Men are familiar with ejaculation of semen. However, most men associate ejaculation with orgasm. It is important to understand that ejaculation and orgasm are two different features.
Ejaculation happens by Emission which denotes that semen enters the posterior urethra and expulsion which signifies the propulsion of semen to the exterior. This process is usually accompanied by an intense sensation of pleasure which signifies the male orgasm. There is usually a rhythmic contraction of pelvic floor muscles, prostate and penis that happens. Alterations in heart rate, a quickening of pulse, change in blood pressure and a tension that builds up that releases and becomes quiet suddenly.
In a small group of men , orgasm may be very delayed or there may be a complete absence even after sufficient sexual stimulation. These men are very distressed as treatment is prolonged and results are not great.Well, at least till now. Common reasons for Anorgasmia are medical conditions like diabetes, hypertension, medications, performance anxiety, relationship problems, negative attitudes about sex, chronic pain and history of prior sexual trauma or abuse.
Treatment involves individualisation and tailoring according to the needs of the patient. Counseling and sex therapy play a major role and partner involvement is key. Recently the drug Cabergoline has shown to be effective in some patients. Combined with replacement of testosterone, the success rates of cabergoline are even better.