Anorgasmia in Men and Orgasmic Disorders – Causes, Diagnosis and Treatments

Most cases of male anorgasmia can be successfully diagnosed and treated

The inability to reach an orgasm is a condition known as “anorgasmia”, “male orgasmic disorder” or “Coughlan’s syndrome.”

Being unable to reach an orgasm can be a difficult problem to cope with. It often leads to stress, anxiety and frustration and in many cases also causes relationship difficulties.

Male anorgasmia can have different causes which can co-occur, but luckily many cases can be resolved. In this article, we will discuss the causes, diagnosis, and treatment options for male anorgasmia.

What is male anorgasmia?

Male anorgasmia is defined as the “persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress.”

Different types of male anorgasmia (or male orgasmic disorder) exist:

  • Primary – An inability to orgasm which existed since the man’s first sexual experience.
  • Secondary – An inability to orgasm which developed at a later stage in life.
  • Generalized – An inability to reach an orgasm in all cases of sexual stimulation.
  • Situational – An inability to reach an orgasm only in certain instances, for example only with a specific partner, or only during sex but not during masturbation.

Male Anorgasmia is often confused with delayed ejaculation, but the two conditions are not the same. A man can reach an orgasm without ejaculating and can also ejaculate without reaching an orgasm, as you can see below:

The male sexual response cycle

The sexual response cycle has four phases:

  1. desire
  2. arousal
  3. orgasm and ejaculation
  4. and resolution

Anorgasmia is a disturbance in the third phase (orgasm). Anorgasmia in men is often mis-diagnosed as erectile dysfunction and low sexual desire, but as you can see, a man can have a desire to have sex, be aroused (have an erection), and ejaculate, but still not be able to orgasm.

A normal “orgasm phase” can be described as two separate processes that happen simultaneously:

  1. Emission and ejection (ejaculation)
  2. orgasm

While orgasm is usually coincident with ejaculation it is a distinct event, experienced cognitively and emotionally.

Prevalence

Studies have shown the prevalence of male anorgasmia to be between 8 and 14%. Acquired anorgasmia is more common than primary anorgasmia.

Anorgasmia causes

Anorgasmia in men could be caused due to different psychological and physical problems.

Psychological causes

  • Depression – depression and other mood disorders are associated with almost all sexual dysfunctions, including anorgasmia in men.
  • Anxiety and performance anxiety – stress, anxiety and performance anxiety can make it difficult to achieve an erection, interfere with sexual desire and make it more difficult to orgasm.
  • Lack of sexual arousal – With erectile dysfunction medications, men can achieve an erection even if they are not highly aroused. It is then more likely for them to have difficulties reaching an orgasm.
  • Unique masturbation habits – Some men masturbate in a unique way in terms of speed and force which is not replicable during partnered sex. This creates a habit that makes it difficult for them to orgasm during sex with a partner. Excessive masturbation temporarily reduces arousal which can also make it more difficult to orgasm.
  • Relationship issues – relationship difficulties interfere with sex. Conflict, anger, keeping secrets and having feelings of hostility towards your partner can make it near impossible to orgasm during sex.
  • Negative attitudes towards sex – Trauma from sexual abuse, sex related phobias such as the “fear of spilling semen” and “fear of defiling your partner” and strict or religious sexual upbringing are associated with male anorgasmia.

Physical conditions

  • Medication side effects – Some antidepressants from the selective serotonin reuptake inhibitors (SSRIs), antipsychotics and opioids may lead to difficulty in reaching orgasm.
  • Hormonal issuesHormonal imbalance disorders, specifically testosterone deficiency, underactive thyroid and elevated prolactin levels can interfere with orgasm.
  • Loss of penile sensitivity – Loss of sensation in the penis can make it difficult to orgasm. Loss of sensation to the penis happens with aging but can also be a sign of another medical problem.
  • Drugs or alcohol – drugs and alcohol abuse hurt proper sexual function and can lead to various sexual dysfunction, including anorgasmia.
  • Medical conditions – medical conditions, such as multiple sclerosis, pelvic injuries, diabetic neuropathy, injuries from surgery, spinal cord injuries, radical prostatectomy, hypogonadism and hypertension can lead to or contribute to anorgasmia in men.

Diagnosis

You can begin by speaking to your doctor about having a few tests that will rule out any physical or medical conditions. Commonly, a blood test would be performed to check to check for abnormal hormones levels.

Your doctor can also check your prescription medications and medical history.

If you are not concerned about medical conditions, it’s now the time to look at the psychological causes. A sex therapist could help you find and treat the issues that are hindering your ability to reach an orgasm.

After having ruled out hormonal, medications, or psychological concerns, further tests can be made to rule out the rarer causes of anorgasmia. These can include biothesiometry (penis sensitivity test) and sacral reflex arc testing.

Treatment

Selecting a treatment for anorgasmia depends on the cause or causes the lead to this condition:

  • Medications side effects – sometimes switching medications is all you need. Ask your doctor about medication alternatives.
  • Testosterone replacement therapy (TRT)– if anorgasmia is caused due to low testosterone levels, testosterone replacement therapy can help.
  • Hormonal imbalance – Most hormonal imbalance cases can be treated using specific drugs that can help restore hormone levels to their normal values.
  • Medications – There are no FDA approved drugs, but a 2012 study showed that a drug called Dostinex (cabergoline) might be helpful for men with anorgasmia; although further research is needed. Alpha-2 receptor blockers such as yohimbine was also shown as helpful for men suffering from anorgasmia in this 2007 study, but further research is needed here due to the very small size of the study.
  • Loss of penis sensitivity – Penile vibratory stimulation is a method in which a vibrator is applied to the frenulum area of the penis with the goal of making the man orgasm. This small study, for example, has shown that this method was able to restore orgasmic function in men with delayed ejaculation.
  • Sex therapy – A sex therapist can help men overcome the various causes that might lead to anorgasmia, these includes performance anxiety, sexual trauma, abuse, relationship issues, and more.
  • Changing masturbation habits – If anorgasmia if caused by unique masturbation habits, masturbation retraining can help men reach orgasm during partnered sex.
  • Psychotherapy – A psychotherapist can help men deal with psychological issues, such as depression, stress and anxiety which can be the cause for anorgasmia.

Summary

Male anorgasmia is a difficult condition which effects both the couple’s intimacy and the man’s personal mood and wellbeing. If you suffer from this condition, there is nothing to be ashamed of. Know that many cases can be treated successfully. Don’t be the one that stands in your way of a satisfying sex life!

Medically reviewed by Oreoluwa Ogunyemi, MD.

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