Male orgasmic disorder (MOD)
Anorgasmia is a male sexual orgasmic disorder in which there is persistent and consistent inability to achieve orgasm, after adequate stimulation that causes personal distress. Approximately 10% of men report difficulties with orgasm. Anorgasmia is more common in women than in men. Primary anorgasmia is used to define the condition of men who have never experienced orgasm while secondary anorgasmia is used to describe a man who once experienced orgasm but lost the ability.
Symptoms of anorgasmia in a man are persistent and consistent inability to achieve orgasm after adequate stimulation.
Anorgasmia can be caused by psychologic problems. Anorgasmia may also be caused by medical problems such as diabetic neuropathy, multiple sclerosis, or complications from spinal cord injury, genital surgery, radical prostatectomy, pelvic trauma, hormonal issues such as low testosterone and low thyroid. A common cause of anorgasmia, in men, is the use of anti-depressants, particularly selective serotonin reuptake inhibitors (SSRIs). It is estimated that one quarter of users of selective serotonin reuptake inhibitors are affected by anorgasmia. Very often anorgasmia is secondary to both psychologic and physiologic causes.
Some men with primary anorgasmia have no personal distress. These men may view sexual activity as pleasant despite their inability to orgasm because they achieve reward from touching, holding, kissing, caressing, and getting and giving attention.
Some men with primary anorgasmia have great personal distress. These men cannot achieve orgasmic release of sexual tension tension and may even experience pelvic pain because of genital vascular engorgement. When a man has sexual activity that is not accompanied by orgasmic release, sexual activity may become a chore or a duty rather than a mutually satisfying, intimate experience. In such circumstances, sexual desire often declines, and sexual activity can result in resentment and relationship conflict. Men with anorgasmia and personal distress should consider undergoing a combined psychologic and physiologic sexual medicine evaluation.
Some men who once had the ability to have orgasm develop secondary anorgasmia from psychologic issues such as drug addiction or alcoholism, depression, grief or loss. Some men develop secondary anorgasmia from physiologic issues such as diminished genital sensation, pelvic surgery or injuries, sexual pain, erectile dysfunction, reduced sexual arousal, hypoactive sexual desire disorder, medications especially SSRI’s and 5 alpha reductase inhibitors, chronic illnesses, or low testosterone and/or low thyroid hormonal states. Whether a man has psychologic-based or physiologic-based anorgasmia, if he has associated personal distress, a combined psychologic and physiologic sexual medicine evaluation should be considered.
Men may develop a situational form of secondary anorgasmia in which the man is more easily orgasmic in some situations (certain partner and certain type of foreplay) and cannot achieve orgasm in other situations. These variations are not usually associated with great personal distress. Should situational secondary anorgasmia cause personal distress, a combined psychologic and physiologic sexual medicine evaluation should be considered.
Psychologic approaches to improving orgasmic function focus on the man exploring psychologic factors such as hypoactive sexual desire disorder, depression, poor arousal, anxiety, fatigue, emotional concerns, past trauma and abuse history, cultural and religious prohibitions feeling excess pressure to have sex, or a partner’s sexual dysfunction such as vaginal dryness, sexual pain or low sexual interest or anorgasmia. Sex therapy involves teaching the use by couples of manual or vibrator stimulation during intercourse. Sex therapy may focus on mindfulness strategies and yoga exercises. Sex therapy also assist the man examine and realign expectations of orgasm. Emotional intelligence, or knowledge of one’s mood or sense of being is important for orgasm function.
Physiologic approaches to improving orgasmic function focus on ruling out contributing medical causes, such as switching medications if appropriate or treating irritable urinary symptoms if appropriate. Blood testing should be considered for sex hormone levels such as testosterone, sex hormone binding globulin, dihydrotestsoterone, LH, FSH, estradiol, prolactin, PSA and TSH. These blood tests will assess testicular function, pituitary function and thyroid function. Medications that may help with orgasm function include dopamine agonists (drugs that raise dopamine), oxytocin, phosphodiesterase type 5 inhibitors and alpha-2 receptor blockers such as yohimbine hydrochloride.
In many cases the combined psychologic and physiologic approaches to resolving the orgasmic dysfunction make the most sense.