Author Topic: San Diego Sexual Medicine’s POIS Research / Kit’s Case  (Read 610 times)

Kit

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Hello everyone! I hope you are all doing well!

I would like to share my personal experience with POIS and what I am doing to find the causes of my POIS and chronic symptoms. I am also looking for specialists and treatment options to treat my POIS and chronic symptoms. I will present it in a diary-like format. Just a head up, this thread will be long and I hope that members will take the time to read this, even if it will take days, weeks, or even months. Just skimming through this thread for information you may be interested in would be okay. This thread is a merge of all my questions that I had for members that has become a case thread.

I would like to talk about my opinion about MRI contrast and recommendation for MRI scheduling, but these topics should be discussed with a medical professional.

This thread will mention experiments that I have tried for some of my chronic symptoms. I strongly advise that you please consult a medical professional if you are interested in trying the same experiments and that you will be 100% responsible for any consequence you may have as a result of the experiment.

I was given permission by Dr. Goldstein to share their POIS information/research here on this forum. I will include discussed hypotheses, the neuro-genital tests I took, my results, and diagnoses. SDSM is relating POIS to the spine. Just noting, the hypothesis discussed with me after me Quantitative Sensory Test (QST) may be for my own personal condition only and perhaps for others who may have spinal disc disease. That is not say it won’t be relevant to all POISers. As a result from my first neuro-genital test, I had an MRI lumbar scan done and obtained findings from both my previous primary clinic and SDSM. I also had MRI scans for my brain and spine and an EEG done for my neurologist. I will be including findings from all three clinics here on this thread.

NOTE: Everything I say may not be 100% accurate, but I did my best to make this thread to be 100% accurate as possible! Please correct me if you find something incorrect or needs to be changed, I will edit it. This thread will be subject to updates and modifications.

I am a 23 year old male with secondary POIS. I am not sure exactly what age I began mastubating, but I remember mastubating as far back around the ages between 13 and 15 and POIS symptoms onset at the age of 18. Hindaring chronic symptoms were developing much later around the beginning of 2017. Most of my blood, urine and imaging tests I took came back normal according to the standards of the laboratories where I had my tests done. To my surprise, the only official abnormal tests I received from these laboratories are Vitamin D deficiency and a herniated nucleus pulposus with central, left-sided annular tear on L5-S1.

I am not a medical professional. Always consult a medical professional before taking any medical advice and suggestions from POIScenter or anywhere on the internet! I am an advocate of the right to medical privacy, so I ask that people please respect my privacy and to consider whether posting their own medical results/data online would be necessary. This information is to be used for POIS research only. I am not promoting nor soliciting for SDSM or anyone!

Here is a link to the forum rules.
https://poiscenter.com/forums/index.php?topic=1.msg10259#msg10259
« Last Edit: July 11, 2021, 05:52:21 PM by Kit »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #1 on: May 01, 2021, 12:19:05 AM »
In March 2020, I had my first phone consultation with Dr. Goldstein. We discussed some of my symptoms, a POIS hypothesis, and recommended labs and testing.

My symptoms after ejaculation; most of these symptoms would last 4 days:
  • Brain fog (trouble recalling, trouble remembering information after it has just been given or a few minutes later, difficulty concentrating)
  • Anxiety
  • Irritation
  • Fatigue
  • Insomnia
  • Depression (can occur a few times if I ejaculate before an important or meaningful event)
  • Lightheadedness
  • Decreased touch and “feel good” sensation of the scalp and an increased dull pain on the center area of the crown of the head (1-2/10 pain severity when gently pushed.)
  • Increased mucus production/stuffy nose
  • Neck “cracking” sounds in the back of the neck. (They are not loud but they can be recorded and heard.)
  • Muscle spasms on the suboccipital muscles (muscles on the back of the base of the neck), upper back muscles, and a few times on the lower back muscles near the spine to the left.
  • Palpitations (In January 2020, I had orthostatic intolerance like-symptoms such as an increased heart rate w/or lightheadedness after sitting or lying down. This was relieved by drinking only water from bottled and filtered water. I have not tried tap water.)
  • Decreased touch sensation of the skin of my arms, legs, neck, scalp and a few other parts of my body.
  • Tingling/crawling sensations that are sometimes accompanied with pain in between, on the sides, and underneath the shoulder blades. (Pain varies in intensity from 1-3/10. Sometimes, there can only be tingling/crawling sensations and no pain and vice versa.  Pain and tingling can occur by using the hands or fingers like washing the dishes, typing on a keyboard, or by holding something like a cooking pot or even something light like my cell phone. Massage can also cause tingling and even staying in the sun for about 30 min can sometimes trigger a “cold” tingling feeling. I also suspect that the tingling may be coming from something that I am eating. I am still looking into this.)
  • Pinching sensations that occur on the back like on the supraspinatus muscles (upper back muscles) and on some muscular parts of the mid back.
  • Ejaculating 3x in one day made a painful muscle spasm near the muscle on the left side of my lumbar spine.
  • Slight burn feeling in the penis during ejaculation and gets relieved immediately after ejaculation. (Occurs rarely.)
  • Muscle Weakness

Here are my symptoms post-ejaculation that I had at some point during a POIS episode that have not returned or have decreased in severity as of today:

Not returned: hot flashes, itchy eyes.

Decreased in severity: headaches, burning sensation of the scalp, increased heart rate with/or lightheadedness after getting up from sitting or lying down, akathisia.

Top POIS symptoms that cause the most hindrance, are the most concerning, and are not in any order: 1.Brainfog, 2.decreased sensation of the scalp and skin of the arms, legs, neck, cheeks and other parts of my body, 3.muscle tension/spasm on the suboccipital muscles and upper trapezius muscles (1-2 pain intensity), 4.anxiety, 5.insomnia.

The development of my POIS:

I believe my POIS developed during my first year of college by the end of my first semester for Fall 2015. For final exams, I remember having trouble remembering what I had studied while doing the exam, and while I do not remember specifically if it was from ejaculation, it most likely was because I have never encountered such an incident. It was also one of the most productive semesters I have ever completed. I also remember taking less classes for the next semester (Spring 2016) because I knew that something wasn’t quite right with me. At the end of 2016, I noticed that something was definitely not right and I needed to seek medical attention. Because of this, I would stay indoors more than usual, rarely seeing the sun, which may have contributed to my vitamin D deficiency. I also viewed pornography with masturbation more than usual and this is what I believe may have contributed to worsening on my physical health and therefore, gradual worsening of my mental health.

In March 2017, I went in for my first doctor’s visit for palpitations, but I did not mention that the palpitations were a result of ejacultion due to embarresment. My pornagraphy use here was still very active. In July 2017, my diet was also not the best eating whatever I felt like eating. It wasn’t until December 2017 when I mentioned that I got sex headches from ejaculating. I was prescribed Ibuprofen for tension headaches and I was reluctant to take the ibuprofen for the concern of my liver and because I felt misheard when I said my headaches came from masturbation and were not general episodic “stress headaches''. When I take two tablets of Advil 30 minutes before ejaculation now (400mg), it helps a little with muscle dullness and slightly with brain fog. Around this time, I had also developed a phobia of medicine due to fear of creating or worsening a problem. This phobia lasted for 3 years. Now, I look at medicine from a scientific perspective but I would still much prefer more natural alternatives. In July 2019, I remember decreasing the amount of times I watched porn to avoid POIS symptoms and by January 2020, I drastically decreased the amount of times I watched porn to avoid POIS symptoms after learning about it. As of now, my pornagraphy use has been very limited. From here and beyond, I have been looking for the cause of my symptoms.

If stress from school, pornagraphy with masturbation, my poor diet or vitamin d deficiency contributed to the development of my POIS, I would not know how. I have changed my habits and have been consistent with these changes with the longest time being about 2 months and a half and I still could not find relief from most of my symptoms. It can also be difficult and counterproductive to be consistent with these changes when POIS hinders a productive day. I also suffer from chronic loss of sensation in parts of the genital and decreased sensation of the legs and I do not remember if these sensation issues have been around since my POIS started or if they developed after my POIS started. So it could be playing a role in my POIS or it just may be a separate issue, and this is where we need help!

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #2 on: May 01, 2021, 12:44:27 AM »
Unfortunately, I suffer from chronic symptoms that I have minimal success in treating and finding relief for. Symptoms that I consider chronic are bothersome and concerning symptoms that are still present after the 4 day mark where most of my POIS symptoms have been reduced by 90% or after 14 days of last ejaculation. A POIS episode can make my chronic symptoms like my ADHD and trouble breathing worse and while they do get better after the 4 day mark, these chronic symptoms still hinder my quality of life during abstinence. With so many symptoms going on, it is difficult deciding what kind of approach I should take.

Thankfully, I can manage many of my chronic symptoms with basic self-care, but that can only do so much. Examples include walking outside for 30 min to an hour 5-6x’s a week, 15-20 min low aerobic exercise at most 3x’s a week, eating healthier, drinking lots of water everyday (32oz-64oz a day), an 8-9 hr sleep schedule, spending time with family and friends, meditation and prayer, and hobbies like listening to music and watching my favorite TV shows. Of course, abstaining will also help with managing POIS and chronic symptoms.

These are other reasons why I am so motivated in getting better is to enjoy these moments without the hindrance of POIS!

Here is the list of my chronic symptoms and incidents that have occured in my lifetime since the onset of my POIS:
  • Anxiety
  • Stress
  • Trouble remembering/recalling, difficulty concentrating, spacing out/zoning out during conversing and not conversing (ADHD self-diagnosed).
  • Decreased sense of smell
  • Cracking sounds around the base of the neck. (Cracking sounds are not loud, but can be recorded and heard).
  • Trouble breathing (1/10 severity that is susceptible to becoming worse from anxiety, using a mask for more than an hour, cold weather or even from sleeping.)
  • After telling bad news to a relative and brushing my teeth one day, I felt a pool of something (maybe blood) in my chest that fell to my lower part of the abdomen causing a hot flash and tinnitus immediately. I got relief from this minutes later. I know another similar incident has happened to me in my lifetime since my POIS onset, but I did not suffer anything significant after those two incidents. (Only happened 2 times since I had POIS).
  • Decreased touch sensation (I can feel temperature, but touch detection seems to have decreased) of the skin of my arms, legs, neck, scalp and a few other parts of my body. (POIS can worsen this symptom).
  • Dull pain of the suboccipital muscles and upper back muscles. The pain actually comes from pressing firmly on the muscles and it’s pain intensity range is from 1-3/10.
  • Tingling/crawling that is sometimes accompanied with 2/10 pain severity in between the shoulder blades and underneath the shoulder blades. Sometimes there can be only tingling/crawling sensations and no pain and vice versa. This can become worse during a POIS episode.
  • Pinching sensation with slight pain in the upper trapezius muscles (occurs rarely and happens more often during a POIS episode.)
  • Unusually frequent cold hands.
  • Semen on the palm and back of the hand caused a burning and itching reaction in the front and back of my right hand during 4-5 minutes of placement and leaving a visible scar/trail. As of today, that scar/trail went away and did not even leave a barely noticeable scar.
  • Rash development from semen placement on my hands.
  • Exercise intolerance (only for running, moderate-high weight training and cardio, and exercise under the warm sun and must take it easier under warmer temperatures).
  • Unusual reactions in the sun after about 20-30min. Reactions would include trouble/decreased sweating, “cold” tingling sensations on the legs, low-energy, “pressured” feeling in the body, lightheadedness and trouble focusing. I also get unusual reactions in cold temperatures after 15-30 minutes and these reactions would include tensing up the lower back, difficulty with breathing and anxiety.
  • Food sensitivities (When eating certain foods, my Fitbit watch displays a heart rate (HR)of 100 - 110, and goes back down to a normal HR of below 99 after a few seconds of digestion. I can sometimes find some relief with decreased stress and anxiety, eating smaller portions of food, and Aloe Vera concentrate supplements. I do get a burning sensation in the esophagus sometimes when I eat foods like citrus fruits and chocolate. Diagnosed as GERD by my gastroenterologist.)
  • Fatigue after eating
  • Loss of sensation on the glans penis and on the left side of the penis shaft and decreased sensation on parts of the leg.
  • Muscle weakness especially in the upper back
  • Unintentional weight loss (I lost 10lbs. in 2 months).
Here is the link to my semen allergy thread:
https://poiscenter.com/forums/index.php?topic=3791.0

Here is the link to my breathing issue thread:
https://poiscenter.com/forums/index.php?topic=3813.0

NOTE: I may have also developed new/worsening chronic symptoms by pushing myself too hard when I needed rest. Now I know that it is very important to listen to my body and rest when needed. My development of new and worsening chronic symptoms may have also developed from unawareness of POIS. But I can not say for sure that these are what caused my new and worsening chronic symptoms. There have been many days where I have had reduced stress and have attempted to manage my anxiety and stress, which does sometimes help to reduce the severity of my POIS and overall well-being, but it has not done anything to make my POIS go away completely.

Top Chronic Symptoms in terms of hindrance, the most concerning and are not in any order: 1. ADHD (self-diagnosis), 2. loss of sensation/decreased sensation of the penis/body, 3. GERD, 4. unusual reactions under the sun and in cold whether 5. Trouble breathing that is susceptible to becoming worse (panic attacks?).

Chronic symptoms that have decreased drastically in severity: painful scalp, orthostatic intolerance like-symptoms (self-diagnosed and found relief with only water).

NOTE: In the beginning, I did not mention all of my symptoms to Dr. Goldstein to avoid confusion, but he knows about all of my symptoms now (has an edited version of this thread). In the beginning, the focus was put on my primary POIS symptoms like brain fog, muscle spasms, anxiety, loss of sensation of my genital/legs and my abnormal neuro-genital testing.

Here is a link to my official abnormal test results found so far from March 2017 to today with their diagnosis(ses) that are still in effect today while searching for the possible cause of my POIS symptoms and chronic symptoms. I also got diagnoses from consultations! You may copy and paste information from the link for forum quotes and other POIS research references:
https://www.dropbox.com/s/gghh1ynkiq5v7cu/Kit%27s%20Official%20Diagnoses%20so%20far.pdf?dl=0
« Last Edit: July 11, 2021, 05:33:29 PM by Kit »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #3 on: May 01, 2021, 12:47:51 AM »
Here is the first hypothesis I discussed with Dr. Goldstein for POIS in March 2020:

"The sensory pathways from the genitals are known to eventually pass to the paracentral lobule cortical neurons in the somatosensory cortex of the brain. There are first order neurons that pass from the genitals and convey temperature, pain, arousal, and itch stimuli that synapse at the conus medullaris (sacral level of spinal cord). There are second order neurons that cross to the opposite side of the cord, passing in the lateral and ventral spinothalamic tracts, and synapse in the thalamus. There are third order neurons that convey sensory neural information from the thalamus that synapse in the paracentral lobule, There are fourth order cortical neurons and their projections. These projections of the paracentral lobule may include limbic structures such as the insula, cingulate cortex, amygdala, hippocampus, medial preoptic area, ventral tegmental area and the mesolimbic system."
"During fMRI studies of adults without sexual dysfunction, orgasm is associated with a predictable activation of various centers of the brain that regulate pelvic muscle contraction, satiation, satisfaction, etc."

"Adults with POIS have not yet been studied in fMRI units at this time. We would like to initiate this research soon."

"It is hypothesized that in adults with POIS, fMRI studies would show that orgasm was associated with abnormal projections to various centers of the brain that are associated with: disorientation, confusion, decreased verbal memory, anxiety, insomnia, depression, seizures, headaches,.
Strategies to reduce these abnormal projections would become the treatments for adults with POIS."

In July 2020, I came in to see Dr. Goldstein for my first in-person consultation and completed the Quantitative sensory test (QST).

We discussed slides a patient receives on his/her first visit, a spine hypothesis, and neuro-genital testing with one test completed.

Here is the link to the slides:
https://poiscenter.com/forums/index.php?topic=3783.0

Here is the link to the description of a QST from SDSM’s website:

http://sandiegosexualmedicine.com/male-diagnostic-tests/neurologic-testing

To find the description, find the paragraph that begins with: “The sensory genital neurologic exam in a man with sexual health problems elicits information concerning sensory pudendal nerve integrity...Quantitative sensory testing involves...”

My QST was abnormal. Here are my diagnoses after the QST:
  • Paresthesia of the skin
  • Segmental and somatic dysfunction of lumbar region
  • Segmental and somatic dysfunction of sacral region.




Basically, I have loss of sensation on my penis glans and on the left side of my penis shaft. My brain was unable to receive hot and cold temperatures from the tip of my penis, on both sides of my penis glans, and on the left side of my penis shaft. The sensation issue on my penis glans and the left side of my penis shaft does not seem to go away, even with abstinence.

NOTE: The fastest way to test for this is with your finger tips if they are cold. Another way I recommend to test for abnormal sensation of the penis or other part of the genital or leg, is using an ice cube and not heat. For the penis glans or any part of the genital or leg, use gloves, a towel or a paper towel(s) to hold and wet the ice cube with lukewarm water to lessen the stickiness of the ice. Use the same gloves, towel or the same or different paper towel(s) to hold on to the ice. Gently tap or rub the ice on either side of the penis glans or on the tip of the penis, but no longer than 3 seconds and can be done no more than 2-3 times. Repeat on the penis shaft or other part of the genitals or legs if needed, again, tap or rub the ice on either side of the part you're experimenting on and follow the same rules that applied. Your brain should not be able to detect cold temperatures if you have abnormal sensation of the penis glans or any other part of the genital or legs. Once more, it would be recommended to talk to a doctor if you decide to do this. Again, you are 100% responsible for the consequences you may have if you decide to test this.
 
Here is the discussed spine hypothesis after the abnormal QST test:

“As we discussed, POIS symptoms may be a manifestation of a radiculitis resulting, in part, to irritation and increased sensory afferent information from various sacral (S2, S3, S4) spinal nerve root (SSNR) pathologies. Sensory afferent information from the genitals (dorsal, perineal, inferior rectal and pudendal nerve) enters the spinal cord as S2, 3, 4 Sacral Spinal Nerve Roots (SSNR). SSNR must pass: i) from S2, 3, 4 (deep at mid buttocks), ii) continue as part of the cauda equina up to T12 (last rib), iii) synapse with the end of the spinal cord at the conus medullaris. It is apparent that in the lower spine region - SSNR are subject to compression
from various sacral and lumbar spinal cord pathologies - Tarlov cysts, annular tear, disc impingement, facet cysts, spinal stenosis. The compression results in irritation and radiculitis - leading to symptoms consistent with POIS. Consistent with this hypothesis, radiculitis of the SSNR is suspected, based on your abnormal neuro-genital testing.”

“Since your testing was abnormal, the next step is to obtain an MRI of the lumbar and/or sacral spinal cord.”

“In some men, orgasmic disorder may be in part related to an imbalance of excitatory and inhibitory neurochemicals in portions of the brain where the sexual reflexes are regulated. There are no current FDA-approved therapies for this sexual disorder for men. The following strategies represent logical and rational efforts to re-balance the neurochemical imbalance thus-allowing libido to happen.”

NOTE: I have not yet taken any medications that Dr. Goldstein has prescribed to me. I wanted to try safer alternatives first like Vitamin D because I was deficient in it. Also, when I discovered this forum, I found out there were more natural and safer alternatives to choose from to treat POIS. I am always looking for a more natural option to treat my POIS and chronic symptoms, but I won’t be entirely skeptical of medications if I know they can help. The medications that Dr. Goldstein prescribed to me were Clonezepam, Topiramate and a recommendation of Adderall, all medications that usually require a prescription by a medical professional.

In April 2021, I took Clonazepam 0.5 with side effects of clumsiness on the first dose and worse symptoms of irritation and clumsiness on the second dose that lasted until 2am in the morning when I woke up. For this reason, I have decided to stop Clonazepam.

Since my QST was abnormal, an MRI was considered. The MRI was completed in August 2020, at my previous primary clinic. One radiologist reviewed my MR pelvis and another reviewed my MR lumbar spine.

Here are my results my MR Pelvis and MR Lumbar both without contrast:
https://www.dropbox.com/s/qwa5qx7498b5wy3/MR%20Pelvis%20and%20Lumbar%20without%20contrast.pdf?dl=0

The Center of Excellence for Genito-Pelvic Dysesthesia (CEGDP) is a collaboration with Dr. Irwin Goldstien, Dr. Choll Kim, and Dr. Barry Komisaruk who diagnose, treat, and manage sexual dysfunctions caused from injury to the sacral spinal nerve roots (cauda equina) of the spine.
https://www.spine-sexmed.org/

Dr. Kim is the one who reviewed my MR pelvis and lumbar spine. Here is his finding:

A herniated nucleus pulposus on L5-S1 with central, left-sided annular tear.

NOTE: Yes, there was a discrepancy between radiologists and Dr. Kim for what my lumbar MRI shows: I got 2 results for Degenerative Disc Disease from my previous primary clinic and I got 2 results for a herniated disk on L5-S1 (one from Dr. Kim and my current primary clinic when I scanned my lumbar spine for possible M.S.). I received an email from Dr. Goldstein showing the obvious annular tear on L5-S1 when it was re-reviewed by Dr. Kim. I am going with my herniated nucleus pulposus on L5-S1 with a central, left-sided tear diagnosis, since it is supported the most. I know my herniated disk is probably the culprit of my loss of sensation on my genitals, but Dr. Goldstein and I are still trying to better understand how it could possibly be related to my POIS, how one area of the spine could be causing all this trouble. The herniated disk is most likely a result from aging of the spine. I was never struck on the lumbar spine and I have never been in a major accident around the onset of my POIS that would have resulted in my herniated disk.

For treatment from SDSM then, Dr. Goldstein would like to try a diagnostic transforaminal epidural steroid injection (TFESI) on the affected L5-S1 to see if this will drastically alleviate my POIS symptoms. The injection was intended to be used as a diagnostic injection by blocking pain signals. It was required that my symptoms be present prior to the injection to determine whether or not my symptoms would be relieved after the injection. Prior to the injection, if my distressing sexual symptoms are present, I would make note of how much they are relieved during the first 2 hours after the injection while numb. If, prior to the injection, and my symptoms are not present, I would be required to perform the activity that usually aggravates my distressing sexual symptoms (i.e. sex, masturbation, etc). The hope would be that the distressing symptoms will last the duration of the pre-injection period and that I will experience marked relief during the first 2 hours after the injection while still numb.

I had decided to refuse the  diagnostic TFESI because of my neurlogist’s opinion about creating another problem if something went wrong with the TFESI. Also, a TFESI to a POIS patient on the spine is a brand new practice I believe, and I don’t think I would have the willingness to handle another new problem.

Treatment options if the diagnostic TFESI were to be successful in reducing POIS symptoms:

Surgery, Chiropractor, Physical Therapy, Shock Wave Therapy.

NOTE: I am trying to avoid surgery at all costs, but I will look at it with an open mind! I do believe that there are better and more safer options than surgery to treat my POIS.

Most of the time, I do not experience any pain as a result of my herniated disc with a left-sided annular tear. I do however, get pain sometimes in my lower back if I get really stressed or when I am really cold and tense. I do sometimes notice some mild-moderate pain in the low back area sometimes after ejaculation or in the shower after ejaculation. Most of the pain for my lumbar spine would occur on the left muscle near my lumbar spine. The pain resulting from stress, exercise/dancing, or cold temperatures, or from anything that would make it ache would go away with sleep. I got a painful muscle spasm on the left muscle near my lumbar spine when I ejaculated 3x’s in one day. Most of my muscle tightness and pain complaints come from my suboccipital muscles and on my upper and mid back muscles. Again, my herniated disk is most likely a result from aging and I do not remember any physical trauma that occurred around the onset of my POIS and beyond.


After the MRI was completed, I completed the Dermatome and Bulbocavernosus Reflex Latency Test on my second in-person visit at SDSM in September 2020:

Here are my Dermatome and Bulbocavernosus Reflex Latency Test results:

Nerve Testing: Dermatome

Dermatome Test Results: Abnormal



Similar to the QST, I was tested for sensation on other parts of my lower body that do not include my genitals. I received a “5 volt” score on my finger (normal), but I received delayed scores on my glutes, thighs, and calves with better scores on my feet.

Nerve testing: Bulbocavernosus Reflex:

Bulbocavernosus Reflex Latency Test: Abnormal



Here is the description of my experience with the
Male Bulbocavernosus Latency Testing (BCR): 

“The bulbocavernosus reflex latency test involves electromyographic monitoring of bulbocavernosus muscle or external anal sphincter musclecontraction in response to mechanical stimulation of the glans penis. The bulbocavernosus reflex latency test is spinal mediated and used to verify function of sensory and motor S 2, 3 and 4 sacral roots as well as the cauda equina. The bulbocavernosus reflex latency test has been found to be delayed, greater than 45 msec, in patients with sexual medicine complaints related to injury to the sensory and motor S 2, 3 and 4 sacral roots as well as the cauda equina.”

“The patient is aware of the need to undergo bulbocavernosus reflex latency testing. Risks and benefits were discussed and informed consent obtained. Risks include skin irritation if shaving of hair is required to attach the adhesive patch in the peri-anal region or local skin irritation from the adhesive patch itself. The patient was placed supine the stirrups. The EMG cable was brought to the patient. Right and left patch adhesive red EMG electrodes with extra EMG conductive gel were placed in the 9:00 right and 3:00 left peri-anal regions. These EMG electrodes would record external anal sphincter muscle activity. A control/reference green patch adhesive EMG electrode with extra EMG conductive gel was attached to the thigh region. The EMG cable was attached to the Uroval Bulbocavernosus Reflex System (BRS) system. The patient was asked to contract and to relax his external anal sphincter muscles. Baseline EMG and contracting EMG activities were recorded. A BRS probe tip was inserted into the BRS probe and the audible click was noted. The BRS system was started. The patient was asked to relax and baseline EMG activity was noted. Multiple mechanical stimulations of the right and left glans penis were performed. A minimum of 15 seconds occurred of baseline activity between mechanical stimulations.”

“Right bulbocavernosus reflex latency values were all greater than 45 msec - these are abnormal and outside the normal range. This test is considered abnormal and consistent with pathology in the sensory and motor S 2, 3 and 4 sacral roots or the cauda equina.”

“Left bulbocavernosus reflex latency values were all greater than 45 msec - these are abnormal and outside the normal range. This test is considered abnormal and consistent with pathology in the sensory and motor S 2, 3 and 4 sacral roots or the cauda equina.”

I did not get any new diagnosis or side effects as a result from these 2 tests.
« Last Edit: May 13, 2021, 06:18:25 PM by Kit »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #4 on: May 01, 2021, 12:56:46 AM »
In January 2021, I completed Urine Samples and Blood Tests for fatigue. Here are the results:
https://www.dropbox.com/s/vqv6cqmd768cpmr/Blood%20and%20Urine%20Jan.%202021.pdf?dl=0

I may also post my blood and urine tests from March 2017 to August 2020 if necessary. There was quite a lot, so please give me some time to get them prepared.

I have also had chest x-rays, EKG’s, and a CT scan of the head and neck, all which were reported back to me normal.

In February 202I, I had an MRI W/O contrast done by my neurologist for my brain and entire spine (cervical, thoracic, and lumbar) for possible Multiple Sclerosis w/POIS. Here are my results:

https://www.dropbox.com/s/bi2nkie4boa5yuq/MRI%20W-O%20Contrast%20For%20Brain%20And%20Spine.pdf?dl=0

Results: No evidence for M.S. was found.

My opinion about MRI contrast and recommendation for MRI scheduling:

NOTE: For MRI contrast, the contrast material that was used for my exam is a Gadolinium contrast medium that is injected into the vein on the arm to enhance the images or pictures. While it is very beneficial for the radiologist to accurately find abnormalities and diseases, there are possible side effects that someone with POIS should consider and determine whether this contract medication would be something that they would believe would be worth the while. Contrast can also be painful just for the first hour and the pain can diminish from there. It can also add up to the cost of the exam and do more harm than good, especially if there isn’t much information about POIS just yet. Also, there is no radiation exposure during an MRI exam making it one of the more “safer” options for people who are looking for body scans and contrast would contradict that safety.

I also recommend splitting up the scans and scheduling them on different days. For example: Brain and Cervical on one day and Thoracic and Lumbar on another day. I had them done together all at once and it was one of the most boring and unpleasant experiences ever!

Here is a link explaining Gadolinium/contrast use in MRI’s:
https://www.drugwatch.com/gadolinium/

I used Gadolinium because I thought it would help find the cause of my tingling in the back or pain on the sides of my spine, the tingling and pain underneath my shoulder blades, or anything explaining my unusual symptoms.

I did not get any side effects as a result of my MRI exam.

In March 2021, I completed lumbar sacral shockwave therapy (LSWT), with physical therapy that was to be done 2-4x’s a week for one month for the loss of sensation issue on my genitals and parts of my leg. I also completed an EEG scan.

Looking for a safer alternative to Dr. Goldstein’s method of diagnostic TFESI and minimally-invasive lumbar spine surgery, I decided to complete LSWT with physical therapy exercises that were to be completed 2-4x’s a week for one month. I did not feel any relief of my POIS symptoms or chronic symptoms right after the shockwave therapy. After 2 days of therapy, I did masturbate and ejaculated with no relief of my POIS or other chronic symptoms. Perhaps three or more months would be enough time to determine if shockwave therapy with physical therapy would be a good combination against my POIS and other chronic symptoms. Because of this, I decided to not come in for my second second session of shocks and to try a different approach. I have also not been able to do physical therapy the way I would like to due to muscle weakness.

My shockwave therapy was delivered by a hand-held electrohydraulic unfocused parabolic reflector probe. The goal was to ameliorate pain and provide anti-inflammatory therapy to the radiculopathy of the sacral spinal nerve root. The applicator used was the OP 155, Frequency 3 Hz; Membrane pressure 3.

I had some back achiness as a result of shockwave therapy, but it went away after sleep. I did not get any new symptoms as a result of shockwave therapy.

Here are my EEG results from:
https://www.dropbox.com/s/mnujgicpemy8nlc/EEG%20Results.pdf?dl=0

In April 2021, I completed a treatment known as Shockwave tibial nerve stimulation (STNS), a treatment for PGAD/GPD. Not very much physical therapy was done. By the end of April I completed the second session of STNS with no physical therapy.

STNS is an office-based procedure whereby a low intensity shockwave device probe is applied 3 cm above the malleolus (ankle bone) halfway between it and the Achilles tendon to stimulate the tibial nerve. STNS is performed in patients who have sexual health problems of genito-pelvic dysesthesia (persistent genital arousal disorder or unusual feelings of pain, arousal, itch, burning, vibration, tingling, etc, in the genito-pelvic area) suspected from triggers secondary to spine pathology in the cauda equina (annular tear, herniated nucleus pulposus, Tarlov cyst).

It did not help to reduce any of my POIS symptoms or any of my chronic symptoms.

At the end of April 2020, I completed my second session of STNS without physical therapy and it did nothing for my chronic state but have not yet determined if it helps with my POIS symptoms.

EDIT June 2021: My second session of STNS without physical therapy did not help me find the relief that I am looking for.

NOTE: I will post my medical results on the “Gather and Post Your Medical Test Results Here” thread and SDMS’s POIS research on the research thread soon and feel free to discuss them there, but I would much prefer to have feedback here on this thread!
« Last Edit: June 04, 2021, 01:18:52 PM by Kit »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #5 on: May 01, 2021, 12:59:13 AM »
This is where I am currently at when it comes to finding some relief or complete relief for my POIS and chronic symptoms. I am still seeking care from my doctors and other healthcare professionals.

The only thing that has truly helped me to maintain a stable life is water. I would drink about 32oz - 64oz a day and this would give me the proper energy I need for the day. When I am hydrated, I would feel “OK” some days and for other days, not so much. I’ve tried niacin (the flush was too much for me), Multi-vitamins, CDB-oil, a gluten-free diet, Lexapro 5mg for about 3 weeks, ginger, garlic pills, GABA, Taurine (GERD prevents further use of Taurine), Vitamin D, Clonazepam and nothing is giving me relief so far (0%-10% relief). NSAID’s (Alka-Seltzer) I think helped at some point for brain fog and muscle pain, but I can’t rely on NSAID’s in the long run. I know that there are many other relief methods that I could try from resources like the Chart of POIS types, everyone’s threads, articles and so forth and I will post here if anything is working for me.

Could an annular tear really be contributing to my POIS symptoms? What about my skin reactions to my own semen? Dr. Goldstein has been able to successfully treat sexual medicines conditions such as Penile Pain, PGAD, and Sleep Related Prolonged Erection (SRPE). SRPE is a condition that causes a painful/prolonged nocturnal erection that interrupts sleep and may cause sleep deprivation, by treating the spine. It is now wonder why he believes my annular and loss of sensation could be related to my POIS. I will post references below!

Dr. Goldstein’s successful treatment of Penile Pain:
https://pubmed.ncbi.nlm.nih.gov/28709890/

PGAD and treatment of the spine:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7004503/

An article regarding the diagnostic and treatment options for SRPE:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693397/

There is currently no article on the successful treatment of SRPE by treatment of the spine, but Dr. Goldstein was able to successfully treat at least one patient’s SRPE by treating the spine pathology.

...

I know this is alot to share, so I really appreciate the time members have taken to look into this. I am not trying to give any false hopes! I will also gladly give the time to help members! I also hope my post can make a contribution to better understand POIS! At this point, I am more concerned about my chronic state than POIS symptoms, so if anybody has a clue as to what is going on with me, I would really love to know! Like I said before, I will always discuss feedback from my doctors first!

I would also like to say: When doing research for your own well-being, don’t forget to also do the other things you love and enjoy doing! It is ok to do research for your own well-being but there is a fine line where too much information just creates unnecessary anxiety and stress. Always rest when needed and don’t push yourself too hard because your health is always first!

Like I said before, I will be updating and modifying this thread!

Thanks for reading, keep helping one another and I wish you all the best!

-Kit
« Last Edit: July 26, 2021, 12:27:57 AM by Kit »

Journey

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #6 on: May 01, 2021, 05:34:56 AM »
During stress acutely I get eye floaters, diaphragm and stomach muscles tightening, neck and shoulder area tightening and slight pressure in the forehead eye area

When I stimulate my glans I get this overwhelming tingly kind of sensation somewhere in the lower area of spine, like how when are you being tingled by somebody and it is too much and you contract your muscles except it happens like at the 3rd/4th level from the bottom in the spine

Journey

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #7 on: May 01, 2021, 05:37:27 AM »
Can I tell that spinal problems could be related to POIS when talking about it on other forums without mentioning you specifically but saying that some POISer/-s have discovered possible spinal problems that could be related to it and probably even could be causing it?

Mushnikk

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #8 on: May 01, 2021, 06:55:13 AM »
Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?
« Last Edit: May 01, 2021, 06:57:22 AM by Mushnikk »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #9 on: May 01, 2021, 10:30:02 PM »
Can I tell that spinal problems could be related to POIS when talking about it on other forums without mentioning you specifically but saying that some POISer/-s have discovered possible spinal problems that could be related to it and probably even could be causing it?

Hi Journey! Of course you can, just mention me as Kit!

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #10 on: May 03, 2021, 01:38:07 PM »
Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?
Bloating? Yes! Fatigue after carbs? I believe so! My dietician recommend that I eliminate corn from my diet to see if this would help with my fatigue after eating. It turns out, when I eliminate corn tortillas and corn products in general from my diet, it helps to reduce my fatigue after eating. It could be that the carbs from the corn tortilla is what was causing the fatigue for me. I would have to experiment with rice and low-non carb foods to confirm this. I am unsure if gut issues are the cause of POIS for me. My gut issue/food sensitivities did not develop until around December of 2019 and Janurary 2020, about four years after the onset of my POIS. I did have gas after eating in the fall of 2018, but I believe that was only because I eat a lot of junk food and fast food. I may have had gut issues, since the onset of my POIS, I just don’t remember anything vividly.

I will be doing a food sensitivity test soon and I hope that with this test, I will be able to regain tolerance to some foods and that it will also help to heal my gut and simultaneously my POIS. My dietician will be guiding me through this. I will also share my results when I get the chance.

I am interested in trying a specific diet to help find relief of my symptoms. So far, I have only tried a gluten-free diet and it didn’t really help. I will discuss diets further with my dietician when I see her again. Have you tried a specific diet that has helped you?

It’s interesting that you say this! I did rely on porn/masturbation, similarly to that of an opioid addiction. I had this issue for more than 2 years and I could not discuss this with anyone until I did with my family. I was able to manage this addiction around July of 2019 and have been able to decrease the amount of times I watched porn/masturbation because of how much it was negatively affecting my life. I relied on porn/masturbation to ironically improve mood, focus, and energy but I would still get POIS symptoms like brain fog, headaches, irritation, but I was able to somewhat overcome my POIS symptoms from the improved mood, focus, energy, stress relief or you can call it, a ‘high’ feeling, after porn/masturbation. Does anyone know what I’m talking about? I had difficulty discussing this with anyone, even my own family. It was a strange but messed up time in my life. This would be a great topic to discuss with my sex therapist. I think I may also look into the realm of opioid addiction/withdrawal research and treatment and see if a type of treatment can help with my POIS. Thank you very much for this comment!

I have not tried Tramadol. I don’t suffer from any moderate to severe pain now thankfully! At the worst, a symptom would be at a 3/10 pain/bothersome severity, but it’s not very often.

Yes, I have been experimenting with CBD oil 750mg oil 5 drops in the morning and before bedtime and I titrate up to a dropperful in the morning and before bedtime for about a month now. There were times where I had missed to take it in the morning or at night, but I think it would have had an effect on me by now. Currently, I am only taking 2 drops at night and I will let you guys know if I get any benefit from that.

I have tried walking, 7 minute jogging, and skateboarding after O and it doesn’t do much for my POIS. I still have brain fog, irritation, just not feeling at 100%. I can still do some movement like jogging and skateboarding, but I can’t do any running or moderate-high intensity cardio. For weight training, I find it best to wait until my POIS symptoms have resolved to do at most a 20-30min up to an hour minute weight training session and to do so safely and not push myself. Even then, it still feels like my body is not responding properly to the workout the way it should be, and I listen to this and stop if I feel that it not a good idea to continue any further. I can probably do lighter weights and shorter sessions to have a consistent workout session in and out of POIS. I will let you know how this goes!

Interesting! How would Silodosin help?

Prospero

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #11 on: May 03, 2021, 05:08:51 PM »
Tramadol is an opioid which, like codeine, may give you an indication regarding problems with endorphin production or receptors, if it helps you. It's not about pain. Pain is absolutely not a major symptom for me and opioids suppress my post-orgasmic symptoms. I also have a story of a kind of addiction to masturbation, in the years when my Pois appeared.
Tramadol/codeine may help for other reasons than opioid issues though, it may notably inhibit microglia or glutamate, it seems.
If you really have problems with opioid receptors, low dose Naltrexone has also been discussed as a possible treatment by some people. I don't know anyone here who reported having used it, though.

Mushnikk

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #12 on: May 04, 2021, 11:45:13 AM »
Do you have any gut issues (bloating, fatigue after carbs, ...)? It seems a prevalent comorbidity here and perhaps a cause.

Have you tried diet changes?

Your symptoms also read much like opioid withdrawal symptoms? Have you tried Tramadol or CBD oil before/after O? Have you tried exercise after O?

Have you tried Silodosin?
Bloating? Yes! Fatigue after carbs? I believe so! My dietician recommend that I eliminate corn from my diet to see if this would help with my fatigue after eating. It turns out, when I eliminate corn tortillas and corn products in general from my diet, it helps to reduce my fatigue after eating. It could be that the carbs from the corn tortilla is what was causing the fatigue for me. I would have to experiment with rice and low-non carb foods to confirm this. I am unsure if gut issues are the cause of POIS for me. My gut issue/food sensitivities did not develop until around December of 2019 and Janurary 2020, about four years after the onset of my POIS. I did have gas after eating in the fall of 2018, but I believe that was only because I eat a lot of junk food and fast food. I may have had gut issues, since the onset of my POIS, I just don’t remember anything vividly.

I will be doing a food sensitivity test soon and I hope that with this test, I will be able to regain tolerance to some foods and that it will also help to heal my gut and simultaneously my POIS. My dietician will be guiding me through this. I will also share my results when I get the chance.

I am interested in trying a specific diet to help find relief of my symptoms. So far, I have only tried a gluten-free diet and it didn’t really help. I will discuss diets further with my dietician when I see her again. Have you tried a specific diet that has helped you?

It’s interesting that you say this! I did rely on porn/masturbation, similarly to that of an opioid addiction. I had this issue for more than 2 years and I could not discuss this with anyone until I did with my family. I was able to manage this addiction around July of 2019 and have been able to decrease the amount of times I watched porn/masturbation because of how much it was negatively affecting my life. I relied on porn/masturbation to ironically improve mood, focus, and energy but I would still get POIS symptoms like brain fog, headaches, irritation, but I was able to somewhat overcome my POIS symptoms from the improved mood, focus, energy, stress relief or you can call it, a ‘high’ feeling, after porn/masturbation. Does anyone know what I’m talking about? I had difficulty discussing this with anyone, even my own family. It was a strange but messed up time in my life. This would be a great topic to discuss with my sex therapist. I think I may also look into the realm of opioid addiction/withdrawal research and treatment and see if a type of treatment can help with my POIS. Thank you very much for this comment!

I have not tried Tramadol. I don’t suffer from any moderate to severe pain now thankfully! At the worst, a symptom would be at a 3/10 pain/bothersome severity, but it’s not very often.

Yes, I have been experimenting with CBD oil 750mg oil 5 drops in the morning and before bedtime and I titrate up to a dropperful in the morning and before bedtime for about a month now. There were times where I had missed to take it in the morning or at night, but I think it would have had an effect on me by now. Currently, I am only taking 2 drops at night and I will let you guys know if I get any benefit from that.

I have tried walking, 7 minute jogging, and skateboarding after O and it doesn’t do much for my POIS. I still have brain fog, irritation, just not feeling at 100%. I can still do some movement like jogging and skateboarding, but I can’t do any running or moderate-high intensity cardio. For weight training, I find it best to wait until my POIS symptoms have resolved to do at most a 20-30min up to an hour minute weight training session and to do so safely and not push myself. Even then, it still feels like my body is not responding properly to the workout the way it should be, and I listen to this and stop if I feel that it not a good idea to continue any further. I can probably do lighter weights and shorter sessions to have a consistent workout session in and out of POIS. I will let you know how this goes!

Interesting! How would Silodosin help?

Re Silodosin, see this study, it worked for me as well: https://sci-hub.se/10.1038/s41443-020-0314-9

Have you tried CBD oil 90 minutes before orgasm with a higher dosage? This was the first thing that made a difference for me. Likely a similar mechanism that is involved with Tramadol. Successful here: https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184

SIBO/low-fodmaps diets and cutting out all sugar also seems to have improved my POIS. Definitely look more into that with a SIBO breath test, and perhaps, if you can through your doctor, get a D-Lactate urine test.

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #13 on: May 08, 2021, 11:34:25 AM »
Tramadol is an opioid which, like codeine, may give you an indication regarding problems with endorphin production or receptors, if it helps you. It's not about pain. Pain is absolutely not a major symptom for me and opioids suppress my post-orgasmic symptoms. I also have a story of a kind of addiction to masturbation, in the years when my Pois appeared.
Tramadol/codeine may help for other reasons than opioid issues though, it may notably inhibit microglia or glutamate, it seems.
If you really have problems with opioid receptors, low dose Naltrexone has also been discussed as a possible treatment by some people. I don't know anyone here who reported having used it, though.
Hi Prosperos! Problems with opioid/endorphin production or receptors would make sense for my case. It could explain the lack of a “euphoric” feeling after exercise and other certain activities like massage and self-massage (sometimes) that would help to make me feel good during or after the activity. I may have screwed up my endogenous opioid system. Congrats on your relief method, I hope that it helps to better understand your post-orgasmic symptoms! What type of opioid(s) do you use to suppress your POIS symptoms, is one of them Tramadol? I have already read the summary Mushnikk has sent me regarding POIS and the endogenous opioid system, so thank you guys for that! I will be discussing this with Dr. I. Goldstein when I have the chance!
« Last Edit: May 08, 2021, 11:43:33 AM by Kit »

Mushnikk

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #14 on: May 08, 2021, 12:47:58 PM »
I can say that tramadol works for me as well. Almost no symptoms with 25mg Tramadol 1 1/2 hours before orgasm plus my premature ejaculation ist gone.

Muon pointed out why both CBD oil and Tramadol work for me:

 
A lower dose of tramadol may be needed when you combine it with CBD:
Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors


plus the Opioid thread here: https://poiscenter.com/forums/index.php?topic=2042.15

and the paper by Jiang et al. discussing the opioid hypothesis: https://sci-hub.se/10.1111/jsm.12813

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #15 on: May 08, 2021, 02:34:11 PM »

Re Silodosin, see this study, it worked for me as well: https://sci-hub.se/10.1038/s41443-020-0314-9

Have you tried CBD oil 90 minutes before orgasm with a higher dosage? This was the first thing that made a difference for me. Likely a similar mechanism that is involved with Tramadol. Successful here: https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184

SIBO/low-fodmaps diets and cutting out all sugar also seems to have improved my POIS. Definitely look more into that with a SIBO breath test, and perhaps, if you can through your doctor, get a D-Lactate urine test.
https://sci-hub.se/10.1038/s41443-020-0314-9
Thank you!

No, I have not tried CBD oil 90 minutes before orgasm with a higher dosage. Congrats on finding treatments that have worked for you, may it help you to find the long-term relief that you are looking for! Dosages that are over 750mg are fairly expensive. Is there a certain strength that you would suggest? Brand? And how many drops would you take before 90 minutes or some other time interval for the CBD oil strength you had?

https://poiscenter.com/forums/index.php?topic=3551.msg38184#msg38184
Wonderful!

I already cut out all added sugars from my diet, or at least I do my very best to! A low-FODMAP diet will be tough. I will consider a SIBO breath test and D-Lactate urine test! They look like they are worth looking into.


Mushnikk

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #16 on: May 08, 2021, 02:50:18 PM »
Hi Kit!

May you also find relief!  :)

Perhaps exercise helps me because of the opioid link (raises endomorphin), I will look for other ways to naturally increase the bindung at that receptor. Or perhaps some gut bacteria produce metabolites that are somehow involved in the opioid system (perhaps a specific prebiotic with that attribute exists?). And a impaired gut makes in "incompetent" immune system leading to virus activation as laid out by nanna1.

I live in Germany and thus cannot recommend you a CBD brand. Perhaps have a look at the CBD subreddit for a recommendation. I take ~ 12 drops of 10% oil before orgasm, and three drops the next morning and night. I also go to bed right after orgasm. And look for a full-spectrum oil.

Prospero

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Re: San Diego Sexual Medicine?€™s POIS Research / Kit?€™s Case
« Reply #17 on: May 08, 2021, 04:30:25 PM »
@Kit: I used codeine because I had a bad experience the second time I took Tramadol (seemingly serotonin symptoms). However I don't take codeine often (I did so only two times, in fact), because I somewhat fear tolerance in the long run, and also because it causes me constipation (like all opioids) while I'm already constipated ordinarily. So most of the time I only take Paracetamol after O. (My trials with both Tramadol and codeine were with brands associating them with Paracetamol; Paracetamol alone is already rather efficient [50 to 80% symptoms reduction], but not as much as with opioids [100%].)

@Mushnikk: If Tramadol helps you for premature ejaculation, it may be because of its serotonergic properties. As for me I don't have this problem of PE.
It may be noticed that Paracetamol is said to act also on cannabinoid receptors, maybe a link with CBD oil?

Regarding Silodosin and blocking Alpha1-A receptors, can there be a link with nanna1's theories, the POIS cascade triggered by A1A overexpression, or generally speaking by norepinephrine?
« Last Edit: May 09, 2021, 07:32:50 AM by Prospero »

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #18 on: May 12, 2021, 10:04:07 PM »
I can say that tramadol works for me as well. Almost no symptoms with 25mg Tramadol 1 1/2 hours before orgasm plus my premature ejaculation ist gone.

Muon pointed out why both CBD oil and Tramadol work for me:

 
A lower dose of tramadol may be needed when you combine it with CBD:
Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors


plus the Opioid thread here: https://poiscenter.com/forums/index.php?topic=2042.15

and the paper by Jiang et al. discussing the opioid hypothesis: https://sci-hub.se/10.1111/jsm.12813
That’s good to hear! It’s interesting how Tramadol helped your PE.

Muon is awesome, he and nanna1 have helped me with the technical aspects of the forum.

Ok, so there is a correlation with cannabinoid and opioid receptors. I will need to study up on that!

And thanks for the other links, there is so much more to learn!

Kit

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Re: San Diego Sexual Medicine’s POIS Research / Kit’s Case
« Reply #19 on: July 11, 2021, 05:09:48 PM »
Or perhaps some gut bacteria produce metabolites that are somehow involved in the opioid system (perhaps a specific prebiotic with that attribute exists?). And a impaired gut makes in "incompetent" immune system leading to virus activation as laid out by nanna1.

I live in Germany and thus cannot recommend you a CBD brand. Perhaps have a look at the CBD subreddit for a recommendation. I take ~ 12 drops of 10% oil before orgasm, and three drops the next morning and night. I also go to bed right after orgasm. And look for a full-spectrum oil.

Hi Mushnikk, sorry for the very late reply, I needed time to focus on managing my mental health. All of that seems very interesting. With so many treatment options for my POIS, I would need to prioritize what treatment/therapy options would be best for me. I have never tested positive for any viruses, which makes experimenting for immune competence therapy not as urgent as other treatment options, but I can sure experiment when I am ready and see if it is a prepack that will work for me.

No problem, I found a CBD Full-Spectrum Oil 1,000mg which is also organic. I took 12 drops and 20 drops of oil 90 minutes before orgasm, but unfortunately, it did not help to reduce my POIS symptoms. The 20 drops delayed my symptoms up to an hour. I tried taking CBD oil before with a few drops in the morning and before bedtime, but I would get nightmares when I take it this way. When I decided to not take CBD Oil on the fifth day of this regime, I had a pleasant dream that night. This has happened to me a couple of times and I am unsure if I want to continue taking CBD oil this way because of this. I may have to try a different regime with CBD oil if I want to keep experimenting with it.

Thank you for sharing with me your experience with CBD oil!