ORGASM: DIFFICULTY and FAILURE IN MALES
The effects of central nervous system factors, and a problem with Allopregnanolone
When “getting together” doesn’t mean “coming together”
BACKGROUND
Setting the stage:
The central nervous system “setup” for sexual arousal begins when the hypothalamus receives one or more emotional, cognitive, visual, auditory or tactile signal, indicating that sexual activity is “in the offing”. Dopamine and Oxytocin are released, which have a calming effect on the Sympathetic Nerve Center in the spinal cord (it lies between the 11th Thoracic and the 2nd Lumbar vertebrae) and a stimulatory effect on the Sacral Parasympathetic Centre, in the tip of the spinal cord.
The sacral Parasympathetic centre activates the nerves to the penis and “Cowper’s glands” in the male, or the Clitoris and “Bartholin’s glands”, in the female, stimulating the release of Nitric Oxide, which results in penile, or clitoral, erection and secretion of lubricatory fluids (by Cowper’s glands in the male and Bartholin’s glands, in the female).
Stimulation of the “Glans Penis” or the “Glans Clitoridis”
The sequence, in both sexes: once the reflex centre (male, or female) in the spinal cord is primed, sensory nerve signals generated by penile, or clitoral stimulation, passing up the “afferent” nerves to the sacral nerve centre (located at S2-S4 in the spinal cord) excite the reflex arc to “maximum”...... Then rhythmic (orgasmic) contraction of the pelvic floor and periurethral musculature begins.
The female pelvic floor contractions add powerful stimulation to the male’s sensory receptors, maximising the afferent stimulation to the arc and accelerating the process of his orgasm.
Desensitisation of the spinal reflex arc
With age, several of the factors leading to activation of the orgasmic reflex arc may weaken, or become blocked:
Reduced penile sensitivity and slowed nerve conduction may delay excitation of the reflex arc
Lower Testosterone may retard “setting the stage”: one would expect “lowT” to be a frequent problem in the female, whose Testosterone production can fall to zero even before age 25: but pardoxically, women are less likely than men, to suffer orgasmic failure.
High baseline prolactin: some older men have age-related hypothyroidism, with high prolactin: both conditions blunt the orgasmic surge.
Hypothyroidism (True, or intracellular), presenting as usual with reduced initiative, low energy and “drive”, may affect the libido, the erection & lubrication process and /or the orgasmic response in either sex.
Chronic diseases: Diabetes, vascular disease, and neuropathy reduce nerve and blood flow, probably due to the Low T3 Syndrome, which accompanies most chronic conditions.
Psychological factors: Stress of any origin, including the performance anxiety which accompanies new relationships, can delay orgasm.
DRUGS
Many drugs may retard orgasm – in fact during my 14 years of family practice, I prescribed an antidepressant, Buproprion, to a number of young men who complained of premature ejaculation: it worked quite well, slowing the orgasmic reflex enough to allow the female time, to prime her reflex arc.
The anorgasmia “suspect list”, as enumerated by the Mayo clininc and others, includes
Tricyclic antidepressants (TCAs).
SSRIs (antidepressants)
Monoamine oxidase inhibitors (MAOIs).
Antipsychotics.
Anti-mania medications.
Antihistamines
Medications used to treat high blood pressure can cause erectile dysfunction and some antihistamines and decongestants can also cause erectile dysfunction or problems with orgasm/ejaculation.
? Do older women have the same problem?
Women do not experience the same reflex failure pattern because the female orgasmic pathway is different. They do experience changes that can make attaining orgasm more difficult, but many women report that orgasms become better, and more easily attained, with age.
What changes for women (supported by Health Digest & GoodRx)
Reduced estrogen → reduced genital blood flow can slow arousal and decrease clitoral sensitivity.
Vaginal dryness and atrophy →Pain or discomfort can prevent relaxation, which is essential for orgasm.
Pelvic floor weakening Weaker contractions → less intense orgasms.
Lower Testosterone → Women, too, rely on testosterone for desire and orgasmic intensity.
Medication effects: SSRIs can cause anorgasmia in women, as they do in men.
Psychological stress, anxiety about body-image changes, or relationship dynamics can inhibit orgasm.
However many older women report that they experience no decline in orgasm quality, and some (according to a Kinsey Institute survey) experience better orgasms with age, due to improved self-knowledge and communication skills, absent worry about pregnancy, and being less inhibited and more comfortable with self-stimulation (or directing stimulation).
So both sexes can experience reduced genital sensitivity, slower arousal, medication-related orgasmic blunting, chronic disease effects and / or psychological barriers, etc. but the root causes differ: in men, neurological + hormonal + ejaculatory reflex changes are the main factors, while in women, estrogen loss, aging of the vaginal tissue and arousal pathway changes are more responsible for diffculty with orgasm.
