Speaking up about orgasms

Men often don’t talk about delayed or absent orgasm. Still, these issues can have a profound impact on their sex life.

This article is a repost which originally appeared on Harvard Men’s Health Watch

Edited for content

Erectile dysfunction continues to be the main sex-related issue among older men. Yet, two other problems also can arise with age: anorgasmia, the inability to achieve an orgasm during sex, and delayed orgasm, in which it takes longer than usual to reach orgasm and ejaculate despite proper stimulation. Men can experience either one or both.

While these conditions can cause stress for both men and their sexual partners, they don’t have to hinder a healthy, active sex life.

“Orgasms are pleasing and satisfying, but you often can achieve sexual satisfaction without one,” says urologist Dr. Michael O’Leary, director of Men’s Health at Harvard-affiliated Brigham and Women’s Hospital. “With the right approach, these conditions can have little, if any, impact on whether you can enjoy intimacy.”

Two similar conditions

With anorgasmia, you can get an erection and enjoy stimulation from intercourse even though you can’t reach orgasm. Research has defined delayed orgasm as taking longer than 30 minutes to achieve orgasm and ejaculate, although the time can vary per person. Some men with delayed orgasm can experience the sensation of orgasm but don’t ejaculate.

It’s not known how common these conditions are, as men are often reluctant to discuss them with their doctor or partner. Nor is it clear why they become more frequent with age.

However, a report in the November 2015 issue of Fertility and Sterility pointed to a combination of possible factors, like changes in penis sensitivity, lower testosterone levels, medication side effects, and lack of exercise.

The conditions also can occur when a man enters a new relationship. For instance, a man may feel under stress about pleasing his new partner. If he has not been sexually active for a while, he may struggle with performance anxiety. Men also may feel pressured to climax within a specific time frame, which can exacerbate the problem.

Treatment and options

Before rushing to your doctor for help with either of these conditions, Dr. O’Leary suggests that you first look at the larger picture of how it affects your overall sex life.

“It’s normal to want to maintain the sexual vigor of your youth, but men have to realize that their body changes with age. Sometimes, that means your sex life, too,” he says. “Even if you don’t always have an orgasm, you and your partner can still experience pleasure from the intimacy that accompanies any sexual encounter.”

Still, if an orgasm problem affects your sex life, certain strategies could help. The following are some options to discuss with your doctor.

Sexual therapy. Therapy with a sexual health expert can address the issues that may be causing orgasm trouble, especially if it’s related to a new relationship or some other psychological issue. “Many times, it’s not a physical problem, but the connection between the brain and body,” says Dr. O’Leary.

Testosterone. Since both anorgasmia and delayed orgasm can be related to low testosterone levels, a simple blood test can determine if you might benefit from supplementation.

Medication. There are no FDA-approved drugs to treat anorgasmia or delayed orgasm. Even so, one drug, called cabergoline (Dostinex), has received attention. Orgasm is associated with a surge in prolactin, a hormone made in the brain’s pituitary gland. If blood prolactin levels are always high, there is no surge. Cabergoline lowers levels to allow the surge normally experienced with orgasm.

A study in the March 2016 issue of Sexual Medicine found that men’s orgasm problems improved after they took 0.5 milligrams of cabergoline twice a week for about 10 months. About half of the group said their orgasms returned to normal. The drug tends to be well tolerated and it’s presumed safe, although its long-term effects are unknown. Consult with your doctor about whether this could be an option.

Some antidepressants, especially selective serotonin reuptake inhibitors like fluoxetine (Prozac) and sertraline (Zoloft), may cause anorgasmia or delayed orgasm. In fact, doctors will sometimes prescribe these drugs for men with the opposite problem, premature ejaculation. If you take an antidepressant, talk with your doctor about lowering your dosage or switching to a different one.

Change sexual positions. Modifying sexual positions or foreplay practices with your partner may increase arousal and help achieve orgasms, according to guidelines from the American Urological Association.

Penile vibratory stimulation. This clamplike device is placed around the penis and vibrates to stimulate the nerves in the base of the penis. It’s used before sex and can be incorporated into foreplay.