Delayed Ejaculation/ Inability To Ejaculate (Male Anorgasmia)

Anorgasmia as the persistent absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress. Related to anorgasmia is delayed orgasm, where a person can still achieve orgasm, but with much difficulty. Delayed orgasm is seen as a less severe form of anorgasmia. These 2 conditions are on the other end of the spectrum of ejaculatory disorders, with the other side being premature ejaculation.

While definitions vary slightly from the World Health Organisation to the International Consultation on Sexual Medicine to the Diagnostic and Statistical Manual of Mental Disorders, one thing is for certain – for males who experience anorgasmia, it causes marked personal distress. 

Anorgasmia can be primary or secondary. Primary anorgasmia means that the person has never achieved orgasm before. Secondary means that orgasm has been achieved in the past, but now can be reached only under specific circumstances or not at all. 

The exact prevalence of anorgasmia is unknown, but numbers can range from less than 1% to more than 5% of males. What we do know is that it is more common in the older population and in people with pre-existing medical, urological, neurological or psychiatric issues.


Causes of Male Anorgasmia

Endocrinological causes include hormonal imbalances such as testosterone deficiency, hyperprolactinemia and hypothyroidism. When these hormones are abnormally low or high, they can not only impair the ejaculatory function, but the erectile function and sex drive as well. 

Medications such as antidepressants (especially SSRIs), antipsychotics and opioids can also cause anorgasmia. This side effect of certain antidepressants has led to the development of a drug known as Priligy, which can delay ejaculation and is used in the treatment of premature ejaculation. 

Some men obtain greater pleasure from masturbation than they do with sexual intercourse. They may continue deep-seated habits such as frequent masturbation or using idiosyncratic masturbation techniques. This hyperstimulation results in a situation where vaginal or oral intercourse may not be able to replicate the stimulation achieved through idiosyncratic masturbation. This may result in reduced penile stimulation during sexual intercourse, leading to difficulty achieving an orgasm.

Penile sensation loss has been shown to increase with age and those with sexual dysfunctions. Age-related loss of peripheral nerve conduction may account for the increased onset over age 50 years. The less sensitive your penis is, the more difficult it is to achieve ejaculation. 

Anorgasmia has also been associated with multiple psychological conditions. Some of these conditions include anxiety, fear and relationship difficulties. Anxiety and fear of hurting the female, impregnating the female, childhood sexual abuse, sexual trauma, repressive sexual education/religion, performance anxiety, sexual anxiety and general anxiety are common. Anorgasmia based on a situational aspect (i.e. difficulties with a specific partner and not another) is more likely to be due to a psychological etiology.

Neurological conditions such as multiple sclerosis, spinal cord issues such as cauda equina syndrome, neuropathy (nerve damage) caused by diabetes, and uncontrolled hypertension (high blood pressure) can also cause anorgasmia. 

Complications from prostate surgery (prostatectomy) or radiation therapy to treat prostate cancer can also result in anogasmia.

Diagnosis of Male Anorgasmia

Your doctor will do a thorough history and physical exam. This should include an evaluation of all medications you take or have taken in the past and past procedures and medical interventions as well. 

Depending on your doctor’s evaluation, they may order further tests including blood tests to evaluate endocrine and hormonal function, sugar levels, a biothesiometry which measures penile sensitivity, a sympathetic skin test, and/ or a sacral reflex arc testing examines the spinal nerves. Imaging investigations may also be done. 

If necessary, your doctor may refer you to a urologist if a physical cause is suspected or a mental health professional if it appears a psychological issue. 


Treatment options

Treatment will depend on the underlying pathology. 

If the cause is due to an underlying disease, management of that underlying disease is the first step in the management of anorgasmia. If the cause is due to a medication, stopping it or changing to a different medication should be considered. If there is a hormonal imbalance, it can be treated with medication to adjust the hormones.

If organic causes are ruled out, the patient may benefit from a thorough psychosexual evaluation (along with his partner). Some psychotherapy techniques that have been used are masturbation retraining/desensitization, adjustments of sexual fantasies, changes in arousal methods, sexual education, sexual anxiety reduction, increased genital stimulation, and role playing an exaggerated orgasm alone and/or with his partner. 

There are some medications that have been used to treat anorgasmia, including Cabergoline, Bupropion, Amantadine and Oxytocin as some. However, these are off-label uses.

Some cases of anorgasmia have also been treated using penile vibratory stimulation (PVS) in patients with penile sensitivity loss. In PVS, a vibrator is applied to the frenular area of the glans penis to produce mechanical stimulation to trigger orgasm.

Male anorgasmia, just like with all types of sexual dysfunction, can take a significant toll on a man’s physical, psychological, and emotional life and result in significant sexual dissatisfaction, as well as that of his partner. The most important step in addressing this condition is to come to a diagnosis, rather than allowing shame, guilt or frustration to get in the way of your relationship.

Next read: Premature Ejaculation


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7 Ways to Last Longer In Bed – Premature Ejaculation

Many men and their partners wish that they could last longer in bed. Finishing early or earlier than the partner may cause frustration and disappointment.
The main cause of this is a condition called Premature Ejaculation.
Based on a study done on 500 men, men on average lasts around 5 and a half mins. So if you are hitting this number or more, you are fine. However, if you ejaculate within 1 min, then it is considered to be premature ejaculation and you should consult a doctor and seek treatment.
Even though some men may be around the average, they may still want to last longer. So whether you have Premature Ejaculation or not, here are 7 ways that you can do to help you last longer in bed.

7 ways that you can do to help you last longer in bed.

1. Take mental breaks

Premature Ejaculation is usually a psychological issue. When one gets too sexually stimulated, that is when the man cannot control his ejaculation. One way is to distract yourself from the stimulation by thinking of mundane things like mathematical calculations or tomorrow’s grocery list.

2. Control techniques

There are a few exercises or techniques that you can apply to prevent early ejaculation. For eg.

a) The stop and squeeze technique:

Just before ejaculation, withdraw and squeeze the head of the penis. You need to do this at the right time as squeezing too late will still result in ejaculation.

b) Withdrawal technique:

Just before you feel like ejaculating, you withdraw your penis to immediately remove the sexual stimulation. This is not as effective as the one above and you would also have to withdraw at the right time and not a second too late.

c) Stop and start:

You or your partner stimulate your penis until you feel like you’re going to have an orgasm. Stop the arousal for about 30 seconds or until the feeling passes. Start the stimulation again and repeat three or four more times before you actually ejaculate.

3. Masturbate before sex

By masturbating 1- 2 hours before sex, it helps to reduce your sexual urge and the urge to ejaculate hence allowing you to last longer. Generally, after one round of ejaculation, you will need a longer time for the second one.

4. Foreplay is key

Men tend to focus on ejaculation as the only objective of sex. Focus on pleasing your partner and foreplay is a big part of that. With foreplay, it also helps to prolong the duration and heighten the pleasure. Your partner might even get more satisfaction out of this than just penetration. Find out what turns your partner on.

via GIPHY

5. Use thicker condoms

Thicker condoms help to reduce the sensitivity of the penis and hence delay ejaculation. Although most men don’t really like using thick condoms as they might find it difficult to stay aroused or they don’t like how it feels.

6. Communicate

Talk to your partner. Let her know what you’re going through so that both of you can try out different things that can work to delay ejaculation and prolong sex. This will also promote a better understanding between the two of you and improve your relationship. With better understanding, there will be fewer disappointments or frustrations.

7. See your doctor – Erectile Dysfunction Clinic Singapore

If the above still doesn’t help, you should see your doctor and find out if you might have any underlying condition that may cause this issue. If there are any problems like Erectile Dysfunction or Diabetes, your doctor will need to treat that first.
Your doctor also can recommend or prescribe medications to help you last longer in bed. – Erectile Dysfunction Treatment Singapore
Tag: ED Treatment Singapore
Now that you’ve got the 7 tips, you can go out there and try it out for yourself and become the best lover you can be between the sheets.

Take Care!


Also, Read:

  1. Things to do to maintain your penis health
  2. 10 Ways to Improve Sexual Performance for Men
  3. An Overview of STD by an STD Doctor
  4. Anal Warts! What You Need To Know
  5. 8 Thing You Did Know Know About Your Penis
  6. Weak Erection: Does Size Matters?
  7. Sexual Health Advice for Travellers 
  8. What you need to Know about Erectile Dysfunction 
  9. Sex During Period (Sex & Menstruation) What To Know
  10. What You Need to Know about Premature Ejaculation Treatment
  11. What you need to know about Testosterone Deficiency Syndrome
  12. What is HIV / AIDS Signs and Symptoms

Is Premature Ejaculation a Problem?

Too Fast? Too Slow?

Premature ejaculation or PE occurs when a man reaches orgasm and ejaculates with minimal stimulation or within a very short period of time.
There is no uniform cut-off timing for what constitutes as PE, and in the past, most experts would agree that last less than one minute is a cause for concern.
However, newer guidelines suggest that any man who feels they do not have control over when he ejaculates and that it causes distress to him and his partner can be considered to have premature ejaculation.

Is Premature Ejaculation a Problem?

Of course, Premature Ejaculation is a real problem if:

  • It is causing or arising from inter-personal relationship problems.
  • It is causing or arising from psychological issues like anxiety and depression.
  • It is a sign of hidden erectile dysfunction (ED).
  • It is due to a low serum Testosterone level.
  • It is a sign of an underlying medical disease.
  • It is due to stopping a drug.
  • It is severe enough to affect fertility.

Sometimes premature ejaculation may be caused or worsened by other conditions, such as anxiety and depression, erectile dysfunction, prostatitis and testosterone deficiency.
These conditions will be assessed with a clinical history and may need further investigation if appropriate.

Is there any treatment for Premature Ejaculation?

There are several options for treatment of premature ejaculation, although a combination of certain medication and non-pharmacological treatments often give the best results.

If you think that you or your partner may be suffering from premature ejaculation, please visit our Men’s Clinics for a thorough evaluation and discussion on Premature Ejaculation Treatment options.

Take Care!


Related Read:

  1. STD Risk for Receptive Unprotected Anal Sex in Men
  2. 10 Ways to Improve Sexual Performance for Men
  3. Weak Erection? Erectile Dysfunction? Improv Erection with Pills
  4. Weak Erection: Does Penis Size Matters?
  5. Pearly Penile Papules (Bumps On Penis)
  6. Phimosis – Unusually Tight Foreskin 
  7. An Overview of STD – From an STD Doctor
  8. What are the Signs & Symptoms of HIV and AIDS?
  9. What Causes Men’s Pattern hair loss (Androgenic Alopecia)
  10. Pills That Prevent HIV – HIV PrEP & HIV PEP
  11. What are the Causes of Foreskin Infection?