When people think of male sexual dysfunctions, problems such as erectile dysfunction (ED) or premature ejaculation (PE) often come to mind. But there’s a third sexual issue that’s more common in men than you might expect — the inability to reach orgasm.
Anorgasmia is a sexual disorder in which a man or woman finds it difficult or impossible to reach orgasm. During sex or masturbation — even if you’re aroused and sexually stimulated and using the best toys in their arsenal — people with this condition just can’t get over the finish line.
For many men, anorgasmia is about more than just a lack of orgasm. The inability to finish can cause secondary issues. Anxiety, avoidance, depression and a reduced level of interest in sex can all arise — and that’s before we talk about how incredibly sexually frustrated men with this problem can become.
There’s no ready-to-use medication for male anorgasmia, and figuring out the cause can be difficult. But various treatments can help relieve symptoms for any guy willing to seek help.
You probably have lots of questions, and we have answers. Below, we’ll explain what anorgasmia is, cover the causes, symptoms and treatment options, and give you some advice on what to do next if you have issues relating to your ability to reach orgasm.
Anorgasmia is the persistent or recurrent difficulty achieving orgasm — or the inability to reach orgasm during sexual stimulation.
It can occur during sexual intercourse or masturbation and is often a significant cause of personal distress related to sex.
Anorgasmia is referred to by a few different names. You may have heard it described as delayed orgasm, inhibited orgasm, retarded orgasm/ejaculation or inhibited ejaculation.
But while all these names may refer to essentially the same problem, anorgasmia as a whole can actually come in several forms.
Cases of anorgasmia in men are usually categorized into two groups: primary anorgasmia and secondary anorgasmia.
Primary anorgasmia is typically defined as anorgasmia that affects a man for his entire sexual life. If you’re affected by primary anorgasmia, you may have found it slow, difficult or impossible to reach orgasm. And the problem may have started from your first few sexual experiences.
Secondary anorgasmia is typically defined as anorgasmia that develops after a period of normal sexual experiences. In other words, it comes seemingly out of nowhere after years of otherwise normal sexual function.
With this type of anorgasmia, you may notice that you can no longer reach orgasm and ejaculate, even after years of having sex or masturbating without any issues.
Secondary anorgasmia may also present as situational. This means it could be related to particular types of intimacy or created after an event that caused some emotional distress, like sexual abuse.
While anorgasmia is less common than other male sexual performance issues, the issue affects a considerable number of men.
Some research has found that approximately 1.5 out of every 1,000 men are affected by primary anorgasmia. And roughly 4 percent of men under the age of 65 are affected by secondary anorgasmia.
Many factors may cause or worsen male anorgasmia.
Some causes of male anorgasmia are psychological, such as depression or anxiety. Others are physical, such as nerve damage, loss of penile sensitivity, use of certain medications or hormonal health issues.
We discuss more on nerve damage in our neurological ED guide.
Let’s take an in-depth look at all the potential psychological and physical causes of male anorgasmia.
Psychological factors that may cause male anorgasmia include:
Depression. If you’re depressed, it may keep you from finishing. Sexual issues such as difficulty reaching orgasm are common in men with depression. If you’re depressed, you may experience difficulty getting or maintaining an erection, a reduced sex drive and/or anorgasmia.
Anxiety. Anxious about work, intimacy or life in general? It could keep you from getting off. Anorgasmia may be caused by certain forms of anxiety, including anxiety relating to sexual relations. Factors like a fear of pregnancy, sexual trauma and general anxiety (among others) may all cause anorgasmia.
Lack of sexual arousal. While the causes can be complicated, one simple cause is sometimes overlooked: You might just not be into it. Sometimes, a simple lack of sexual arousal can make it more difficult to orgasm. Some men — particularly those who use ED medications to treat other medical conditions related to performance — may be able to get an erection without feeling sexually aroused but find it hard to reach orgasm.
Physical factors that may cause male anorgasmia include:
Use of SSRIs. Anorgasmia is a known side effect of many selective serotonin reuptake inhibitors (SSRIs) — a common type of antidepressant. Many SSRIs cause a range of sexual issues, including reduced sexual desire and inability to orgasm. Since SSRIs are used to treat depression, it can be difficult to know if anorgasmia is caused by the medication itself or a symptom of depression.
Use of other medications. Other medications, such as antipsychotics and opioids, may also affect your sexual performance and ability to reach orgasm. For the record, some recreational or illegal drugs may also complicate your getting-off process. Keep this in mind if you’ve been drinking, smoking, or doing recreational drugs.
Low testosterone. Research suggests that hormonal deficiencies, including low levels of testosterone, may play a role in anorgasmia. A small study of 206 men with difficulty achieving orgasm found that 21 percent had clinically low testosterone levels.
Other hormonal issues. In addition to testosterone, several other hormones may affect orgasm and ejaculation. For instance, prolactin and other hormones related to prolactin levels may be associated with anorgasmia.
Loss of penile sensation. Research suggests it’s normal to lose some level of penile sensitivity with age. If your penis is less sensitive or if you’d describe it as numb, you might find it more difficult to reach orgasm during sexual activity.
Nerve damage. Damage to the nerves in your lower body, whether from a pinched nerve, an injury to the spinal cord, surgery to the genitals or prostate, pelvic trauma, diabetic neuropathy or other nerve-damaging diseases, can potentially cause anorgasmia.
Masturbation. Solo sessions may also contribute to anorgasmia. Over time, masturbation can affect your sexual performance and habits. For example, some men find masturbation more pleasurable than sex due to certain masturbation techniques or sexual fantasies. Research suggests men with anorgasmia tend to masturbate often. There’s also a real link between anorgasmia and unusual masturbation practices.
It’s fairly obvious that anorgasmia has a direct impact on your ability to orgasm, so we’re not going to keep belaboring the point. But while mental health and sexual health issues may sometimes be related to the cause of your anorgasmia, they might also become symptoms.
Because of its effects on sexual performance and pleasure, anorgasmia can often cause issues such as anxiety, frustration and general sexual dissatisfaction. These may lead to other sexual issues like erectile dysfunction and a reduced sex drive.
What this may look like for you could include any of the following:
Avoiding intimacy because you know you’ll be unable to finish
Masturbating excessively in an attempt to finish
Relationship problems caused by frustration of not finishing
Simply losing interest in sex, knowing the pleasure isn’t likely to come
If this sounds familiar, it’s time to talk to a professional and get to work on treatment. But before treatment, you’ll need to get diagnosed so your healthcare provider can understand more about what’s keeping you from getting over the finish line.
By now, you hopefully realize this problem isn’t going away without help. Still, it’s worth saying: If you find it difficult or impossible to achieve orgasm during sex or masturbation, it’s important to talk to your healthcare provider.
A healthcare professional will work with you to accurately diagnose the root cause of your orgasm issues and recommend a suitable treatment.
When you visit your healthcare provider, they may perform a physical exam and ask about any medications you use. If you’ve recently developed anorgasmia after starting a certain type of medication, make sure to let your provider know.
Depending on the possible cause of your anorgasmia, your healthcare provider might suggest a range of tests, including:
Testosterone, prolactin, thyroid and other hormone tests. These hormones can all affect your sexual performance. You can check them with a simple blood test and often get your results within a few days.
Penile sensitivity tests. If a physical factor is the suspected cause of your anorgasmia, you may need to undergo testing to check your penile sensation. Several tests are used for this purpose, including biothesiometry, skin testing and sacral reflex testing.
These tests can help your provider more accurately diagnose the underlying issues that may cause you to experience difficulty reaching orgasm.
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Since male anorgasmia can occur for numerous reasons, there’s no one-size-fits-all pill you can take to treat your symptoms and help you orgasm normally.
In fact, there’s currently no FDA-approved medication designed specifically for anorgasmia in men.
If your anorgasmia is related to a physical or psychological issue, your healthcare provider may refer you to a urologist or a psychiatrist for specialized treatment.
Depending on the specific cause of your anorgasmia, you might benefit from a range of treatment options. Common treatments for anorgasmia include:
Psychotherapy. If your anorgasmia is caused by a psychological issue, you may benefit from psychotherapy. Talk therapy is often helpful for treating sexual dysfunction caused by anxiety, depression and other mood disorders. Online counseling is also a great option if you prefer virtual therapy.
Sex therapy. Certain forms of sex therapy may help you enjoy sex and reach orgasm more easily. You and your partner may benefit from changing your arousal methods, exploring sexual anxiety reduction techniques with a sex therapist or just discussing them openly as they pertain to your relationship.
If your anorgasmia is related to masturbation, changing the way you masturbate or switching up your sexual fantasies may improve your sexual performance and treat anorgasmia.
Changing medications. If you currently use SSRIs or other antidepressants, you might need to switch medications. Certain antidepressants, such as bupropion, are less likely to cause sexual side effects and may help improve anorgasmia in men.
Medications for hormonal issues. If your anorgasmia is caused by a hormonal issue, your healthcare provider might prescribe medication to increase or decrease your levels of certain hormones. For prolactin-based anorgasmia, your healthcare provider may suggest off-label treatment with the drug cabergoline. If your anorgasmia is caused by low testosterone, your healthcare provider might recommend supplemental testosterone.
Penile vibratory stimulation. If you have a reduced level of penile sensitivity, vibratory stimulation could help you achieve more well-rounded sexual function. This form of treatment involves vibration to the frenulum — an elastic area of tissue near the tip of the penis — and may help induce orgasm and treat anorgasmia.
Your healthcare provider will help you figure out the most effective treatment option for your unique needs. Be sure to closely follow their instructions, and if you’re prescribed medication to treat anorgasmia, use it as prescribed for optimal results.
Anorgasmia can be a frustrating occurrence, especially when it affects you and your partner’s ability to enjoy sex. That sucks, but it can stop sucking.
If your sex life has been put on hold because of orgasmic dysfunction, keep this in mind as you seek out solutions:
A wide range of factors, from psychological issues to physical ones, may affect your ability to reach orgasm and ejaculate during sex.
There’s no one-size-fits-all treatment for anorgasmia.
If you have recurring or persistent anorgasmia, talk to your healthcare provider about testing and treatment options.
With the right combination of testing and treatment, it’s often possible to improve anorgasmia and enjoy sex without any concerns about your ability to successfully reach orgasm.
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Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.