Male Anorgasmia: Causes & Treatments

Anorgasmia is a medical term for a man that cannot regularly reach orgasm regardless of the amount of stimulation provided.

It is also known as delayed orgasm and is a condition that affects many older men, especially those who have had prostate or colon cancer treatment.

Men often experience orgasm problems, including anorgasmia, due to healthy aging, medical conditions, and pharmaceutical use. This article primarily addresses orgasm dysfunction in older men, mainly due to the prostate or pelvic surgery.

There is a wealth of research on erectile dysfunction but little on other sexual dysfunctions common in older men. Prostate surgery often damages or destroys the nerves that control erections.

But, even men with the total destruction of these nerves can achieve an erection using injectable medication. And, for men without nerve damage, a urologist can prescribe any one of several effective medications to overcome erectile dysfunction.

However, for men with delayed or nonexistent orgasms, there are no approved treatments or pharmaceuticals. Anorgasmia is a known side effect of radical prostatectomy, but it remains an understudied complication since no recommended treatment is recommended. Because they have no specific treatment for it, some urologists just ignore the problem. However, for many men, anorgasmia has a substantial effect on their quality of life.

Anorgasmia is one of many prostate treatment complications that span the range from urinary incontinence during sexual activity (climacteric) and orgasmic disturbances such as anorgasmia, changes in orgasmic sensation, and painful orgasm. There is a huge need for physicians to be aware of these problematic issues and discuss them with patients.

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Orgasmic Dysfunction

Maintaining the orgasmic function is very important to many men. However, as a man ages, he may notice a host of different sexual ability problems.

An Internet search for male orgasmic problems results in several million hits, the vast majority of which are premature orgasm or premature ejaculation issues. While this might be an issue for some younger men, it is rarely an issue for older men.

Many of the articles from such a search discuss psychological problems. While some orgasmic problems do result from psychological issues, they are rare. Essentially, such issues result from the medical thinking of several decades ago when no treatments existed, and the thinking was limited.

Orgasm difficulties due to psychological issues are rare for most men, especially in stable relationships.

In particular, psychological issues are used as a crutch by doctors who do not want to spend the time needed to ferret out the cause of a man′s problem. Instead, will try to blame it on a mental problem.

When a man has experienced normal orgasms regularly throughout his life begins to lose the ability to have an orgasm, it is certainly a strong indicator that it is time to dig further to find and possibly remedy the cause.

Common Non-Surgical Causes of Anorgasmia

There are common causes that can cause or exacerbate Anorgasmia. Some of the more common ones are below:

  • Pain-relieving drugs – Opioids, NSAIDs, and other pain-relieving drugs – Sensations of pain and pleasure use some of the same brain neurotransmitters, thus any substance that reduces pain also has the potential to affect the quality or pleasurability of an orgasm.

  • Alcohol – While a small amount may enhance sexual activity, larger amounts can reduce all sensations. (re: feeling no pain!)

  • Nicotine – A dangerous and highly addictive chemical. It affects blood circulation in the body by constricting blood vessels and reducing blood flow to all body organs, including the penis. Lifetime smokers often experience both erectile dysfunction and anorgasmia due to the reduced blood supply to pelvic organs.

  • Gabapentin and Lyrica – both drugs are anticonvulsant medications used to treat seizures, post- herpetic neuralgia (pain from shingles), peripheral neuropathy, and certain other types of nerve pain. The theory is they quiet nerve impulses, thus reducing nerve pain. Quieting the nerves in the penis will certainly cause delayed or absent ejaculation.

  • Antidepressants drugs – Virtually every drug in this class has sexual side effects. If anorgasmia started around the time the drug was started, it′s a good be the drug is causing it,

  • Flomax – This very common drug is used to treat almost every man suffering from urinary difficulties from Benign Prostate Hypertrophy (BPH), which encompasses a high percentage of men over 50. However, it can significantly reduce the feelings associated with an impending orgasm, and, in some cases, eliminate the possibility of orgasm completely. Its sexual side effects are well documented and include abnormal ejaculation, failure to ejaculate, and. decreased ease of ejaculation. Other drugs typically prescribed for male prostate problems have undesirable side effects as well. 1 1

  • Prostaglandin – This is a group of chemicals that have multiple purposes in the body. One of the groups, called PGE-1, is a chief player in the contraction and relaxation of smooth muscle and the dilation and constriction of blood vessels. Prostaglandin PGE-1 is a strong vasodilator used for men with severe erectile dysfunction. It is supplied as either an injectable drug (injected directly into the penis) or a penile suppository placed in the urethra. The introduction of prostaglandin into the erectile chambers or the penis or infra-urethrally will usually cause a man to have an erection within about 10 minutes regardless of sexual arousal level. Dosing is critical. A low dose may not cause an erection, and a higher dose may produce an erection but inhibit orgasm.

  • Age and Circumcision. – It is well documented that penile sensitivity declines with age.

  • Circumcision also affects penile sensitivity negatively. Unfortunately, since the vast majority of circumcisions are performed in infancy; there is little a man can do to remedy the situation, but anything that improves blood flow or nerve communication in the body can potentially help.

  • Refractory period – This is the amount of time when a man cannot get another erection or have another orgasm. It varies from a few minutes in younger men to several days in the elderly. In most men, this is not an issue. Satisfactory sex causes multiple temporary hormone level changes that tend to decrease desire for another sexual encounter. 2 2

  • Other conditions – Anything that affects or inhibits blood circulation will increase the potential to develop anorgasmia. This includes diabetes, high blood pressure, and most coronary conditions.

Treatment Induced Sexual Problems

A radical prostatectomy is a surgery that removes the entire male prostate gland. A 2012 study noted that approximately 90,000 RPs are done in the US yearly. The surgery has numerous side effects that permanently affect a man′s quality of life.

The side effects of receiving the most focus in current literature are erectile dysfunction and incontinence. However, there is a high prevalence of other side effects, such as anorgasmia after a prostatectomy. 3 3

Preserving the ability to achieve an orgasm is extremely important for most men. Urologists tend to focus on sexual recovery techniques after prostate surgery to recovering penile erectile function and resolving incontinence after surgery.

However, recovering erectile function may or may not result in satisfactory and healthy sexual life for patients and their partners. Post-treatment recovery should be focused not only on erectile function but also on the wide range of resulting sexual problems. Restoration of erectile function alone is not enough. On the contrary, clinicians must focus on patients’ full sexual rehabilitation.

Erectile function is a distinct entity of sexual health after prostatectomy, but not the only one. Recent studies indicate that about one-third of men that have had a prostatectomy also have post-surgical anorgasmia.

In addition, nearly 80 percent of surgical patients report altered sensations and decreased orgasm intensity that was still present four years post-surgery. Diminished orgasms in older patients are common. However, surgery exacerbates the effects of normal aging with its own set of debilitations.

Unfortunately, radical prostatectomy is still the treatment recommended most often, even though a recent study in The New England Journal of Medicine suggested that only about 3 percent of patients gained benefit from it, and nearly 100 percent of patients suffered from some type of sexual dysfunction resulting from the surgery for the rest of their
lives. 4 4

Treatment of Anorgasmia

Unfortunately, there is currently no approved medical treatment for anorgasmia or decreased orgasmic sensation.

When a man has an orgasm, a refractory period occurs during which he cannot generally get another erection or orgasm. This is primarily due to a normal increase in the prolactin hormone level in the blood after orgasm. Prolactin levels in men tend to increase with aging.

Anorgasmia, in some men, appears to be related to high circulating levels of prolactin.

  • Cabergoline – A dopamine agonist drug that normalizes serum prolactin levels. In a recent study, researchers administered cabergoline to improve orgasm sensation in men potentially. They reported that more than 50 percent of patients responded to this treatment by regaining some orgasmic ability. 5 5

  • ED drugs – While studies have not found significant improvement in orgasmic function with the use of phosphodiesterase type 5 inhibitors (Viagra and other ED drugs), these drugs can sometimes improve orgasmic function, possibly due to increased nerve sensitivity of an erect organ due to the drug.

  • Medications – Any man with anorgasmia or loss of sensation during orgasm should review his medication list carefully. (See above) Some drugs may have specific effects on nerve communication and sensitivity.

  • Dietary Adjustments – Obesity and consumption of rich, fatty foods may contribute to orgasm problems.

  • Omega 3 Fatty Oils – such as pure coconut oil, are known to have enhanced skin health and nerve communication. The regular use of such oils trans-dermally on the penis glans may accelerate nerve healing and communications of the penis glans’ sensitive nerves, thus improving orgasmic ability. This may be especially true of men that have been circumcised.

  • Herbal Remedies – Nutritional or herbal agents that increase blood flow in the body, such as L-Arginine, Gingko Biloba, and others can help improve circulation and rectify many sexual problems, including erectile dysfunction and anorgasmia.

Coping with Anorgasmia

Anorgasmia can have a significant impact and create an emotional burden for a man and his partner. Like any type of sexual dysfunction, there is probably some sort of solution that is acceptable. Of course, this all depends on the cause of the problem and the partners’ willingness to alleviate it.

For example, the cause of the anorgasmia is a condition such as severe diabetes, muscular dystrophy, or other paralyzing diseases; there may be little hope of recovery. But, by focusing on enhancing sexual pleasure and sexual intimacy, many couples have learned to accept a non-resolvable condition and still have a satisfactory sexual life.

Many men with erectile dysfunction believe that they must have an erection to have an orgasm. This is a myth. An erection is not a prerequisite for an orgasm. A man can be intimate and have an orgasm whether or not he has an erection. Vacuum erection devices (aka – penis pumps) can become very useful in such situations.


Delayed orgasm or anorgasmia is the serious quality of life issues that are associated with significant sexual dissatisfaction. However, understanding the condition and evaluating possible causes can often lead to at least a partial resolution of the problem.

Sexual intercourse and orgasm contribute to marital satisfaction, patient happiness, and relationship stability. These important qualities of life considerations affect all men, including the elderly, and must be considered in any kind of treatment.

Orgasm is a complicated and coordinated response of the body and brain to sexual excitement and stimulation. It depends on a proper balance of nutrients, brain chemicals, and hormones. Anything that affects this balance may disrupt the system.

Many urological treatments can lead to orgasmic dysfunction, including anorgasmia. This includes, but is not limited to, surgery. Medications prescribed by urologists as well as general practitioners for conditions such as diabetes, high blood pressure, high cholesterol, depression, and others can contribute significantly to sexual dysfunction. Unfortunately, many men get their sexual information from colleagues at the gym or on the golf course.

Such information is often inaccurate and leaves men making treatment decisions based on poor quality information. Other men trust their doctors implicitly and accept any treatment they are offered without question.

They are often led into surgery that will do them little good. Both of the above approaches can lead to long-lasting sexual dysfunction that might have been easily avoided if prior research was done by a man before submitting to treatment.

Sudden onset of a sexual debility is often an indicator of a medication′s or treatment′s undocumented or poorly documented side effects. Any sudden dysfunction, sexual or otherwise, should be reported to the providing doctor. The provider should investigate and report to the patient. Lack of investigation and simple dismissal of the problem by a practitioner should indicate to a patient that it is time to look for
another, unbiased, provider.

Many men and their partners are reluctant to challenge or question their health care providers. Keep in mind that everyone has predetermined beliefs. A reputable provider is happy to answer any and all pertinent questions, even if they seem to be very elementary. If the provider seems annoyed or too busy to answer such questions, it′s time to consider finding a new provider.

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  1. Medically reviewed by Darren Hein, PharmD, Side Effects of Flomax, Medline,  University of Illinois on January 10, 2017
  2. Guy A Bronselaer, et al, Male circumcision decreases penile sensitivity as measured in a large cohort., BJU Int, 2013 May;111(5):820-7.
  3. Chinedu Anthonydical Anene, Prostatectomy: Surgery To Remove Your Prostate Gland,  Bens Prostate Blog, January 31, 2020
  4. Paolo Capogrosso,et al, Orgasmic Dysfunction after Radical Prostatectomy, World J Mens Health. 2017 Apr; 35(1): 1–13. 
  5. Adam B. Hollander, MD, et al, Cabergoline in the Treatment of Male Orgasmic Disorder, Sex Med. 2016 Mar; 4(1): e28–e33.

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