It would not be unusual if the word “anorgasmia” is unfamiliar to you.  Doctors rarely ask about the problem and most men will choose instead to suffer in silence as they themselves are reluctant or embarrassed to bring it up to their doctor. 

What is anorgasmia?

Anorgasmia is the inability to reach an orgasm or climax during sexual activity.  It is not the same thing as erectile dysfunction which is where a man has difficulty achieving or maintaining an erection suitable for sexual intercourse.  Erectile dysfunction (ED) can at least be prescribed several effective medications by a doctor but this is not the case for a man with delayed or nonexistent orgasms. 

The problem of anorgasmia is better documented and seen more frequently in women than in men.  The statistics for men who have anorgasmia is believed to be between 5 to 10 percent of all men who have this condition.  For some men anorgasmia presents itself as an inability to reach orgasm only during sexual intercourse.  For others, it might be possible to reach orgasm but only after prolonged and intense non-intercourse stimulation.

Anorgasmia can be categorized as either primary or secondary.  Primary anorgasmia is the term used for men who have never experienced an orgasm. Secondary anorgasmia identifies men who have experienced an orgasm in the past but are now unable to reach climax. 

What is the cause of anorgasmia?

The causes of anorgasmia can be divided between either psychological or physiological issues. 

It is estimated that about 90 percent of anorgasmia problems are related to psychological issues.  The number one psychological problem points to a man’s performance anxiety.  Men who are suffering from anorgasmia often do not have anunderlying physical problem.  Instead, the problem may be due in part to worrying about not being able to perform. Other psychological factors could include the following:

·      Stress

·      Problems in a relationship

·      Past sexual trauma or abuse

·      Negative attitudes about sex

·      Guilt about sex

If there is marital strife or conflict between a couple or a perception of monotonous sex in a bored relationship, this has also been known to contribute to psychological factors of anorgasmia.

Physiological issues causing anorgasmia can often be intertwined with factors that are also contributing to ED.  These factors could include the following:

·      Medications

·      Diabetes

·      Drug or alcohol use

·      Chronic pain

·      Hormonal problems

·      Hypertension

·      Spinal cord injury

·      Multiple sclerosis

It is not unusual for a man to experience anorgasmia from the sedative effects of some drugs, including alcohol.  A side effect of some antidepressant medications, such as selective serotonin reuptake inhibitors, or SSRIs, can include anorgasmia, especially among men.

Any man experiencing chronic pain or a chronic illness can have debilitating effects that can impact his sex life.  Age is another factor as with men, there is a natural slowing down of many physiological processes that could contribute to anorgasmia.

Treating anorgasmia

The first step for any man with anorgasmia is to make an appointment with his doctor for a complete physical examination in order to rule out any possible physical causes for it.  One physical condition to consider is blood testing of sex hormone levels such as testosterone, sex hormone binding globulin, dihydrotestosterone, LH, FSH, estradiol, prolactin, PSA and TSH.  These blood tests will assess testicular, pituitary, and thyroid functioning.  If the problem is due to a physical cause, then the treatment would be to address how to treat that problem in order to reverse anorgasmia.

If anorgasmia is due to psychological issues, then a man should be referred for sex therapy treatment with a qualified sex counselor or sex therapist.  Psychologic approaches will explore factors such as hypoactive sexual desire disorder, depression, poor arousal, anxiety, fatigue, emotional concerns, past trauma and abuse history, cultural and religious prohibitions, or a partner’s sexual dysfunction such as vaginal dryness, sexual pain or low sexual interest. 

In many cases for men with anorgasmia, the combined psychologic and physiologic approaches to resolve anorgasmia makes the most sense.