ANORGASMIA Anorgasmia is the inability to reach an orgasm even with adequate stimulation. It is extremely rare in younger males and much more common in females, who have it with an incidence of about 5 percent. In men, it can be linked to delayed ejaculation. The problem can easily lead to sexual frustration and interpersonal difficulties. The problem can be physiological or psychological. It can be linked to diabetic neuropathy or nerve disease, genital mutilation, multiple sclerosis, trauma to the pelvis, hormone problems, spinal cord injury, or surgical complications after childbirth or hysterectomy. Vulvodynia or pain in the vulva as well as heart disease can be physical causes as well. Drugs that contribute to the problem include SSRIs and other antidepressants, and opioids such as heroin. Primary anorgasmia is when a person has never had an orgasm. It mainly affects women but can occur with men who have a lack of what’s called the bulbocavernosus reflex, which is congenital from birth. It can lead to vascular engorgement in the pelvic area of a woman or low levels of sexual arousal. The problem can be idiopathic and without an obvious cause. Secondary anorgasmia is a problem that happens after there have been normal orgasms in the past. It can be psychological or due to alcoholism, or it can be related to having had pelvic surgery, estrogen deprivation in menopause, illness, rape, or certain medications. Among men with secondary anorgasmia, a radical prostatectomy can lead to anorgasmia due to nerve damage. Situational anorgasmia is a selective problem with attaining an orgasm so that certain conditions lead to the problem rather than all situations. In some cases, there is simply a lack of sufficient foreplay or stimulation that would lead to a lack of an orgasm. It sometimes takes some thinking to try and determine which factors most contribute to anorgasmia in certain situations. In making a diagnosis of the problem, it is a good idea to determine if the problem is psychological or physical. If it doesn’t appear to be psychological, one should look for diabetes, thyroid dysfunction, lipid profile, and hormone levels, such as estrogen,
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