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Efficient treatment of anorgasmia due to penile prosthesis implantation with combined treatment of cognitive behavioral therapy and mirtazapine

Article in Klinik Psikofarmakoloji Bulteni 14(2):92-96 · June 2004 


Although postoperative complications of penile prosthesis implantation have been widely investigated, and has not been found to be associated with orgasm function, little is known about its effects on psychogenic aspects of sexual functioning after such a treatment approach. Reports of orgasmic dysfunction after penile prosthesis operation is lacking in the literature. We report a case who developed orgasmic dysfunction (anorgasmia) after penile prosthesis operation and later showed significant improvement with combined cognitive behavioral approach and miriazapine treatment.

Anejaculation is the inability to ejaculate semen despite stimulation of the penis by intercourse or masturbation. The causes can be psychological or physical and anejaculation can be situational or total.

Situational anejaculation means that a man can ejaculate and attain orgasm in some situations but not in others. Typically, situational ejaculation is stressed induced and occurs selectively. For example, a man who is able to ejaculate at home may not be able to do so in order to provide a specimen in a clinic because he is self-conscious and anxious. In some instances, a man may be able to ejaculate and attain orgasm with one partner but not with another. This usually occurs when there is a psychological conflict in a relationship and difficulty with one partner. In total or complete anejaculation the man is never able to ejaculate, either during intercourse or through masturbation. In the absence of spinal cord injury or multiple sclerosis, deep-rooted psychological conflicts may be the cause for this scenario. Such men however, usually have normal nocturnal (night) sleep emissions of semen.

Total anejaculation is further divided into anorgasmic anejaculation and orgasmic anejaculation. In anorgasmic anejaculation the man is never able to reach an orgasm in the waking state (either by masturbation or by intercourse) and does not ejaculate. This failure to reach an orgasm is sometimes attributed to psychological inhibitions, as was previously mentioned. Some may need a high amount of stimulation before they reach orgasm and do not get this stimulation during intercourse or masturbation. Low serum testosterone levels or psychotropic medications may also prevent men from reaching orgasm and ejaculation. Hormonal therapy for the treatment of prostate cancer can also render men anorgasmic. Most men following complete or incomplete spinal cord injury (SCI) will lose their ability to ejaculate and have an orgasm. Approximately 60% of spinal cord injured males will continue to be able to have erections however. In some instances, men taking medications known as serotonin re-uptake inhibitors (Paxil, Zoloft, Lexapro) will experience ejaculation without the sensation of orgasm.

Bionic wrote:I dont think I had any unrealistic expectations when I decided to get an implant. I really researched it before going ahead. I knew of all the possible complications that could have occured, save one. I know the surgeon well , having worked him on many occasions, over many years as an X-ray tech providing imaging support in procedures that required GU medical imaging, such as kidney stone removal and other procedures. In my opinion he is the best out 5 or 6 guys i worked with. I trust him. I personally know he does alot of implant surgeries.
So hes very experienced.
Prior to the implant decision I had tried oral meds, a ved device and injections with mediocre results.
I was diagnosed with type 2 diabetes a couple of years ago and started realizing that my E.D was not going to get better, but worse. So having read from other members on the Franktalk implant forum that their biggest regret was waiting so long, when they realized the promised benefits of the implants.
I didnt have any scarring from the injections (I didnt inject very long).
So I decided to take the plunge (10/12/2018,AMS LGX infrapubically). I knew there would be some shortening and the possibility of infection.
I remember telling the surgeon I just wanted to make sure I wouldn't regret it.He very confidently told me I wouldnt. Well unfortunately" I DO."
Its bad enough unbeknownst to me, that my penis quietly atrophied over the years I was on medications that had possible impotent side effects like Gabapentin (10 yrs or more) and high blood pressure meds that inhibited nocturnal erections that maintained penis health. So loss the of length is far greater than I expected. (more than 2")
But in addition to that I am unable to feel anything because of numbness I started having right after activation.
I was able to have an orgasm by masturbating a few weeks before activation. And that was in November. And havent been able to orgasm ever since, no matter how I try.
The surgeon is at a loss to explain. Prior to surgery I was able to at least pleasure my self, now Im actually worse off that before the implant. Anyone else have comments on my predicament?