dr. Prasad 11 hours later
Dear XXXXXXX,

I am pleased to know that you've learnt a few things from this portal. I am sure you’ll be able to learn more about your problem and its treatment after your visit to the urologist.

1. The drugs mentioned to you are primarily used in the treatment of rigidity as seen in Parkinsonism (a neuro-illness) patients. There are no large scale studies to prove its effectiveness in the treatment of reduced penile sensation. Nevertheless it is known to reduce ejaculation time.
Discuss about them when you go to visit the urologist. You can try it and I expect you to find it useful especially since the symptoms are related to spinal cord injury.

If possible do consult a physiotherapist and see if something can be done to treat spasticity.

2. As far as parenting a child is concerned, I do not find any reasons that you cannot. Get your semen analysis to know more about it.

3. Yes. You should definitely try sexual intercourse. If you haven't tried yet, talk and discuss about your problems with your partner. You will be able to have successful sexual life.

All is not lost yet.

Thanks for posting this query to me.

Do not forget to close this discussion if you have no more queries for me. Feed backs if any are appreciated.

With Best Regards
Dr. Prasad
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