Causes and Treatment of Male Anorgasmia

Anorgasmia (alternately known as orgasmic dysfunction or Coughlan's syndrome) is the persistent inability to reach orgasm during sex. It is less common in men than women and is especially rare in younger men. Male anorgasmia is closely associated with delayed ejaculation, a condition that itself is more common in older men.

Beyond age, there are many different reasons why a man may experience anorgasmia, both physiological and psychological. The condition may be described as primary anorgasmia, in which a man has never experienced a climax, or secondary anorgasmia, in which the inability to orgasm is caused by an external factor that has altered a man's ability to climax.

While statistics vary on how many men experience anorgasmia, the National Survey of Sexual Health and Behavior in 2009 reported that roughly 9 percent of men did not achieve orgasm during their last sexual encounter. (This doesn't mean to suggest that 9 percent of men have anorgasmia, given that the condition is defined by persistence, but it does hint that it may be a larger problem than previously suspected.)

Anorgasmia should not be confused with erectile dysfunction (the inability to achieve an erection) or low libido (the lack of sexual desire), although the conditions can co-exist.

Psychology can play a central—and sometimes exclusive—role in anorgasmia in men. Among the possible causes, sexual performance anxiety is cited as the most likely reason why a man is unable to achieve an orgasm.

Performance anxiety can affect men of any age but may be exacerbated by erectile dysfunction, a condition more commonly seen in older men. On the flip side, performance anxiety can lead to erectile dysfunction by triggering extreme stress prior to and during sex.

Other psychological causes of primary anorgasmia include negative attitudes about sex (often instilled from childhood), childhood sexual abuse, or such deeply rooted phobias as haphephobia (the fear of being touched) or genophobia (a generalized fear of sex).

With regards to secondary anorgasmia, psychological causes can sometimes be described as situational. Situational anorgasmia infers that you are able to achieve orgasm with one partner but not another or can only have an orgasm under certain conditions. Given the enormous variety of sexual expressions, it is not considered problematic unless it interferes with your relationship or is associated with hypersexuality and the preoccupation with new sexual partners.

Other psychological causes of secondary anorgasmia include depression, grief, chronic fatigue, recent or past sexual trauma, marital strife, or the stress caused by trying to actively conceive.

While some medical professionals will approach male anorgasmia as a purely psychiatric condition, there are, in fact, numerous physiological factors that may contribute to or be the sole cause of the dysfunction.

Primary causes are those you are born with, although they may only fully express themselves as you get older. These may include:

• Congenital absence of the bulbocavernosus reflex (in which the anal sphincter is meant to contract during ejaculation)
• Multiple sclerosis
• Type 1 diabetes, specifically diabetic neuropathy

Secondary causes may include:

• Alcoholism
• Antidepressants
• Cauda equina syndrome
• Complications of genital surgery
• Endocrine disorders that affect hormonal balance
• Low testosterone (hypogonadism)
• Opiate abuse, especially heroin
• Pelvic trauma, including groin or perineal injuries
• Prostate radiation therapy
• Removal of the prostate gland
• Spinal cord injury
• Type 2 diabetes
• Untreated high blood pressure

If you find that you are unable to achieve an orgasm, speak with your doctor or schedule an appointment with a urologist who may able to explore the physiological causes of your condition. A psychiatrist or psychologist may also be needed to identify any emotional or psychiatric factors causing or contributing to the dysfunction.

The treatment would be directed by the diagnostic findings. Among the possible options:

• If a hormonal imbalance is identified, you may be offered testosterone replacement therapy or referred to an endocrinologist for further evaluation.
• A change of medications or drug/alcohol treatment may be recommended if the cause is believed to drug-related.
• Mood disorders, such as depression and anxiety, may require therapy and drug treatment (although care needs to be taken to minimize treatment-related sexual side effects)
• Psychotherapy may help overcome sexual performance anxiety or address past or recent traumas, both sexual and non-sexual.
• Couples counseling may help overcome relationship issues.
• Sex therapy may be used to directly address specific sexual issues that are interfering with your ability to achieve an orgasm.

In some cases, treatment may not be available, particularly if you have undergone a radical prostatectomy, experienced severe pelvic trauma, or have advanced multiple sclerosis.

Treatment would instead be focused on enhancing sexual pleasure and increasing sexual intimacy devoid of an orgasm. A psychologist or sex therapist may help you gain acceptance of your condition and embrace a healthy sexual lifestyle unencumbered by doubt or insecurity.