Anorgasmia or Delayed Ejaculation

What Is Anorgasmia? Here's What to Know if You Can't Physically Orgasm.

The male orgasm occurs through a mixture of testosterone, arousal, and muscle contractions of the penis and the pelvic floor (PC muscles). If anything psychological or physical gets in the way of that process, it can trigger anorgasmia or delayed orgasm, which is estimated to affect 8% of men

Delayed ejaculation — sometimes called impaired ejaculation — is a condition in which it takes an extended period of sexual stimulation for men to reach sexual climax and release semen from the penis (ejaculate).

When men in steady relationships contemplate their sexual woes, erectile dysfunction (ED) is usually at the top of the list. That’s understandable, since 20 to 30 million men suffer from ED, But there is another problem in the bedroom that men are sometimes reluctant to talk about and doctors are unlikely to ask about. It’s called anorgasmia—the inability to reach a climax during usual sexual activity. Some men with delayed ejaculation are unable to ejaculate at all.

It's normal for men to have delayed ejaculation from time to time. Delayed ejaculation is only a problem if it's ongoing or causes stress for you or your partner, occurs in 2-11% of men.

These conditions are in part due to an imbalance between excitatory (dopamine, oxytocin, norepinephrine) and inhibitory (prolactin, serotonin) neurohormones. The diagnosis criteria for these conditions is an intravaginal ejaculatory latency time (IELT) greater than 25 minutes, although it can occur in men who lack the gladipudendal (bulbocavernosus) reflex.

Male anorgasmia is the persistent inability of a man to have an orgasm, even after sexual stimulation. Anorgasmia, or Coughlan's syndrome, affects both men and women, but it's more common in women. Male anorgasmia can be distressing to those who experience it, especially since it often occurs with delayed ejaculation. This is when an orgasm is possible, but it's difficult and takes longer to achieve.

Secondary anorgasmia is close to 50% among males undergoing prostatectomy 80% among radical prostatectomies. This is generally caused by damage to the primary nerves serving the penile area, which pass near the prostate gland. Removal of the prostate frequently damages or even completely removes these nerves, making sexual response unreasonably difficult. Radical prostatectomies are usually given to younger males who are expected to live more than 10 years. At more advanced ages, the prostate is less likely to grow during that person's remaining lifetime.

There is no set time threshold for what defines delayed orgasm. Time threshold for distress is dependent on the partners involved. Some males will reach orgasm with one partner in 15 minutes and have no distress, but with another partner it may cause severe distress because the partner may complain of pain with prolonged intercourse. A population-based survey established that the median intravaginal ejaculatory latency time (IELT) was 5.4 minutes and 2 standard deviations above was approximately 22 Minutes. A provider with a patient complaining of IELT longer than 22 minutes will theoretically qualify him for the diagnosis of Delayed orgasm. One should differentiate between problems with of ejaculation and orgasm.

Physical causes of anorgasmia can include:**

* Medication

* Injury

* Pelvic floor dysfunction

* Underlying illness

*Some medications, such as SSRIs , have anorgasmia as a possible side effect. Your doctor may be able to switch the dosage of your medication, or move you to a different medication entirely that can relieve your anorgasmia.

*Anorgasmia may also be associated with whatever your underlying illness Diabetes and certain cardiovascular conditions, for instance, can impact a person's ability to climax.

*A recent injury can also foster anorgasmia. Breaking a hip, femur, or other bones in the section around the reproductive organs could make sex painful or uncomfortable.

*Pelvic floor dysfunction is an often-overlooked cause of anorgasmia, “If your pelvic floor is really tight, or if your pelvic floor is not really coordinated, that can actually really make it difficult for people to have satisfying sex or orgasm.

Psychological causes of anorgasmia can include:

* Anxiety

* Stress

* Trauma

*Performance anxiety is a common factor that contributes to anorgasmia, The tricky thing is, the more you obsess about whether or not you'll be able to orgasm, the harder it'll be to climax.

*Your anorgasmia might also be linked to stress—about work, family, relationships, finances, etc.—or another mental health issue that's worth seeing a therapist about.

*Sexual performance anxiety (the most common psychological cause of anorgasmia), which can affect men of any age and can be intensified by erectile dysfunction.

* Negative attitudes about sex tied to a repressive religious upbringing or family/parental issues.

* Certain phobias, such as haphephobia (fear of being touched) and genophobia (generalized fear of sexual intercourse).

* Grief, including that brought on by the loss of a partner

*Anorgasmia may also be connected to past trauma, an underlying source of stress that can make sex uncomfortable, painful, or emotionally fraught. If your anorgasmia feels sudden, or you're having trouble during sexual encounters after a traumatic experience, consider speaking to a therapist or other professional.

Physiology of the Male Orgasm

The male orgasm is a complex process. It is the third of four distinct phases in the sexual response cycle: Desire (libido), arousal (excitement), orgasm, and resolution. Male orgasm results from sexual activity and arousal. It involves multiple hormones, organs, and nerve pathways.

Testosterone, a hormone produced in the testicles, plays a central role in this process by enhancing sexual desire that leads to arousal, erection, and ultimately, orgasm. Also involved are contractions of the muscles of the penis, anus, and perineum. This space is located between the anus and scrotum. Ultimately, these contractions propel semen from the body.

During orgasm, the reward center of the brain floods with neurochemicals. These chemicals are responsible for the intense emotional response associated with an orgasm.

* Conditions such as multiple sclerosis, neuropathy (nerve damage) caused by diabetes, and uncontrolled hypertension (high blood pressure)

* Hypogonadism (low testosterone levels) and endocrine disorders that affect hormonal balance

* Complications from prostate surgery (prostatectomy) or radiation to treat prostate cancer

* Cauda equina syndrome, a rare condition in which exposed nerve fibers at the bottom of the spinal cord become irritated

* Congenital absence of the bulbocavernosus reflex, which triggers the anal sphincter to contract during ejaculation

* Substance abuse (especially heroin use)

* Prescription side effects with certain medications, such as antipsychotics, opiates, and antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) like Prozac (fluoxetine)

A man may be unable to achieve a normal orgasm when physical or emotional issues affect any of these parts of the process.

Diagnosis

Your healthcare provider will do a thorough physical exam and review your medical history. This may include an evaluation of all medications you take or have taken in the past.

It's possible that your anorgasmia started about the same time you began taking a new medication.

This initial evaluation will steer the next move: either more tests or a referral to a specialist. This could be a urologist for a physical cause or a mental health professional for a psychological issue. You could get a referral to both.

Tests commonly used to help diagnose the cause of male anorgasmia include:

* Blood tests to measure levels of hormones such as testosterone, thyroid stimulating hormone (TSH), and prolactin, a hormone that affects testosterone levels

* Biothesiometryto measure whether there's a loss of sensation in the penis

* Penile sympathetic skin response to test the function of nerves supplying the penis

* Sacral reflex arc testing, another way to evaluate the function of the nerves that supply the genital area.

Treatment

There is no one-size-fits-all remedy for male anorgasmia. The specific approach depends on the cause as well as test findings. Still, a variety of treatments may be used:

* Testosterone replacement therapy such as Tlando (testosterone undecanoate) or a dopamine-promoting drug, like Dostinex (cabergoline), may restore a man's ability to orgasm

* Therapy and/or medication for depression, anxiety, or other mood disorders that contribute to male anorgasmia

* Psychotherapy to overcome sexual performance anxiety or past sexual and non-sexual trauma

* Couples counseling, which may help resolve relationship issues

* Sex therapy to treat certain sexual issues

* Instruction in digital prostate massage to help stimulate what some people consider to be the male G-spot

* Penile vibratory stimulation.* If you have a reduced level of penile sensitivity, vibratory stimulation (a form of treatment that involves vibration to the frenulum — an elastic area of tissue near the tip of the penis) may help to induce orgasm and treat anorgasmia.

Coping

Male anorgasmia, like any type of sexual dysfunction, can take a big toll on a man's physical, psychological, and emotional life. It may have similar effects on his partner.

The most important step is to seek a medical diagnosis. It does no good to allow fear or embarrassment to prevent you from confronting the issue.

Usually, there is hope. But an effective treatment may not be possible if you:

* Have had a radical prostatectomy (a surgical procedure on the prostate)

* Have suffered severe pelvic trauma

* Have multiple sclerosis

In this case, the best solution may be to focus on enhancing sexual pleasure and intimacy without orgasm. A psychologist or sex therapist can help you embrace a healthy sexual lifestyle in ways you may not have considered.

In Conclusion

Anorgasmia can be a frustrating occurrence, especially when it affects you and your partner’s ability to enjoy sex.

As we explained above, there’s no one-size-fits-all treatment for anorgasmia. Instead, a large range of different factors, from psychological issues to physical ones, may affect your ability to reach

orgasm and ejaculate during sex. With the right combination of testing and treatment, it’s often possible

to improve anorgasmia and enjoy sex without any concerns about your

ability to successfully reach orgasm.