Anorgasmia

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Along with lack of desire (lack of libido, sexual inappetence or anaphrodisia), it is one of the most common sexual dysfunctions of women (especially after menopause) and they often go to the extreme of pretending a climax to please their partner. There may be anorgasmia in men, but it is less frequent and difficult to diagnose, as it is hidden behind the misconception that ejaculation is an orgasm. It consists of not reaching orgasm or climax in a normal way.
5% of the causes of anorgasmia are organic and have to do with the use of drugs, drugs, suffering from endocrine or chronic diseases, among others. Meanwhile, 95% respond to psychological factors such as anxieties, depression, myths about sexuality, learned attitudes and even belief system.

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Definition:

Anorgasmia (also known as orgasmic dysfunction or Coughlan syndrome) is defined as the persistent or recurrent difficulty of achieving orgasm after sufficient sexual stimulation, which causes personal distress. Late orgasm and anorgasmia are associated with significant sexual dissatisfaction.
Anorgasmia is the recurrent and persistent inhibition of orgasm, manifested by its absence after a phase of normal excitement, and produced through stimulation that can be considered adequate in intensity, duration and type.

Can be:

Secondary anorgasmia: it is suffered by those who, after a period of having had orgasms normally, stop experiencing them systematically.
Absolute anorgasmia: when it is not able to reach orgasm through any procedure (self-stimulation, heteromasturbation, etc.).
Relative anorgasmia: when one is unable to reach climax in a certain way; for example, coital anorgasmia.
Situational anorgasmia: when you can reach orgasm only in certain specific circumstances.
A focused medical history can shed light on potential etiologies, which include: medications, loss of penile sensitivity, endocrinopathies, penile hyperstimulation, and psychological etiologies, among others.
They have been considered as one of the extremes of a spectrum of orgasm synchronization disorders, the other being premature ejaculation, some men do not ejaculate for medical reasons, but still experience orgasms (retroperitoneal surgery, radical prostatectomy).
Anorgasmia, in young men or men with reproductive interest, is the failure of insemination and therefore male infertility. Anxiety and frustration, which can lead to other sexual problems such as erectile dysfunction (ED) and loss of sexual desire.
It is very important to understand that orgasm is a completely separate process from ejaculation, although they are designed to occur simultaneously, men with anorgasmia do not ejaculate.
Others define anorgasmy as the perceived absence of orgasm, regardless of the presence of ejaculation. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines late orgasm as a marked delay in ejaculation or a marked infrequency or absence of ejaculation in almost all or almost all occasions (75-100%) of conjugal sexual activity without the person wanting it, persisting for at least 6 months and causing severe distress to the person. Sexual dysfunction is not explained by another non-sexual disorder, medication, type of relationship, anguish or stress.
Situational dysfunction implies that the man has problems in one particular setting or settings while it functions normally in others, and may be mild, moderate, or severe.
There is no established time threshold for what a normal climax is in normal intercourse, but the average would be 5.5 minutes and if it is more than 22 minutes it is considered as a delay of ejaculation.

Orgasm physiology:

The physiology of the male orgasm is more evident than that of the female orgasm. This is because it is almost always associated with ejaculation, which is a visible fact. However, it is often thought that they are synonyms and in reality they are not.
The male orgasm refers to the set of muscular contractions that take place in the pelvis, rhythmically, and that release sexual tension. These are usually accompanied by a physical and psychological sensation of pleasure. Ejaculation, on the other hand, refers to the expulsion of semen through the penis.

Ejaculation can occur without orgasm. Therefore, male orgasm and ejaculation are two different processes, although most of the time they occur simultaneously. Only when there are neuronal dysfunctions, one process separates from the other. There can also be orgasm without ejaculation, as in cases where there is genital stimulation before reaching adolescence.
Causes of anorgasmia:
Testosterone deficiency
Hypothyroidism
Hyperprolactinemia
Antidepressant and antihypertensive medications among others
Antipsychotics
Opioids
Psychosexual causes
Hyperstimulation
Loss of sensation in the penis

The etiology of his condition was divided into the use of selective serotonin reuptake inhibitors (SSRIs) (42%), low testosterone (21%; mean total testosterone 268±111 ng/dL), abnormal sensation in the penis (7%), chronic penile hyperstimulation (2%) and psychogenic (28%). Age-related hormonal decreases (lower testosterone levels) and age-related peripheral nerve conduction loss may explain the increased onset from age 50.
Endocrinopathies
The role of prolactin in men is not fully understood. However, it is well understood that higher-than-normal prolactin levels, hyperprolactinemia, may result in an inhibitory effect on sexual desire . Mild forms of hyperprolactinemia (defined as >420 mU/L or 20 ng/mL) generally have no impact on sexual function; however, severe hyperprolactinemia (defined as >735 mU/L or 35 ng/mL) can have significant effects on sexual function, including erectile dysfunction and suppression of testosterone production.
Prolactin secretion is positively influenced by prolactin-releasing factors (PRFs): thyroid-releasing hormone, oxytocin, vasopressin, and vasoactive intestinal peptide. Serotonin is involved in the control of prolactin secretion through serotonergic inputs that stimulathe paraventricular nucleus. Therefore, SSRIs are capable of causing hyperprolactinemia.
Hyperstimulation
Some men get more pleasure from masturbation than from sexual intercourse and may continue deeply ingrained habits such as frequent masturbation. Vaginal intercourse or orogenital stimulation may not be able to reproduce the stimulation achieved through masturbation and this may result in a reduction in penile stimulation, which can lead to difficulties in achieving orgasm.
Loss of Penile Sensitivity
Loss of sensation in the penis has been shown to increase with age. In a review of the literature, sensory thresholds of the penis were plotted according to age as well as sexual functional status. It was found that loss of penile sensation was most commonly present in older men and those with sexual dysfunction, especially diabetics.
Psychosexual Causes
Fear and anxiety during sex have been examined, and the most common triggers include: hurting women, impregnated women, childhood sexual abuse, sexual trauma, repressive sexual education/religion, sexual anxiety, general anxiety, and conflict in men in their first sexual relationship after becoming widowed or divorced.
The man may also suffer from a lack of sexual arousal, which inhibits his ability to achieve orgasm. The man may achieve an erection without achieving adequate arousal to continue sexual intercourse, such as men who achieve an erection with the help of erectogenic medications.
It has been shown that the acute and chronic stress of immobilization led to an increase in adrenal glucocorticoids causing an increase in the gonadotropin-inhibiting hormone that suppresses the HPG axis through the inhibition of gonadotropin-releasing hormone.
SSRIs/Medicines
There are numerous medications that have been implicated in the genesis of the drug, including antidepressants (especially SSRIs), antipsychotics, and opioids. The same is true for beta-blockers and various medications that can cause hyperprolactinemia.

Conclusions:

The identification of the onset of the ailment is crucial, whether it is long-standing or acquired. Then, understanding whether the condition is generalized or situational is also critical to understanding the problem. Asking patients to describe a typical sexual encounter is often a useful tactic for revive possible contributing factors.
Asking about how long a man tries to have sex before stopping can also provide valuable information about the problem. Some older men, due to inadequate upper-body strength exercise reserve, cease sex earlier than they did when they were younger.
Several lifestyle changes include: steps to improve intimacy, reducing the frequency of masturbation, changing masturbation style, and decreasing alcohol consumption.
Psychosexual Therapy
Once the organic causes have been ruled out and in some cases, the patient can benefit from a comprehensive psychosexual evaluation (together with his partner). There are numerous types of psychotherapy techniques that have been used, including: retraining/desensitizing masturbation, adjusting sexual fantasies, changing arousal methods, sex education, reducing sexual anxiety, increasing genital stimulation, and the role of playing an orgasm alone or with your partner.
Pharmacotherapy >.
Bupropion 15 – 60 mg 150 mg (inhibits reuptake of dopamine and noradrenaline)
Cyproheptadine 4 – 12 mg(antihistamine)
Amantadine 100 – 400 mg 75 – 100 mg (dopaminergic agonist)
Yohimbine 20 – 40 mg (an adrenergic receptor blocker α-2)
Oxytocin 20 – 24 IU (an intranasal peptide)
Cabergoline 0.5 mg (in case of hyperprolactinemia)
Testosterone supplementation (in case of deficit)
First, we might consider withdrawing any offensive medication if possible, such as SSRIs, although our clinical practice consists of contacting the doctor who prescribes SSRIs and asking him or her to coordinate drug manipulation (vacation, substitution or cessation of treatment) and monitor the patient.
Electroejaculation (EEJ)
In select and recalcitrant patients who have failed with all other conservative methods, the EEJ is a viable option for recovering semen for fertility purposes. Electroejaculation requires transrectal probe placement and low-level electrical current delivery in patients without spinal cord injury.

 

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