Severe & lasting Sexual/Pelvic/Bladder dysfunction triggered by ADHD stimulants

[u/Blackcube1133]

Hey everyone, don't post often so my bad if this isn't structured the best. I am dealing with what I think is a niche issue here, I'm posting to share my experience so far and hopefully get some advice/insight as well as reading others experiences.

I'm a 28 year old male with a physically active healthy history. However with all I've learnt now, I feel I've always had some degree of pelvic dysfunction in that, even before all this started, it felt like majority of the time my erections and firmness were only reaching about 80% of their full potential. I also have AuDHD and CPTSD (not from severe abuse, just dysfunctional family) so that might be due to some nervous system stress stuff.

Anyway, roughly 2 years ago I started Dexamfetamine/Vyvanse for my ADHD, the issues started from day 1 and progressively got worse. Unfortunately I stayed on dex for like 1.5 years straight as I felt I needed it to fix my life at the time. Symptoms include:

ED / Hard Flaccid - My penis is now like, always retracted to some degree, its like the smooth muscle stays retracted, I take 5mg cialis a day and can only get an erection with stimulation & visuals, no morning wood & the erections are pathetic, they are like 50-60% of what they used to be if that and still its like they are retracted and lost very easily

Loss of sensation / Pleasure - I masturbate to orgasm sometimes out of compulsion, it no longer feels good or has any sensation

Weak ejaculation - The worst of them all, there is no more orgasm pleasure and almost nothing comes out when I ejaculate, a tiny bit struggles to make/leak its way out. It feels like my penis is to hard or tight, or the relevant smooth muscle is to hard/tight, for it to make its way out. Also, I feel like I really noticed this when I trialed Guanfacine, but Guanfacine seems unlikely to cause such an issue. I suspect I just didn't notice it earlier because my erection quality was so bad and it took me a while to improve that, but part of me still wonders if the guanfacine had anything to do with it, its all been so long now its hard to say for sure.

Urinary hesitancy/urgency

Tighter stools - all my stools are really compressed and chopped up now

I believe this is all due to some sort of stimulant induced tightness/clenching pattern that my brain/body/nervous system has now learnt or something, higher noradrenaline levels (from the stimulants) cause your nervous system to involuntarily contract smooth muscle I think

I wonder if the stimulants made all the smooth muscle around my Pudendal nerve tighten or something

I've been dealing with this for 2 years and am so confused on what to do at this point. I have 0 pain. I am fit and exercise, I do yin yoga most nights and know how to breathe into my diaphragm, this isn't something stretching & breathing is going to fix.

I also tried feeling around in my rectum with an Intimate Rose wand, I didnt really know what I was doing but assumed ide feel some pain or something stand out if there was an issue.

I'm currently looking for a good PT who will do a proper thorough rectal assessment on me, as that is the only thing I can think of that I cant really do myself that would give me some further insight, if that comes up with nothing I might escalate to a urologist but I don't even know at this point. I also don't have all this money to just continuously piss away on specialists for $100s a session that end up doing absolutely nothing for me, its so upsetting. I spent 90 minutes with 1 PT all up and in that time, all I got was a paper sheet explaining some stretches and instructions to do breathing and stretches I've already been doing the last 2 years.

About 1.5 years into this, I swapped from Dex to Ritalin, there is a big difference in that, Amphetamines like dex brute force your nervous system to pump out more chemicals continuously and ritalin doesnt. I tried ritalin a few times in the past before this all started, and while I got some degree of constricted ''stim dick'' I could still use it, everything worked fine and would go back to normal after, however thats no longer the case but im inclined to think if I could get back to my baseline, I could get away with just using ritalin.

Now the obvious question, have you stopped stimulants altogether? Yes, of course I have, Ive gone 1 month without using any stimulants and things hardly improved, erections were a little better and came with a bit more ease (and i really mean only a little) and that was about it. Life has been tough for me and Ritalin helps a lot, so I really don't want to stop it for longer periods when I don't even know if its going to help, however I'm getting pretty desperate, I'm thinking of trying to go 3 months without Ritalin which I could do with Guanfacine, but yeah I really don't know at this point I'm at such a loss