Anorgasmia

What Is Anorgasmia?

When you think of male sexual dysfunction, concerns like erectile dysfunction (ED) or premature ejaculation (PE) probably come to mind first. But there’s another sex-related issue that’s more common in men than you might expect: difficulty orgasming.

Both delayed orgasm and anorgasmia are male orgasmic disorders that make it difficult or impossible to reach orgasm. In the case of anorgasmia, which affects both men and women (when it would be considered a female orgasmic disorder), there’s a total inability to reach orgasm, not just a delay. People with this condition just can’t get over the finish line during sex or masturbation, even if they’re aroused, sexually stimulated, and using the best toys in their arsenal.

For many men, anorgasmia is about more than just a lack of orgasm. The inability to finish can cause secondary issues, like anxiety, avoidance, depression, and a reduced level of interest in sex. It can also be highly sexually frustrating.

There’s no go-to medication for male anorgasmia, and figuring out the cause can be difficult. Below, we’ll explain more about the meaning of anorgasmia, the most common symptoms, and the potential causes. We’ll also share some of the available treatment options if you’re unable to reach orgasm.

Anorgasmia Meaning

Anorgasmia is the persistent or recurrent inability to achieve orgasm with adequate sexual stimulation.

It can occur during sexual intercourse or masturbation and is often a significant cause of personal distress related to sex.

A few different names are often used interchangeably with anorgasmia. You may have heard it described as delayed ejaculation, delayed orgasm, inhibited ejaculation, or inhibited orgasm. While most of these terms suggest difficulty reaching orgasm, anorgasmia refers to the absence of an orgasm.

Types of Anorgasmia in Men

Cases of anorgasmia in men are usually categorized into two groups: primary anorgasmia and secondary anorgasmia.

If you have primary anorgasmia, it means you have found it impossible to reach orgasm for your entire sexual life. This type of sexual dysfunction may have started from your first few sexual experiences.

With secondary anorgasmia, the inability to orgasm develops after a period of normal sexual experiences. In other words, it comes seemingly out of nowhere after years of otherwise orgasming normally.

Secondary anorgasmia may also be situational. This means it could be related to particular types of intimacy or events that caused some emotional distress, like sexual abuse or more commonly performance anxiety.

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. It also appears to be more prevalent in aging men who may experience loss of orgasmic sensitivity related to medical comorbidities like diabetes. And some men who watch a lot of porn are unable to orgasm without that kind of visual stimulation.

Symptoms of Anorgasmia

The most obvious symptom of anorgasmia is not being able to orgasm. But there are also more subtle symptoms that may result from anorgasmia.

For example, mental health conditions may contribute to anorgasmia (more on that in the next section), but they might also be symptoms.

Because of its effects on sexual health and pleasure, anorgasmia can often cause issues such as anxiety, frustration, and general sexual dissatisfaction. These may lead to other sexual problems like erectile dysfunction and a reduced sex drive.

That might look like:

• Avoiding intimacy because you know you’ll be unable to finish

• Masturbating excessively in an attempt to finish

• Relationship issues caused by the 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 who can help you understand the underlying cause and come up with the best plan for treatment.

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Anorgasmia Causes

Some causes of male anorgasmia are psychological, such as depression or anxiety. Others are physical, such as nerve damage, spinal cord injuries, loss of penile sensitivity, use of certain medications, or hormonal health issues.

Let’s look at some of the potential psychological and physical causes of anorgasmia.

Psychological Causes of 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 trouble getting or maintaining an erection, a reduced sex drive, and/or anorgasmia.

• Anxiety. Anxious about work, intimacy, or life in general? Everyday stressors could keep you from getting off. Anorgasmia may also be caused by certain forms of anxiety, including anxiety relating to sex. For example, fear of pregnancy or past sexual trauma might cause anorgasmia.

• Lack of sexual arousal. While the causes can be complicated, one simple cause is sometimes overlooked: You might not be into it. Sometimes, a simple lack of sexual arousal can make it more difficult to orgasm. Another cause in this bucket is porn addiction/dependency. It’s not that porn is bad. No judgment here. It’s just that some men find that their coupled sex does not replicate the arousal they experience watching porn.

Physiological Causes of Anorgasmia

Physical and medical 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 side effects, including reduced sexual desire and inability to orgasm. Because SSRIs are used to treat depression and anxiety, it can be difficult to know if anorgasmia is caused by the medication itself or by the underlying psychiatric condition.

• Use of other medications. Other medications, such as antipsychotics and opioids, may also affect your sexual performance and ability to reach orgasm.  A common medication prescribed for BPH symptoms, tamsulosin (Flomax) is often associated with anejaculation or retrograde ejaculation, and for some men this will manifest as anorgasmia. Some recreational or illegal drugs may also complicate your ejaculatory function. Keep this in mind if you’ve been drinking, smoking, or doing recreational drugs.

• Low testosterone. Research suggests hormonal deficiencies, including low testosterone levels, may make it more difficult to reach orgasm.

• Other hormonal issues. In addition to testosterone, several other hormones may affect orgasm and ejaculation. For instance, high prolactin levels may be associated with anorgasmia. (SSRIs, other psychiatric drugs and tumors on the pituitary gland can increase prolactin levels.)

• Loss of penile sensitivity. If your penis is less sensitive or if you’d describe it as numb, you might find it more challenging to reach orgasm during sexual activity. Loss of penile sensation becomes more common as you age.

• Nerve damage. Damage to the nerves in your lower body or genitals, whether from a pinched nerve, spinal cord injury, radical prostatectomy, pelvic trauma, diabetic neuropathy, or other nerve-damaging diseases, can potentially cause anorgasmia.

• Masturbation. Over time, excessive masturbation can affect your sexual performance and habits. For example, some men find masturbation more pleasurable than sex due to specific masturbation techniques or sexual fantasies. Research suggests men with anorgasmia tend to masturbate more often than men who can orgasm normally.

Risk Factors for Anorgasmia

Risk factors for anorgasmia include:

• Advanced age. As you age, you may experience a loss of penile sensitivity or develop chronic health conditions that increase your risk of anorgasmia.

• Mental health conditions. Having a mental health condition like anxiety or depression can contribute to anorgasmia. So can taking medications for these conditions.

• Past trauma. If you are a victim of sexual abuse or trauma, you may develop anorgasmia.

• Chronic medical conditions. These conditions include neurological issues, diabetes, pelvic floor problems, heart disease, urinary tract disorders, prostate cancer, hormonal imbalances, spinal stenosis of lumbosacral spine or degenerative neurological conditions like multiple sclerosis or Parkinson’s disease.

• Strict cultural or religious background. Growing up with negative attitudes about sex can influence your sexual response and lead to anorgasmia.

• History of substance abuse. Heavy drinking or drug use are common risk factors for male orgasmic disorders.

Diagnosing Anorgasmia

If you find it difficult or impossible to achieve orgasm during sex or masturbation, it’s essential to talk to your healthcare provider.

They’ll work with you to accurately diagnose the root cause of your orgasm issues and recommend a treatment plan.

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 new medication, make sure to let them know.

Depending on the possible cause of your anorgasmia, your healthcare provider might suggest a range of tests, including:

• Testosterone, prolactin, thyroid, and other blood tests to evaluate hormonal health. These hormones can all affect your sexual performance. You’ll get a simple blood test, and your results will often be ready within a few days.

• Penile sensitivity tests. If your healthcare provider suspects a physical factor is causing your anorgasmia, you may need to undergo testing to check your penile sensation. There are several tests they might use for this, including biothesiometry, which measures a person's vibration perception threshold, 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.

Anorgasmia Treatment

Because 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.

In fact, there’s currently no FDA-approved medication explicitly intended for anorgasmia in men.

If your anorgasmia is related to a physical or psychological issue, your healthcare provider may refer you to a neurologist, urologist, psychiatrist, or sex therapist for 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 a psychological issue is causing your anorgasmia, 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 or couples 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 discussing your concerns openly. If your anorgasmia is related to masturbation, changing the way you masturbate or switching up your sexual fantasies may improve your sexual problems and treat anorgasmia.

• Changing medications. If you currently use SSRIs or other antidepressants, your doctor might recommend switching medications. Certain antidepressants, such as bupropion, are less likely to cause sexual side effects and may help improve anorgasmia in men. (Never stop taking your prescribed medications without talking to your healthcare provider first.)

• Erectile dysfunction medications. If you have any degree of ED at all, your healthcare provider may recommend taking an ED medication like sildenafil (Viagra®). While ED medications don’t treat anorgasmia directly, they can lessen sexual performance anxiety, help to stimulate sensory nerves in the penis, and allow you to stay hard for longer to give yourself more of an opportunity to achieve an orgasm. For example, studies show they can improve orgasmic function in patients with SSRI-associated sexual dysfunction.

• Medications for hormonal issues. If a hormonal issue is causing your anorgasmia, 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 testosterone replacement therapy.

• 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 holding a vibrator 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 determine the most effective treatment plan for your unique needs. Be sure to follow their instructions closely, and if you’re prescribed medication to treat anorgasmia, use it as prescribed for optimal results.

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Anorgasmia Prevention Tips

Anorgasmia can be a frustrating occurrence, especially when it affects you and your partner’s ability to enjoy sex.

While you can’t always prevent anorgasmia if an unexpected health condition or injury triggers it, there are steps you can take to lower your risk of developing this sexual dysfunction in the future.

To reduce your risk of anorgasmia, do the following:

• Follow your prescribed treatment plans for existing health conditions

• See a therapist for emerging symptoms of anxiety or depression

• Practice open and honest communication with your partner

• Avoid excessive consumption of alcohol

• Quit smoking

• Challenge negative beliefs about sex

• Lead a healthy lifestyle by following a nutritious diet, getting adequate sleep, and exercising regularly

• Practice pelvic floor exercises

Final Takeaways

If your sex life has been put on hold because of orgasmic dysfunction, keep this in mind as you seek out solutions:

• There are different types of anorgasmia. Men or women with primary anorgasmia have never been able to have an orgasm. Those with secondary anorgasmia used to be able to have orgasms but can’t anymore. Also, some people with anorgasmia can have orgasms in certain situations (like only when masturbating), and others can’t have orgasms in any sexual situation.

• Both physical and mental health conditions can contribute to anorgasmia. Common causes include depression and anxiety, nerve damage, use of certain medications, and hormonal imbalances.

• There’s no one-size-fits-all treatment for anorgasmia. 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. You should also tell your healthcare provider about any additional ejaculation problems like weak ejaculation that might be occurring alongside your trouble coming.

If you’re losing your erection before you’re able to finish, you may also want to discuss erectile dysfunction treatments with your provider.

Medications like Viagra, Cialis Together® (tadalafil), Stendra® (avanafil), or chewable ED meds can help improve your sexual performance and get you closer to the finish line.