Medically reviewed by Mary Lucas, RN
Written by Our Editorial Team
Last updated 12/23/2020
When people think of male sexual dysfunctions, problems such as erectile dysfunction (ED) or premature ejaculation (PE) are usually the first that come to mind.
While these are relatively common sexual issues, some men are affected by a totally different type of sexual dysfunction: anorgasmia.
Anorgasmia is a sexual disorder in which you may find it difficult or impossible to reach orgasm during sex or masturbation, even if you’re aroused and sexually stimulated.
For many men, anorgasmia can cause issues such as anxiety and a reduced level of interest in sex.
While there’s no ready-to-use medication for male anorgasmia, a variety of treatments may help to relieve your symptoms and improve your ability to orgasm.
Below, we’ve explained what anorgasmia is, as well as the factors that may cause you to have issues related to your ability to reach orgasm.
We’ve also talked about how anorgasmia can be diagnosed and treated to help you to reach orgasm during sex more consistently.
Anorgasmia is a persistent or recurrent difficulty achieving orgasm, or 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 variety of different names. You may have heard of it described as delayed orgasm, inhibited orgasm, retarded orgasm/ejaculation or inhibited ejaculation.
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, such as erectile dysfunction and a reduced sex drive.
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 their entire sexual life. If you’re affected by primary anorgasmia, you may have found it slow, difficult or impossible to reach orgasm beginning from your first few sexual experiences.
Secondary anorgasmia is typically defined as anorgasmia that develops after a period of normal sexual experiences. 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.
While anorgasmia is less common than other male sexual performance issues, it’s still an issue that affects a reasonable number of men.
Some research has found that approximately 1.5 out of every 1,000 men are affected by primary anorgasmia, with about three to four percent of men under the age of 65 affected by secondary anorgasmia.
A variety of 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.
Psychological factors that may cause male anorgasmia include:
Depression. 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. Anorgasmia may be caused by certain forms of anxiety, including anxiety that relates to sexual relations. Factors such as a fear of pregnancy, sexual trauma, general anxiety and others may all cause anorgasmia.
Lack of sexual arousal. Sometimes, a simple lack of sexual arousal can make it more difficult to orgasm. Some men, particularly those who use ED medications, may be able to get an erection without feeling sexually aroused but find it hard to reach orgasm.
Masturbation. Over time, masturbation can have an effect on 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 that men with anorgasmia tend to masturbate often. There’s also a real link between anorgasmia and unusual masturbation practices.
Physical factors that may cause male anorgasmia include:
Use of SSRIs. Anorgasmia is a known side effect of many selective serotonin reuptake inhibitors, or SSRIs — a common type of antidepressant. Many SSRIs cause a range of sexual issues, including reduced sexual desire and inability to orgasm.
Because 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.
Low testosterone. Research suggests that hormonal deficiencies, including low levels of testosterone, may play a role in anorgasmia. A study of men with difficulty achieving orgasm found that 21 percent had clinically low levels of testosterone.
Other hormonal issues. In addition to testosterone, several other hormones may have an effect on orgasm and ejaculation. For example, prolactin and other hormones related to prolactin levels may be associated with anorgasmia.
Loss of penile sensation. Research shows that it’s normal to lose some level of penile sensitivity with age. If your penis is less sensitive, you may find it more difficult to reach orgasm during sexual activity.
Nerve damage. Damage to the nerves in your lower body, whether from 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.
Sometimes, more than one factor may contribute to anorgasmia and other sexual performance issues, such as use of medication and a simultaneous underlying health issue.
Because male anorgasmia can occur for a variety of reasons, there’s no one-size-fits-all pill that you can take to treat your symptoms and help you orgasm normally.
In fact, there isn’t yet any FDA-approved medication that’s designed specifically for anorgasmia in men.
If you find it difficult or impossible to achieve orgasm during sex or masturbation, it’s important to talk to your healthcare provider.
They’ll be able to 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 you about any medications you use.
If you’ve recently developed anorgasmia after starting a certain type of medication, make sure that you let your healthcare provider know about this.
Depending on the possible cause of your anorgasmia, your healthcare provider may suggest a range of tests:
Testosterone, prolactin, thyroid and other hormone tests. These hormones can all affect your sexual performance. You can check these hormones via a simple blood test, with your results typically ready in 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 to more accurately diagnose the underlying issues that may cause you to experience difficulty reaching orgasm.
If your anorgasmia is related to a physical or psychological issue, your healthcare provider may refer you to a urologist or psychiatrist for specialized treatment.
Depending on the specific cause of your anorgasmia, you may benefit from a range of different treatment options. Common treatments for anorgasmia include:
Psychotherapy. If your anorgasmia is caused by a psychological issue, you may benefit from undergoing psychotherapy. Therapy is often helpful for treating sexual dysfunction caused by anxiety, depression and other mood disorders.
Sex therapy. Certain forms of sex therapy may help you to enjoy sex and reach orgasm more easily. You and your partner may benefit from changing your arousal methods and sexual anxiety reduction techniques.
If your anorgasmia is related to masturbation, changing the way you masturbate or your sexual fantasies may improve your sexual performance and treat anorgasmia.
Changing medications. If you currently use SSRIs or other antidepressants, you may need to switch medications. Certain antidepressants, such as bupropion, are less likely to cause sexual side effects and may improve anorgasmia in men.
Medications for hormonal issues. If your anorgasmia is caused by a hormonal issue, your healthcare provider may 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 may recommend treatment with supplementary testosterone.
Penile vibratory stimulation. If you have a reduced level of penile sensitivity, vibratory stimulation (a form of treatment that involves vibration to the frenulum — an elastic area of tissue near the tip of the penis) may help to induce orgasm and treat anorgasmia.
Your healthcare provider will let you know the most effective treatment option for you. Make 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.
As we explained above, there’s no one-size-fits-all treatment for anorgasmia. Instead, a large range of different factors, from psychological issues to physical ones, may affect your ability to reach orgasm and ejaculate during sex.
If you have recurring or persistent anorgasmia, talk to your healthcare provider.
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.