Anorgasmia is the inability to have an orgasm or when it is extremely difficult to have an orgasm.

An orgasm is different than when a man ejaculates. Ejaculation is when the semen comes out of the penis.  Orgasm is the pleasurable sensation that the man experiences.  They usually occur at the same time.  But a man can have an ejaculation without an orgasm and he can have an orgasm without an ejaculation.

Men who have had prostate surgery often become unable to ejaculate.  This is usually because the prostate is removed and the amount of semen produced is dramatically reduced.  It can also be because when a man ejaculates the semen goes backward into his bladder instead of coming out of his penis.  When this occurs this is called retrograde ejaculation.

Prostate surgery, procedures and radiation therapy can also make it more difficult for a man to reach his climax or have an orgasm.  This is sometimes a result of damage to the nerves supplying the penis.

Many other factors can make it difficult or impossible for a man to experience the pleasurable sensation of his orgasm.  These include many medications, including, antidepressants (amitriptyline, desipramine, doxepin, imipramine, maprotiline, nortriptyline, protriptyline, clomipramine, fluoxetine, paroxetine & venlafaxine), alpha blockers (prazosin, terazosin & labetalol), sympathetic nerve blockers like guanethidine, anti-ulcer medications like cimetidine, MAO inhibitors like isocarboxazid, phenelzine & tranylcypromine, neuroleptic drugs like haloperidol, thiothixene, perphenazine, trifluoperazine & resperidone, and mood stabilizers like topiramate.

Sometimes a man's low testosterone level plays a part in his inability to have an orgasm.

Other factors that may inhibit orgasm are the use of alcohol, marijuana, cocaine, opioids, amphetamines and ecstasy.

Psychological factors such as gender identity and sexual orientation confusion, history of trauma, rape or sexual abuse may cause anorgasmia.  

Some severe medical illnesses have been shown to inhibit the male orgasm, including diabetes, high blood pressure and pain syndromes. 

There are no FDA approved medications specifically approved to treat anorgasmia or inhibited male orgasm.

The approach to treating a man's inability to have an orgasm is multi-factorial and includes the following:

medication causes
drug use causes
medication substitution
medication holidays
testosterone supplementation
nasal oxytocin

It is often easier easier to treat a man for erectile dysfunction than it is to help him have an orgasm.  That said, we have seen some encouraging results with nasal oxytocin spray.  * This spray needs to be used during intercourse just before a man would normally anticipate having an orgasm.  Some of the possible side effects of nasal oxytocin are difficulty urinating, tightness in the chest, irregular heartbeat, difficulty breathing, confusion, swelling, seizures, rash, headache, nausea, vomiting, loss of appetite, allergic reactions, high blood pressure and sub-arachnoid hemorrhage.

The use of nasal oxytocin spray during intercourse might seem odd or inconvenient, but for those men that oxytocin enables to have an orgasm, it is well worth it.

*  While we will certainly try to help all of our patients, as with any medical treatment, there is no guarantee of specific results, as results can and usually do vary from patient to patient. All time frames mentioned are approximate and may vary from patient to patient.




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