Male Orgasmic Disorder (302.74)

DSM-IV-TR Criteria

• 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 disturbance causes marked distress or interpersonal difficulty.
• The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition.
• Specific type:
  • Lifelong Type
  • Acquired Type
• Specify type:
  • Generalized Type
  • Situational Type
• Specify:
  • Due to Psychological Factors
  • Due to Combined Factors

Associated Features

• Male orgasmic disorder refers to a delay in or absence of orgasm following a normal phase of excitement and an adequate degree of stimulation. Male orgasmic disorder is most often situational. The male may have an issue reaching orgasm with a certain partner, but not through masturbation.
• Male orgasmic disorder has also been termed delayed ejaculation, ejaculatory incompetence, and retarded ejaculation.

Child vs. Adult Presentation

This disorder occurs once the individual has become sexual active and is not seen in children.

Gender and Cultural Differences in Presentation

• Research shows that this occurs in every race and ethnic group. This disorder is more commonly found in women.
• In Lifelong Type manifestations will occur around the age of puberty
• In certain genetic hypogonadism disorders such as Klinefelter’s syndrome, certain body signs and symptoms may alert the physician
• In acquired Type of Male orgasmic disorder, the patient will have had the previous experience of normal sexual function. In these cases, it is usually a situational factor that precipitates the disorder.

Epidemiology

It is rare for males to have a lifelong form of the disorder. Research shows that about 8% of males have experienced this at one time or another.

Etiology

• The causes are mostly psychological.
• The psychological causes can be intrinsic or extrinsic. Intrinsic factors include the fear of getting the partner pregnant, depression, low self-esteem, stress, bad relationships, and traumatic experiences with sex. The extrinsic factors may include the absence of a private location to perform, or perhaps, fatigue from other parts of life.
• Although male orgasmic disorders are generally psychological, there are cases where the causes are organic. The disorder could be caused by hypogonadism, in which enough testosterone is not produced. Pituitary conditions, thyroid disorders, and diseases of the body or penis may also cause orgasmic disorder. Additionally, medications such as as blood pressure medication or antidepressants or substance abuse- narcotic or alcohol- can cause this disorder.
• The most common causes of the male orgasmic syndrome are psychological in nature. The responsible psychological mechanisms may be “intrinsic” (due to basic internal factors), or “extrinsic” (due to external or environmental factors).
• The disorder can result from trauma but can also be acquired through problems within relationships.

Empirically Supported Treatments

• The most effective treatment is psychotherapy. This might require the partner to be actively involved with the therapy as well.
• Before the orgasmic disorder can be treated, the cause of the condition must be discovered, then the treatment will follow accordingly. If the condition is caused by a physical problem, treatment for the physical problem is sought. However, if the condition is caused by a psychological problem, psychotherapy and sex therapy are commonly used. In couples sex therapy, the couple is often taught to focus on relaxation, exploration, decreasing inhibitions, and improving sexual communication. Sex therapy focuses on increasing sexual stimulation and reducing performance anxiety.

Prognosis

The prognosis of a male with males orgasmic disorder is dependent on whether the condition is lifelong or acquired and the conditions causes.Prognosis is best when it can be demonstrated that the condition is related to some extrinsic or environmental factor that can be correlated. The prognosis is also favorable in those cases that are due to an organic disorder such as thyroid disorder or hypogonadism. The prognosis is a grimmer when the disorder is found to be a secondary to a deeper and chronic psychological or psychiatric problem that it in itself carries an unforgivable prognosis.

Additional Information

Male orgasmic disorder