Libido sensation

[neue01]

What are people lack of libido like? How does this physically manifest itself for you. For me I know it is not a mental thing because I can achieve performance when mentally stimulated but struggle with lack of a physical sensation. It stands that I might be able to achieve arousal mentally but the sensations around it are limited. My pleasure center or area of physical sensation is very limited and fluctuates a lot as to how limited it is. It also seems that my sensation around going number 1 and number 2 are toned back as well. Is this how it tends to be for others suffering with this symptom here?

[jj77]

Neue, I think it's very hard to find a convincing explanation to the CPPS/ED connection. I've had times when I thought it was a psychological thing, others when it all seemed a mechanical/organic thing, others when a clear connection to muscle tension seemed obvious. At the beginning of 2007 erections were totally back and I believed that the whole thing had a 100% psychological problem (2006 was really stressful for a variety of reasons), but after 2 months things returned to "normal".

So far, here's what I'm sure about:

a) it's not related to any difference in penis sensitivity.
b) it anyway depends on mind, at least partially: with my old girlfriend things were difficult at the beginning and then generally easier, with a casual one (and a condom), things become very difficult, etc.
c) it came out of the blue, after a huge flare up (and the peak of my stress).
d) luckily, I still can deliver pleasurable sex to my actual girlfriend, but much fun is removed for me (it has become more a sport, if you know what I mean).
e) (but this is just a sensation) lack of libido can be caused by the feeling of not being totally right. can you experience libido if you know that you are not gonna perform well? I don't think so, but again, it's not more than an opinion.
f) most importantly: I've always had a degree of anxiety related to sex, so not always thing ended up right, especially on first dates.
g) recovery time has extended.

My penny is that, in the end, ED can emerge in chronic prostatitis / chronic pelvic pain syndrome for a mixture of causes. Anxiety predisposition, muscle pressure/tension, some still unknown hormonal change (like the cortisol deficiency that may probably emerge from the recent study we are talking about in another thread) and just some old plain stress. That could explain why it shows up only in a delimited portion of patients.

Hope I explained myself, as English is not my mother tongue.

[neue01]

Great post. Definitely some things to think about in this regard. It's really a tricky issue and you are right that there is a huge mental component to it all. I dance back and forth between it being a metal issue or a mechanical issue. I have seen the effects of both in myself. I can definitely say that if you are having muscle issues in the area the sexual thoughts and feelings in that area might be profoundly effected. Especially muscles around the prostate and the urethra. It seems to me that it has multiple components.

I'd be interested in knowing how many people pull through this and gradually get their libido and sexual capacity back inline. Right now mine is very finicky and I can feel lots of muscle spasms and such in the areas around the prostate that I am massaging out. I also am getting random ghost pains in the urethra when I squeeze sometimes.

On a positive note I seem to have almost gotten rid of my dribbling after urination as I'm developing better control again of my urethral sphincter area.

[BrettP]

I can say for certain, that I have no problems getting erections, in fact when I do they are even harder than they used to be, and I may even get them more often, especially in the morning. However, it seems that sex has become less pleasurable for me, and I'm positive that this is due to the tension in the pelvic floor. This has caused a drop in my libido, its almost a mental conditioning, if something becomes less pleasurable, you want to do it less (or if it causes you to flare) I would say that's the only connection I can see in myself regarding a ED/ lack of libido...

[neue01]

This is how it is for me largely too. I can get a response from my system when mentally stimulated but my libido on it's own can be pretty shot and I do not feel the full range of sensation that I used too with ejaculation. My morning and nocturnal erections are fairly present but feel strange in their sensation a lot of the time. These issues all seem to have an effect on my response time from time to time and it's been really annoying. I have had many a flare up though where performance of any sort is completely out of the question. I seem to still get my flare ups from food containing gluten or large amounts of sugar. I'd love to be able to eat a normal diet again someday.

[J Dimitrakov]

This is how it is for me largely too. I can get a response from my system when mentally stimulated but my libido on it's own can be pretty shot and I do not feel the full range of sensation that I used too with ejaculation. My morning and nocturnal erections are fairly present but feel strange in their sensation a lot of the time. These issues all seem to have an effect on my response time from time to time and it's been really annoying. I have had many a flare up though where performance of any sort is completely out of the question. I seem to still get my flare ups from food containing gluten or large amounts of sugar. I'd love to be able to eat a normal diet again someday.

One possible explanation is related to BH4 which is involved in nitric oxide (NO) metabolism. Patients with chronic prostatitis / chronic pelvic pain syndrome have abnormal BH4 levels which result in low NO levels and erectile and orgasmic dysfunction.

Best,
JD

[boulder]

What's the synthase pathway that leads to NO? Would a chronic prostatitis / chronic pelvic pain syndrome patient be wasting their time (and money) taking (L-)arginine supplements if they have abnormal BH4 levels?

[J Dimitrakov]

What's the synthase pathway that leads to NO? Would a chronic prostatitis / chronic pelvic pain syndrome patient be wasting their time (and money) taking (L-)arginine supplements if they have abnormal BH4 levels?

NO is also known as "endothelium derived relaxing factor". The body makes NO from arginine and oxygen and various NO synthases.

Yes, it appears that a person with a BH4 deficiency is unlikely to benefit from L-arginine. Here's an interesting study:

J Androl. 2008 Mar-Apr;29(2):153-63. Epub 2007 Oct 31.

Oral administration of tetrahydrobiopterin attenuates testicular damage by reducing nitric oxide synthase activity in a cryptorchid mouse model.

Kondo Y, Ishikawa T, Yamaguchi K, Yada T, Fujisawa M.
Division of Urology, Department of Ogran Therapeutics, Faculty of Medicine, University Graduate School of Medicine, Kobe, Japan. [email protected]

Experimental cryptorchidism has been shown to induce germ cell apoptosis. Nitric oxide (NO), a ubiquitous free radical produced by NO synthases (NOSs), has been associated with apoptosis in a number of cell types. However, the regulation of NOSs in experimental cryptorchid testes remains unknown. Tetrahydrobiopterin (BH4), an essential cofactor of NOS, plays an important role in the generation of NO. It has been reported that activation of the immune system stimulates an increase in endogenous BH4 rate-limiting enzyme GTP cyclohydrolase I (GTPCH I) activity, resulting in an increase in intracellular BH4 levels and BH4-dependent NO synthesis in various cells. We examined the effect of dietary treatment with BH4 on GTPCH I, BH4 synthesis, NO production, and testicular damage in cryptorchid model mice. Male mice were treated with oral BH4 starting from age 4 weeks or received standard diet only, and right cryptorchid testes were created surgically at age 10 weeks. The testes were evaluated 0, 3, 5, 7, and 10 days after surgery by assays of testicular weight, BH4 and dihydrobiopterin (oxidized BH4) levels, GTPCH I mRNA levels, NOS protein expression levels, NO concentration, and nitrotyrosine (product of ONOO(-); determinant of NO-dependent damage) levels. In untreated mice, GTPCH I mRNA and BH4 levels increased and eNOS protein expression, NO concentration, and nitrotyrosine levels increased gradually. BH4 treatment decreased GTPCH I mRNA and BH4 levels, with concomitant reduction of eNOS protein levels, nitrotyrosine levels, and NO concentration, resulting in reduced testicular damage. Our findings demonstrate that supplementation with BH4 could provide a new therapeutic intervention for heat stress-based testicular dysfunction.

Best,
JD

[boulder]

Yes, it appears that a person with a BH4 deficiency is unlikely to benefit from L-arginine.

Thank you, Dr. Dimitrakov, for your fast and informative answer!

I apologize if this is a question whose answer is obvious, but, in the interest of clarification, let me ask: Is it thought that all chronic prostatitis / chronic pelvic pain syndrome patients have a BH4 deficiency, or just a certain subset of the chronic prostatitis / chronic pelvic pain syndrome patient group?

[J Dimitrakov]

We are starting to look into that right now. BH4 testing (if done properly) is not trivial and I am not aware of any studies that have evaluated the prevalence of BH4 abnormalities in CPPS.

Will keep you posted.

Best,
JD

[boulder]

Once again, Dr. Dimitrakov, thank you very much for your fast and informative answer!

[Xams2387]

Very old post and my first so I don't know if ppl will respond but I definitely can only get aroused mentally too. I'll see a hot girl or picture and rationally get aroused but nothing stirs down below. It's very noticeable in public/bars because I have no drive. No urge. Nothing physically stimulating

[dockuda]

Xams2387 I read your post and wanted to respond. I have dealt with this for quite some time and have been following the message boards for about 2 years, hoping I would come across someone who understands my symptoms. This concept of chronic pelvic pain in the pelvis is a very complex diagnosis and I have noticed, no very well understood.

Currently I have no sensation in my glans penis, and I can try masturbating until I pull the head off but nothing happens. My erections are not normal at all. The process of visually stimulating, arousal, and spontaneous erection does not exist. When I do orgasm, I can only feel it in the prostate. That increased friction that I once enjoyed that increases the girth of the erection and pleasure is gone. I also no longer get morning erections, which is a sign in and of itself that there is an organic cause and not a psychological etiology. I often experience pain as by bladder is filling, and sciatica like pains on the left side of my buttocks. Oftentimes I will have shooting pains in my penis as well. I was told for years that I had chronic prostatitis, but my prostate exam has always been normal. I attended Dr. Wise's clinic in California and unfortunately it did not benefit me at all. After doing my own research I strongly feel that I am dealing with Pudendal neuropathy. I am being referred to a physiatrist who will do testing of my pudendal nerves. I am not sure if this helps any, but I am not sure that anyone in these forums have a firm idea of what causes this problem and what really treats it.

[webslave]

Dockuda, your symptoms are not typical of a CP/CPPS patient. If you have a pudendal nerve problem, it should also be affecting defecation. Have you had any urinary or fecal incontinence? Imaging of the lower spine? Postural pain (absent when sitting on toilet, present when sitting on other surfaces)?

As I've said before, there are numerous organic causes of impotence. You need to see a specialist to evaluate them.

[Xams2387]

I have very similar issues as him. I thought they were definitely common in chronic prostatitis / chronic pelvic pain syndrome patients?