Male Orgasmic Disorder

Definition

In DSM-IV, male orgasmic disorder (formerly called inhibited male orgasm) is defined as persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person's age, judges to be adequate in focus, intensity, and duration. The DSM-IV criteria for male orgasmic disorder are presented in Table 66-2. Although there is some subjective judgment involved in just what length of time is required to constitute delayed orgasm, most men with this disorder who are seen in clinical practice complain of the absence of rather than delay in orgasm.

Diagnostic Issues

The majority of men who seek treatment for inhibited orgasm show a pattern of situational, rather than global, inability to reach orgasm. Perhaps the most common syndrome is when the man can reach orgasm in his own masturbation, or during manual or oral stimulation by his partner, but cannot have orgasm intravaginally during intercourse. Other men complain of being able to reach orgasm only occasionally. Often, these are older men who are having sex quite frequently. This type of case is best not treated, but the patient is simply given reassurance that orgasm need not occur every time he makes love. An explanation of normal aging changes in sexual response will often deal with the concerns of this type of patient.

Nearly all men who suffer from inhibited orgasm have a history of previously being able to reach orgasm normally. Lifelong inhibited orgasm is quite rare.

In the majority of men, male orgasmic disorder is actually secondary to another sexual problem. The most common presentation is the man with hypoactive sexual desire and inhibited orgasm. These men typically are having sex in response to coercion from their partners. If a man really does not want to have sex, and is doing so only in response to pressure from a partner, he may not become aroused enough to reach orgasm, even though he is able to maintain an erection. A man with this symptom pattern should not be treated for male orgasmic disorder, as treatment will usually fail. Instead, treatment should focus on his hypoactive sexual desire or the relationship conflict. Similarly, a man whose inability to reach orgasm coexists with erectile failure should be treated for the erection problem; orgasmic function usually returns when the erectile problem is resolved.