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
