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For whatever it's worth, I'll contribute my knowledge and experience about difficulty/inability to orgasm.

Please add to this list any substance or factor that you know of that interferes with your ability to orgasm, or the quality of your orgasms.

Please add anything you know about the loss of penile sensitivity:

1. Any substance that reduces pain will tend to reduce pleasurable sensations as well, since pain and pleasure sensations involve the use some of the same neurotransmitters in the brain. These substance will likely reduce the quality of your orgasms as well as reduce your ability to orgasm:
1.a. Opiods and Synthetic Opiods. (I'm a chronic pain sufferer, have been on pain management narcotics for 12 years due to osteoarthritis. Eventually, I got used to the effects of the narcotics. They cause some decrease in the quality of and/or my ability to orgasm, but not so much as they did when I first started taking them. However, that last statement is not true with higher doses than I now take. Higher doses will completely prevent my orgasms from occurring. The physical feelings leading up to orgasm are completely absent. I am generally numb all over.)
1.b. NSAIDs. If I don't take an NSAID the day before or on the day my wife and I have sex, I am more likely have a good orgasm. This statement includes: Aspirin, Celebrex, Ibuprofen (Motrin, Advil), Diclofenac (Voltaren), and others.
1.c. Alcohol. Its initial ingestion reduces pain. I know from experience that in large amounts, it reduces all sensations.
1.d. Nicotine. It is well documented that nicotine reduces pain. Does this reduce pleasurable sensations, too? Probably. I haven't used tobacco in decades so I can't speak from experience about nicotine interfering with orgasms. Nicotine does reduce blood flow to the penis. Draw your own conclusions.
1.e. Amphetamines. Small amounts, like those found in normal Adderall prescriptions, seem to enhance our sexual experiences. (My wife and I, both.) But slightly higher doses seem to reduce pain and inhibit orgasmic pleasure, possibly to the point that I can't orgasm. I'm not quite sure about this because the effect is subtle. But, oddly, at slightly higher doses, our sexual pleasure is markedly increased and sexual desire lasts for hours, even if I can't climax.
1.f. Flomax. This drug is used to treat male difficulty in urination because of BPH. It significantly reduces the feelings associated with an impending orgasm, and in some cases, the desire to have sex at all. I do not take it on the nights before we have sex the next day. Its sexual side effects are well documented: https://www.healthline.com/health/enlarged-prostate/flomax-side-effects#side-effects
1.g. Trimix. The pain from prostaglandin is the problem. It can be so intense that I can't tell if I can have an orgasm or not. That being said, if I can keep my injection to the minimum dose that will produce a hard and long lasting erection, Trimix is not a terrible problem but it is damn aggravating and an interference.
1.h. Gabapentin. A drug to treat neuropathy, it reduces nerve pain. https://americanaddictioncenters.org/neurontin-abuse/gabapentin-lyrica
1.i. Lyrica. A drug to treat neuropathy, it reduces nerve pain. https://americanaddictioncenters.org/neurontin-abuse/gabapentin-lyrica
2. Age. It is well documented that male and female sex organ sensitivity declines with age, no matter if hormone replacement therapy is being used.
4. Poor quality/insufficient sleep and rest.
5. Hunger.
6. Having frequent sex. I am very familiar with this one, all my life. It seems my sexual appetite has always been bigger than ability to consume. Penile injections have aggravated this because my wife and I now have sex very frequently. Our love making is so wonderful that we don't care (a lot). However, there's a price to be paid for this. The price is that our brains become soaked with the "happy" neurotransmitters (endorphins, oxytocin, dopamine, serotonin). Staying in that condition for days or weeks reduces the number of neuroreceptors because the brain thinks they aren't necessary. It can take some time (days, weeks, months) for the rebalancing of the ratio of transmitters to receptors to occur. The brain has to create more neuroreceptors and that can take time.
7. The Male Refractory Period. It varies from minutes to days. https://atlasbiomed.com/blog/whats-going-on-with-hormones-and-neurotransmitters-during-sex/. This is mostly about the "happy" neurotransmitters (endorphins, oxytocin, dopamine, serotonin). With regard to sex, the male brain works differently than the female brain.
8. The longer we make love, the harder it is for us to orgasm. Both of us get slightly numb. I never had this problem until we started making love for hours (Trimix). Our sex organs, especially the penis, were never designed to be used like this.
9. Leaving cock rings on too long or having them too tight. Either one will slowly make my glans numb. This lack of penile sensitivity interferes with my ability to orgasm.
10. Dehydration. Too little water in your body? Less water for your penis, diminished results for inflation of the penis in an erection. Less inflation, less sensitivity. Also, semen is primarily water. If you want more semen, stay hydrated.

Items 6 and 7 in this list are closely intertwined.

Niarceel...Agree with you on everything and learned some too. I'm 78 and sensitivity has been fading. Also on 2-4 Advil a day due to my NPH disease. However my GF and I usually have a few glasses of wine or saki ...then have a light dinner before going to the bedroom once a week. She's 50 and the booze buzz don't bother her except allow me to do whatever I want. Sometimes my orgasm is quick and sometimes it takes a while. Can tell the difference if I hold off on Advil and lighten up on the booze. She is like clockwork no matter what.
Thank you for posting your knowledge and experience.

I appreciate both of you guys contributing your information and experience. I've had problems with this forever and frankly it depresses me. I'll definitely be more conscious of the things I'm putting in my body and how it's possibly affecting my performance.

Thank you both,
San

I think I'm in the process of solving my anorgasmia problem. I hope my experience will help you:

https://www.franktalk.org/phpBB3/viewtopic.php?f=22&t=11080&p=123906#p123906

This URL references a very educational document about anorgasmia:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816679/

It lists various causes and treatments.

I am currently taking dutasteride for hair loss and it should definitely be on that list, I haven't ejaculated in months.

@Niarceel - Thanks for your detailed list. I did a compendium of causes I gleaned out of the longer thread on this topic a while back but just in summary form. See this: viewtopic.php?f=22&t=10287&start=10#p93004

I did this post there recently:

"I had a small epiphany recently. I had a misfire injection. In a bit of a hurry and seemed like a dull needle. I guess it did not penetrate the cavernosa even though the 5/16" needle was buried to the hilt, as after injection, it just popped back. So I got the injection sub-cutaneously which causes grief and no erection. It caused a big red angry swell on the front right. After 3 1/2 years this was the 2nd such misfire.

The epiphany: I soaked the member in a cup of ice water several times a day fr 3 days to reduce swelling and tissue damage - - - it did not hurt. Icewater with ice. I gather the junior member's nerves are clearly atrophying?? Years ago surfing in 50's water it was in pain and withdrew. Not now.

Waxing philosophical. First viagra use to failure for many years, and now Trimix/PGE working good and extending a great sex life. Wife has never had it better. But we are getting older and doing things that some combination of nature and genetics did not intend for some. They say half jokingly that all men would die from prostate cancer if they lived long enough. Maybe likewise now, with ED at bay, sooner or later we all get DE if we soldier on with our chemically fabricated boners. My wife's mother confided many years ago that their sex life faded in their late 50's due to her husband's ED and he was a frustrated French horn-dog. He never even got a chance to get to the DE stage. We are thanks to the miracles on modern medicine and willingness to try them. Of course it's in the genes and then exacerbated by all the other contributing factors mentioned above and by life's toxic chemicals and exposures no doubt. It's frustrating and it's getting harder to get off every month. I'd guess that most of us had a touch of youthful PE. Now it's the wife's turn. Karma."

1/2

2/2, Niarceel - Besides all those drug exposures and, indeed, "overuse" on your list, I am approaching it also from a PN - peripheral nerve neuroapthy standpoint. Nerves dull, like a lot that slows and fails in older age as with lots of biological functions (immunity, etc). I have mild "idiopathic" PN setting in in my feet. The penis is a "peripheral" so . . . The icewater dunk test affirms it is not as sensitive.

There are other drugs that can cause PN like levaquin and cipro. I've had to take them a lot for past chronic sinus infections and a bout of prostatitis long ago. It's an official label warning. Who knows how much accumulated nerve damage has been done due to chemicals and drugs.

And I'm wondering out loud how much DE has to do with a "tight hole". DE seems an affliction more in older gents with older women who may have bore children and are a bit boggy now maybe? Has anyone done any anecdotal study on a tight versus a boggy receptacles? I can coax an ejaculation in 10-15 min working alone but it takes 35+ minutes after 45+ min of sex but that is also with an injection. I have not been able to get off during vaginal sex in over a year and have been on TriMix/PGE for 3 1/2 years now. Yes our women are now the dazed beneficiaries of much longer gratifying rocking sex but many want a load too to fulfill the act. Many think it has beneficial health benefits to receive a fresh load (not an old stale one).

Just thoughts for convo . . . .

I have a convo with my urologists practice expert on men's dysfunction next week. What should I ask and ask for?

Stew52 wrote:(edited for focus)
Yes our women are now the dazed beneficiaries of much longer gratifying rocking sex but many want a load too to fulfilll the act.

On the one part of your post I have thoughts/experience on:

My girlfriend is greatly gratified when I ejaculate/orgasm inside her (whether vagina or mouth). I suspect she may be responding less to the feeling of receiving my hot (body temperature) load than to the feeling that she owes me an orgasm and feels she has not done her "job" if I don't ejaculate.

In my younger days, women I was with did not like having to deal with the "wet spot" after sex. The warmth of that wetness soon turns cold and clammy, but I noticed that even if we exhanged places, it tended to follow her wherever she lay. Bummer for her. Solved by a soft towel. Or anorgasmia.

My current girlfriend can feel when my penis pumps out my semen. It seems incredible to me that her vaginal walls and vaginal sphincter re sensitive enough to detect the pulsing. But she attests strongly that it is so and confirms it contemporaneously, so I am sure she is not embellishing the story.

So, my orgasm does gratify her, whether it occurs simultaneously with hers, before or after and for the reasons of sensation of my pulsing into her or for her feeling of "job well done." So, I don't look that gift horse in the mouth (or vagina).

Occasionally, I don't cum. So, I assure her it is no problem for me. I owe womankind a LOT of orgasms from my earlier days when I came and whatever woman I was with did not. I just tell her that she is collecting on that debt.

Lost Sheep - indeed I tell my wife that this is paybacks for all the times when younger with the usual touch of youthful PE that she was left wanting at the threashold. I now get the white flag of surrender with eyes rolled back. And a state of bliss. That is very gratifying. If more men, and women, kept up with their sex lives more women should experience this reversal.

As far as the feeling of a woman with a man approaching climax, indeed my wife could always sense it. In part the penis really engorged in the run up and made full contact while pulsing as you say. I also note after 3 1/2 years on injections that my girth has increased noticeably. There are times for 10's of minutes where I now barely have to move and she is in ecstacy as if in that ejactulatory embrace. She'll say, "stop moving (pumping) so much" . I think this is having a similar effect but for a much longer period. SHe calls it "the clutch" and it's an intense orgasm. It's been a year since I left a deposit though and I'd like to solve that if possible. Have a call with the Uro's expert on men's issues Tuesday. Anyway this is all a blessing while it lasts.

As far as the load, she always felt it mixed with her juices and made a much more pleasant aroma as well as helping flush her out. She never objected.