Dear doctor;

I have not had an orgasm in a month. I am embarrassed to bring this up, but for the many times I have had intercourse with my girlfriend last month, I would end up tired without ejaculating. It bothers me a lot as I am forced to feign orgasm. What could be the problem?

Concerned Tom, 26.

Dear Concerned Tom,

You are suffering from what is known as anorgasmia, that is, lack of orgasm during sexual activity. Most of the men discuss about erectile dysfunction but few talk about this problem, though it does exist. Ninety per cent of cases of anorgasmia are said to be psychological in origin related to anxiety. Anxiety could be due to some problem at work place or home or simply related to "performance in bed.” Orgasm is a pleasurable sensation obtained at peak of sexual activity, whereas ejaculation is simply emission of semen at end of activity. The two are different and one may occur without another or the two may occur together. 

Negative attitude toward sex from childhood due to sexual abuse as a child, witnessing quarrel of parents, e.t.c. can also contribute to this problem. Tension with partner, boredom with daily routine, these are other issues that can lead to lack of orgasm. Anorgasmia can also occur due to use of alcohol,  depression, chronic sickness, or acute health problems. Hormonal disorders like hypothyroidism, hypoadrenalism can cause this condition. Drugs like antidepressants, some antihypertensives like propranolol can also impair orgasm.

In cases where it is related to anxiety, counselling is often helpful in curing the condition. Relaxed noise-free environment, long foreplay by both partners helps one to obtain an orgasm. One should remember that it is not necessary to have an intercourse every night when together. Just being together for few times increases the desire and helps one to achieve orgasm and ejaculation whenever one  has an intimate relationship. 

If the problem is secondary to some organic disorder, cure of that disorder helps. If it is drug induced, stopping the offending drug helps to improve this problem.Improvement has also been seen with stopping alcohol. Use of prolactin two to three times per week has shown improvement in male orgasm disorders in clinical trials.