An Overview of Male Anorgasmia

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.

It's estimated that about 8% of men have delayed or absent orgasm. It's less common among younger men and increases with age.

The condition should not be confused with erectile dysfunction (the inability to achieve an erection) or low libido (lack of sexual desire). However, these conditions may co-exist.

There are multiple causes of male anorgasmia. They include:

• Physiological problems present at birth
• Side effects from surgery
• Medications
• Psychological issues

A treatment plan can be created once the cause has been identified. Then a man should be able to regain normal and satisfying sexual function.

This article will explain the types and causes of male anorgasmia. It will also address diagnosis and treatment as well as how to cope with this condition.

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.

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

Types

Men can experience one of two types of anorgasmia:

• Primary anorgasmia, when a person has never been able to have an orgasm
• Secondary, or situational, anorgasmia, when orgasm can be reached only under specific conditions, such as during oral sex or masturbation

Causes

The potential causes of male anorgasmia can be divided into two categories: physiological and psychological:

Physiological

• 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)

Psychological

• General mental health issues such as anxiety, stress, depression, relationship difficulties, and hostility
• 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
• Early sexual abuse and trauma
• 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

Diagnosis

To treat male anorgasmia, it must be diagnosed accurately. If you're dealing with this problem, a visit to your primary care healthcare provider can get the process started.

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
• Biothesiometry to 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

Sometimes, changing the dosage of a prescription is all that's necessary to return sexual function to normal. It's a simple "cure" that serves as a reminder about why it doesn't pay to postpone a trip to the doctor.

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.

Summary

There are two types of male anorgasmia and two primary causes: physiological and psychological. Diagnosis is straightforward, and many treatment options exist.

Coping with the condition can be difficult for the man as well as his partner. But taking a proactive stance and seeing a physician as soon as possible can help both people resume their sexual activities with confidence.

A Word from Verywell

Male anorgasmia can be frustrating and embarrassing for a man at any age or stage of life. There are many possible reasons why a man does not reach orgasm. However, once the cause is clear, effective treatment options abound. They can restore sexual function to normal.