Anorgasmia in men is one of the forms of sexual disorders, persistent (persistent) or recurrent inability to achieve orgasm against the background of normal arousal with prolonged stimulation. Pathology is manifested by difficulty in achieving orgasmic discharge, erasure of sensations or anorgasmia. Diagnosis depends on the expected nature of the pathology: a man may need to consult a urologist, andrologist, sex therapist, endocrinologist, ultrasound, a number of laboratory tests. Treatment correlates with the cause and may include psychotherapy sessions, drug therapy, etc.
Male orgasmic disorder is considered among sexual dysfunctions and is often detected in combination with erection and ejaculation disorders, dyspareunia. According to studies conducted in the USA and Europe, more than 30% of men face some form of sexual disorder, of which anorgasmia accounts for 8-14%. Due to the sensitive nature of the problem, this figure may not reflect its true prevalence. Pathology occurs in representatives of all races and ethnic groups. The disorder is registered in men of any age, but in older representatives of the stronger sex, anorgasmia in men is diagnosed more often, which is associated with natural aging processes and changes in the hormonal background.
Pathology may have an organic or psychological origin (the latter is more common). Responsible psychological mechanisms can be “internal” or “external”. Destructive feelings of guilt, anger, low self-esteem, depression, fear are attributed to internal psychological reasons, and unfavorable living conditions, disharmonious relationships, a history of sexual violence, incest, features of upbringing with the suggestion of sex shame are considered as external psychological factors. Organic causes include:
- Hormonal disorders. Hypogonadism (Klinefelter syndrome, testicular atrophy), thyroid pathology (hypothyroidism) and pituitary gland (Cushing’s syndrome) negatively affect sexual desire and potency. An imbalance of hormones (testosterone, estradiol, prolactin) disrupts the neurohumoral regulation of the copulatory cycle and leads to sexual dysfunction, including anorgasmia.
- Neurological pathology. Diseases of the nervous system: stroke, multiple sclerosis, diabetic and alcoholic (toxic) polyneuropathy, spinal cord injuries are considered as triggers of anorgasmia in men. Due to the blocking of the transmission of nerve impulses along the reflex arc, any violations in the sexual sphere are expected.
- Urological interventions. Operations on the prostate gland (prostatectomy, prostate adenoma tour) and the bladder are often complicated by damage to the nerves, sphincter and detrusor, which disrupts copulatory functions. The passage of radiation therapy for prostate cancer also negatively affects innervation.
- Inflammatory processes. Chronic prostatitis, colliculitis, vesiculitis of specific and nonspecific genesis often occur with a violation of sexual functions. These nosolologies are often accompanied by anorgasmia or painful orgasm. Without timely and adequate treatment of urological diseases, orgasmic sensations lose their brightness, and inflammatory obturation of the mouths of the vas deferens leads to a decrease in sperm volume.
- Side effects of medications. Taking certain medications – phenotizines (antipsychotics), medications to reduce high blood pressure (thiazides), alpha- and beta-blockers, tricyclic antidepressants, opiates, neuroleptics, antiepileptic drugs (topiramate), 5-alpha reductase inhibitors, etc. can lead to a state of anorgasmia. After discontinuation of therapy or replacement of medication, normal function is restored in most cases.
Orgasm and ejaculation in men are inextricably linked: the more semen is ejected, the more intense the orgasmic discharge. The structures involved include the appendages of the testicles, the vas deferens, the seminal vesicles, the prostate gland, the prostatic urethra and the neck of the bladder. The pathological process in the above organs affects the onset of orgasm and its intensity. Violation of sympathetic innervation leads to a block of release of oxytocin, neuropeptide, vasoactive intracellular peptide, nitric oxide and GABA. It is these neurotransmitters that are responsible for muscle contraction of the above anatomical structures. Equally important is the participation of dopamine and serotonin, the main neurochemical mediators. Dopamine promotes the release of semen, and serotonin slows down this process, so anorgasmia develops with an overabundance of serotonin.
An important role belongs to innervation: ejaculation and orgasm occur due to the supply of signals to the brain, if there is a violation of the conduction of nerve fibers, ejaculation and orgasmic discharge will not be. During sexual intercourse, the bladder neck normally prevents retrograde sperm casting, which is mediated by sympathetic regulation of the T10-L2 roots. If for some reason these impulses are blocked, the semen is thrown into the bladder, and orgasmic sensations are either absent or manifest as a “dull” orgasm. Any damage to the spinal cord and its branches at the S2-S4 level can paralyze the contraction of bulbospongiousand ischiocavernous muscles and contribute to orgasmic and ejaculatory dysfunction of varying severity.
Anorgasmia in men are mainly considered in the general classification of sexual dysfunction, which includes changes in libido, erection, ejaculation and orgasmic discharge proper. Some experts consider delayed ejaculation, aneaculation and retrograde ejaculation together with dysorgasmia, believing that these physiological processes are inextricably linked. Despite the many classifications, most practitioners adhere to ICD-10 and the more modern DSM-5 guidelines, where “male orgasmic disorder” is replaced by delayed ejaculation. By origin , the following types of anorgasmia in men are distinguished:
- Primary anorgasmia. A state in which there has never been a feeling of climactic satisfaction under any circumstances (including masturbation). In terms of prognosis, it is the most serious type of pathology.
- Secondary anorgasmia. There is a difficulty in achieving orgasm, although orgasmic discharge was present earlier. Pathology is acquired in nature.
Also in andrology, the classification of anorgasmia is used depending on the conditions of occurrence:
- Situational anorgasmia. The most common type of orgasmic disorder. A man experiences an orgasm in strictly defined situations: during oral sex, masturbation, when changing partners, etc. Situational anorgasmia is not a pronounced problem if a variety of sexual manifestations suits both partners.
- General anorgasmia. The inability to get sexual pleasure regardless of the circumstances and sexual attraction to a partner, even with strong arousal and sufficient stimulation of the genitals.
The main manifestations are erased sensations, difficulty in getting an orgasm or its complete absence. In addition, a man complains about a decrease in sexual desire, a weakening of the erection, numbness of the penis, fatigue and lack of satisfaction after sex. Ejaculation can occur without orgasmic discharge. The ejaculation of semen is not intense, sluggish (may be premature), the amount of sperm is reduced. Secondary to orgasmic disorder are apathy, depressed mood, irritability, decreased performance. Some men are able to maintain an erection and have sex, the lack of orgasm during ejaculation is not so noticeable to the partner, but if this causes anxiety, leads to frustration and low self-esteem, you need to seek help.
This type of sexual pathology is fraught with congestions – stagnant phenomena in the pelvis. Prolonged blood filling without ejaculation can be complicated by prostatitis, vesiculitis, inflammation and hypertrophy of the seminal tubercle. If for a considerable time, despite external sexual stimulation, orgasm does not occur, then prostatism may develop. At the same time, there is a dull pain in the perineum, in the sacrum and thighs, as well as unpleasant sensations in the head of the penis, testicles and frequent urge to urinate. If the situation exists for a long time, the complication may be chronic pelvic pain syndrome. Sexual dysfunction has a depressing effect on the psyche, which is manifested by hidden or overt depression. In addition, men have an increased risk of developing cardiovascular diseases.
A preliminary diagnosis is made based on complaints and anamnesis, after which they proceed to a physical examination. With psychogenic genesis, instrumental and laboratory diagnostics are not informative enough. Male orgasmic disorder may be part of sexual dysfunction, including erectile dysfunction, abnormal ejaculation, and hypoactive sexual desire disorder. The following tests may be useful to identify potential contributing conditions:
- The study of the hormonal profile. Determination of the level of testosterone, dihydrotestosterone, LH, FSH, TSH in the blood serum helps to identify disorders associated with the synthesis of sex hormones. According to their level, they judge the correct functioning of the testicles, thyroid gland, pituitary gland and adrenal glands, which helps to establish the hormonal imbalance accompanying anorgasmia.
- Research on STIs. If an inflammatory genesis is suspected, it is possible to prescribe PCR diagnostics for sexual infections, microscopy of a urethral smear and prostate secretion, and performing back-sowing on nutrient media. When identifying specific pathogens, the examination is carried out not only for the man, but also for his partner.
- Urine analysis. The study is performed with an “erased” orgasm without ejaculation. The presence of sperm in the urine indicates retrograde ejaculation. As a rule, retrograde ejaculation can be assumed if the patient is taking alpha blockers and/or has been operated on for prostate or bladder disease.
- Ultrasound examination. Ultrasound of the prostate and scrotum organs in orgasmic disorders allows you to assess the condition of the testicles and prostate gland. With the help of ultrasound scanning, latent inflammatory process, testicular hypotrophy, cryptorchidism, etc. can be diagnosed. The study is of an auxiliary nature.
Therapeutic measures depend on the cause. Patients often seek help from a urologist-andrologist, who determines further management tactics. With the exception of organic pathology (concomitant diseases), a man with anorgasmia in men is referred for consultation to a sex therapist or psychotherapist who has experience in managing such patients. The following therapy options may be considered:
- Psychological impact. Hypnosis, psychoanalysis, cognitive behavioral therapy and other techniques are used to eliminate feelings of guilt, misconceptions about sexuality, etc. Treatment with a sex therapist will be effective in patients with preserved emissions and orgasm during masturbation.
- Drug therapy. Studies have shown that the antidepressant imipramine is effective in orgasmic disorder in men associated with psychotic disorders. Medications that can restore orgasm include dopamine agonists, oxytocin, 5-phosphodiesterase inhibitors, and alpha-2 receptor blockers. In many cases, a combined medical and psychological approach to resolving anorgasmia in men in a man makes the most sense.
- Correction of major diseases. Patients with hormonal disorders in endocrine nosologies are treated by an endocrinologist. Perform correction of blood glucose in diabetes mellitus, carry out hormone replacement therapy for hypo-androgenism, hypothyroidism, etc. Patients taking SSRIs may be prescribed second-line medications with fewer side effects.
Prognosis and prevention
The lack of orgasm can worsen the relationship in a couple and lead to sexual disharmony. The prognosis for a patient with orgasmic syndrome depends on the cause and occurrence, with acquired pathology it is better. The prognosis is also favorable in cases where the physiological cause is determined and its correction is possible. The prospects are serious if anorgasmia in men is secondary to a psychiatric illness or to conditions that themselves have an unfavorable prognosis. The longer the problem exists and the more conditions that support it, the more difficult the therapy is and the less chance of success. Preventive measures include stress limitation, full-fledged work and rest regime, commitment to a healthy lifestyle.