An Overview of Male Anorgasmia

Male anorgasmia is the persistent inability of a man to have an orgasm, even after sexual stimulation. Although anorgasmia, or Coughlan's syndrome, affects both sexes, it's more common in women. The prevalence of delayed or absent orgasm in men is estimated to be about 8%. It's less common among young men and increases with age.

That said, male anorgasmia can be distressing to those who experience it, especially since it often occurs along with delayed ejaculation. The condition should not be confused with erectile dysfunction (the inability to achieve an erection) or low libido (the lack of sexual desire), although these conditions may co-exist.

There are myriad potential causes of male anorgasmia, ranging from physiological problems present at birth to side effects from surgery or medications to psychological issues. Once the cause has been determined, a treatment approach can be devised to help a man regain normal and satisfying sexual function.

Physiology of the Male Orgasm

The male orgasm is a complex process. It is the third of four distinct phases comprising ejaculation: arousal, plateau, orgasm, and resolution/refraction, although not all men ejaculate during an orgasm.

Male orgasm results from sexual activity (physical sensation) and arousal (cognitive awareness). 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 (libido) that leads to arousal, erection, and ultimately, orgasm. Also involved are contractions of the muscles of the penis, anus, and perineum which ultimately propel semen from the body.

During orgasm, the reward center of the brain is flooded with neurochemicals, inciting the intense emotional response associated with an orgasm. When any of these aspects are affected by physical or emotional issues, a man may be unable to achieve a normal orgasm.

Types

There are two types of anorgasmia:

• Primary anorgasmia: Orgasm has never been achieved.
• Secondary, or situational, anorgasmia: Orgasm can be reached only under specific circumstances, such as during oral sex or masturbation.

Causes

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

Physiological

• Congenital absence of the bulbocavernosus reflex, which triggers the anal sphincter to contract during ejaculation
• 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 
• Substance abuse (especially heroin use)
• Prescription side effects with medications such as antipsychotics, opiates, and antidepressants—in particular, selective serotonin reuptake inhibitors (SSRIs) such as 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 but can be exacerbated by erectile dysfunction, more common in older men
• Negative attitudes about sex tied to a repressive religious upbringing or family/parental issues typically established in early childhood
• 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

Accurately diagnosing the underlying cause of male anorgasmia is essential to treatment. If you're dealing with this problem, a visit to your primary care healthcare provider can get this 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. Of particular note may be whether the onset of your inability to orgasm happened to have coincided with starting a new prescription.

Depending on your healthcare provider's initial evaluation, they may order further tests or refer you to a specialist. This may be a urologist for a physical cause or a mental health professional for a psychological issue, or perhaps both given the overlap between body and mind in sexual health.

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

• Blood tests to evaluate endocrine function and 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, a posssible side effect from a condition like diabetes
• Penile sympathetic skin response
• Sacral reflex arc testing to examine the motor and sensory branches of the pudendal nerve (which carries sensation from the external genitalia and the skin around the anus and perineum) and nerve roots

Psychological issues that may be considered include relationship status and satisfaction and potential causes of stress that may be interfering with sexual function.

Treatment

There is no one-size-fits-all remedy for male anorgasmia. The specific approach to treating this problem obviously will depend on the cause as well as specific diagnostic findings. However, there are certain treatment protocols that often are used in specific situations:

• When a medication is found to underly anorgasmia, changing the dosage or switching to a different prescription may be all that's necessary to return sexual function to normal.
• In the case of hormonal issues, testosterone replacement therapy or a dopamine promoting drug such as Dostinex (cabergoline) often can restore a man's ability to orgasm.
• Depression, anxiety, or other mood disorders that contribute to male anorgasmia can be treated with therapy and/or medication. If drugs are prescribed, it's important to be aware that certain ones may exacerbate sexual dysfunction.
• Psychotherapy also may be beneficial for overcoming sexual performance anxiety or addressing past sexual and non-sexual trauma that may play a role in anorgasmia. Similarly, couples counseling may help resolve relationship issues.
• Specific sexual issues may be resolved with the guidance of a sex therapist.
• Digital prostate massage, a technique in which a finger is inserted into the rectum prior to or during sex to manually stimulate the prostate gland, considered by some to be the male G-spot.

Coping

Male anorgasmia, like any type of sexual dysfunction, can take a significant toll on a man's physical, psychological, and emotional life, as well as that of his partner. The most important step is to seek diagnosis, rather than allowing shame or feelings of discomfort to eclipse or obscure your determination to deal with anorgasmia.

If you have had a radical prostatectomy, severe pelvic trauma, or have advanced multiple sclerosis, there may not be an effective treatment. The best solution may be to focus on enhancing sexual pleasure and intimacy, even without orgasm. A psychologist or sex therapist can help you embrace a healthy sexual lifestyle.

A Word from Verywell

Male anorgasmia can be frustrating, embarrassing, and distressing for a man at any age or stage of life, as well as for his spouse or sexual partner. Because there are so many possible reasons for an inability to reach orgasm, this condition sometimes can present challenges in diagnosing a cause.

Once it's clear why someone is experiencing anorgasmia, there usually are obvious and effective treatment options available for restoring sexual function to normal.