I can’t cum – what to do?

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Orgasm inhibition: When you can’t come

The so-called inhibition of orgasm in men – i.e. the delayed or non-existent orgasm – represents a heavy burden for those affected and quickly leads to a vicious circle, from which one can usually only get out with professional help.

Table 1: Categorization of sexual dysfunctions in DSM-IV and ICD-10

What is a missed or delayed orgasm?

Normally, after sufficient sexual arousal and stimulation, the man experiences both orgasm and ejaculation (ejaculation). In the case of orgasm inhibition , however, sexual climax occurs very late or not at all . As a consequence, there is no ejaculation. If such orgasm disorders occur, it is very stressful for those affected.

In DSM-IV, the American Classification of Mental Disorders, orgasm inhibition is defined as a persistent or recurrent delay or absence of orgasm after a normal period of sexual arousal during sexual activity that the investigator, taking into account age, considers to be adequate in intensity, duration, and type holds.¹

A distinction is made between inhibition of orgasm:

  • Hypoorgasmia: the man can climax only occasionally
  • primary anorgasmia: the man has never had an orgasm in his life
  • secondary anorgasmia: the man has lost the ability to have an orgasm over the course of his life

Complete anorgasmia is accompanied by anejaculation, i.e. the absence of ejaculation.

Die verschiedenen Arten der Orgasmushemmung können entweder situativ oder generalisiert eintreten. Bei der situativen Orgasmusstörung kann dabei unter bestimmten Bedingungen, zum Beispiel bei der Selbstbefriedigung, beim Oralverkehr oder in bestimmten Stellungen der sexuelle Höhepunkt erreicht werden.

In contrast to premature ejaculation, delayed ejaculation is quite rare: between 3% and 8% of men show symptoms of orgasm inhibition².
However, orgasmic disorders usually go hand in hand with erectile dysfunction. The reason for this is the psychological stress that the delayed or absent orgasm represents for those affected. The resulting worries make sex life more difficult and build up pressure to perform, which is counterproductive for a healthy erection – and can lead to erectile dysfunction.

No orgasm: Impact on sex life and partnership

If a woman doesn’t reach the climax, it’s usually not questioned. However, if the man does not come, he is quickly confronted with questions such as: “Don’t you find me attractive?”, “Don’t you like the sex?”, “What’s wrong with you/me?”. This misunderstanding combined with the man’s frustration often leads to pressure to perform, conflicts in the partnership and insecurities in sexual contexts.

Additionally, sex is increasingly viewed as tedious by both sides. Because while the man is chasing after the climax during intercourse, the moisture in the vagina decreases and the friction becomes painful for both parties. It is not uncommon for the sex to be broken off, accompanied by frustration and discomfort.

As a result, one increasingly avoids sex and instead – if an orgasm is possible here – lends a hand. However, this withdrawal increases the problem and usually leads to a vicious circle, which, to make matters worse, can also result in erectile dysfunction. In addition, the partner quickly feels superfluous if the man only achieves orgasm through his own activity and also has to struggle with feelings of inferiority.

Can I fulfill our desire to have children – even without an orgasm?

If the man’s inhibition of orgasm gets in the way of the desire to have children, this quickly leads to dissatisfaction and doubts about the partnership. Because if there is no orgasm, there is usually no ejaculation and the woman cannot be fertilized naturally.

Many do not know that not having an orgasm is not the same as impotence. If the man’s sperm are healthy, they can reach the woman in another way – namely with the help of artificial insemination. For this purpose, the sperm are removed from the testicles and epididymis and artificially inserted into the woman’s egg cell.

Why can’t I have an orgasm?

Only rarely are the causes of an impaired ability to have an orgasm in men purely physical in nature: the development and maintenance of delayed or non-existent ejaculation is usually based on the interaction between physical and psychological factors as well as certain behavioral patterns.

Organic causes of anorgasmia

Inhibition of orgasm can be a symptom of various physical illnesses . These include, among others:

  • diabetes
  • neurological diseases, e.g. B. multiple sclerosis, Parkinson’s
  • tumors, e.g. B. Prostate cancer
  • hormonal disorders, eg testosterone deficiency
  • Nerve damage, eg due to operations or injuries to the pelvis or spine
  • Inflammation of the genitals

In addition to these organic diseases, taking certain medications can also impair the ability to experience orgasm . These drugs include, for example, antidepressants, tranquilizers or antipsychotics. Regular drug use – including alcohol, marijuana or cocaine – also affects the ability to have an orgasm.

Another organic cause of delayed or no climax during sex is simply the aging process . The reason is the age-related decrease in the sensitivity of the penis. Such reduced sensitivity can also be the result of circumcision or too “hard” masturbation.

No orgasm: psychological causes

In addition to organic causes, an inhibition of orgasm can also be caused and maintained by psychological and social factors . Causal psychological factors include:

  • Pressure to perform, fear of failure
  • Self-esteem issues, discomfort/inhibitions
  • Fears, eg of an unwanted pregnancy
  • too little experience with your own body
  • unrealistic expectations and sexual deadening, e.g. B. through porn
  • Stress & conflicts in everyday life / at work / in relationships / in the family
  • too much focus on the partner
  • Depression, burnout
  • Trauma, eg through sexual abuse
  • Situational factors, e.g. lack of privacy, an uncomfortable environment or bad timing

Such causative psychological factors, as well as physical illnesses, can cause orgasmic inhibition. However, the psyche can also be crucial for the maintenance and manifestation of orgasmic inhibition. Even the one-time absence of the climax can generate stress and cause pressure to perform and problems with self-esteem in the person concerned. This usually starts a vicious cycle that keeps orgasm inhibition alive and makes it very difficult to identify where the disorder is coming from.

Behavior as a cause of orgasmic disorders

In addition to organic and psychological factors, certain behaviors during sexual activities can also cause inhibition of orgasm. Boredom in bed or engaging in sex practices that you don’t like yourself can be the cause of a lack of orgasm or a lack of arousal. Too long foreplay is usually counterproductive if the man has problems reaching the climax.

I can’t have an orgasm – when should I see a doctor?

If the orgasm does not occur over a longer period of time and this affects the quality of life of the person concerned, a doctor – preferably a urologist – should be consulted immediately.

The doctor usually gets a preliminary picture of the extent of the disorder in an initial consultation. Information about known previous illnesses and the intake of medication is already collected. The penis and testicles are then palpated so that the degree of touch sensitivity can be clarified. Depending on the results of the examinations, the patient is examined for other possible underlying diseases. Urine tests or blood tests in the laboratory can be helpful to identify possible triggering diseases.

If no causative disorders or medications are identified, or treatment of identified disorders or changes in medication do not produce any changes, a visit to a psychotherapist or sex therapist should be considered. The therapist can use diagnostic procedures such as questionnaires or discussions to identify possible psychological causes for the inhibition of orgasm.

Diagnosis of inhibition of orgasm: treatment and therapy options

Not climaxing at all or being late can be frustrating. However, just like premature ejaculation, delayed and absent orgasm can also be treated.

Depending on the degree of severity, simple behavioral changes are enough to heal orgasm inhibition . The be-all and end-all here is open communication between the person affected and their partner. This is the only way to clear up misunderstandings and create trust. In addition, pressure on both sides can be reduced. Sharing preferences and fantasies can also help increase the chance of orgasm!

If just communicating isn’t enough, it’s helpful to work on behavior in the bedroom. The boring routine should be interrupted and variety should be created, for example by varying locations or positions. In addition, the stimulation of the man should be increased – for example by including sex toys or exploring new erogenous zones.

If all of this still doesn’t produce a climax, then going to the doctor – preferably a urologist – is no longer avoidable. If organic diseases or the use of certain medications are identified as the cause of orgasm inhibition during medical research, treating the underlying disease or changing the medication has top priority.

Special nerve-stimulating therapy options can also help to increase the sensitivity of the penis again. An example is the so-called percutaneous penile vibrostimulation or vibration stimulation. The nerves in the man’s genitals are trained by vibration and thus sensitized. Special masturbation exercises show similar effects.

Special drugs that are approved for other indications but are said to have an ejaculation-promoting effect can also be used. Due to the different side effects, however, this should be discussed thoroughly with an expert. An example of this is taking the hormone oxytocin³.

Since those affected quickly fall into a vicious circle of worry, stress and the lack of an orgasm, it is often too late for purely physical treatment. In most cases, only targeted psychotherapeutic treatment can help here . In a so-called sex therapy, honesty, acceptance and openness to new sexual experiences of both partners are encouraged. The aim is to reduce stress and pressure to perform. In addition, the man is guided to find new ways to arouse himself and thus improve the perception of the body and the penis. Therapy should focus less on acceptance and more on changing the situation.

In addition, profound causes for the orgasm problems can be identified and addressed during psychotherapy – e.g. B. Trauma, self-esteem issues, or unrealistic expectations of sex.

Prognosis in anorgasmia

Whether one can be freed from orgasmic inhibition depends on the cause and the situation of the person concerned.

If psychological factors are the cause of the disorder, it is often possible to help those affected to have a normal orgasm with the help of sex and psychotherapy. What is important here – in addition to the active cooperation of the person concerned – is an understanding and supportive environment. Therefore, the partners are included in most therapies. In addition, the sufferer should work on harmful environmental conditions such as stress or conflict.

If the orgasm problems are due to an underlying disease, the prognosis depends on the type of disease. Thus, with healing, the inhibition of orgasm can also disappear, whereas other diseases can lead to complete infertility. Here, however, the following usually applies: the earlier the disease is treated, the higher the chances of recovery! If a specific drug is the trigger, switching or reducing the dose of the drug can normalize the ability to have an orgasm.

Overall, the prospect of an improvement in orgasm inhibition with appropriate treatment is very good. The prognosis worsens with previous illnesses that are difficult to treat or with the use of drugs and medication.

The explanations and lists of possible treatment options are purely informative and do not replace consultation with your doctor or the explanations about the intake, mode of action and side effects from the product-specific leaflet.

Isabel D White

Isabel D White

Isabel led the Royal Marsden Hospital (London) psychosexual therapy service until 2019. She works in partnership with individuals & couples to explore physical, emotional & relationship factors that contribute to sexual difficulties after cancer. These include: low desire, erection, arousal or orgasmic difficulties, sexual pain & sexual avoidance. She adopts an integrative approach to personalized therapy using psychosexual therapy (sensate focus framework), biomedical management (erectile dysfunction medication & devices, menopause & vaginal health strategies, sexual aids) & psychoeducation.

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