Anorgasmia

[Michael Scally MD]

Jenkins LC, Mulhall JP. Delayed orgasm and anorgasmia. Fertil Steril. http://www.fertstert.org/article/S0015-0282(15)01957-3/abstract

Delayed orgasm/anorgasmia defined as the persistent or recurrent difficulty, delay in, or absence of attaining orgasm after sufficient sexual stimulation, which causes personal distress.

Delayed orgasm and anorgasmia are associated with significant sexual dissatisfaction. A focused medical history can shed light on the potential etiologies, which include medications, penile sensation loss, endocrinopathies, penile hyperstimulation, and psychological etiologies.

UNFORTUNATELY, THERE ARE NO EXCELLENT PHARMACOTHERAPIES FOR DELAYED ORGASM/ANORGASMIA, AND TREATMENT REVOLVES LARGELY AROUND ADDRESSING POTENTIAL CAUSATIVE FACTORS AND PSYCHOTHERAPY.

 

[Handle2]

So Wellbutrin (Bupropion) is useless for treating delayed ejaculation/anorgasmia?

 

[Yowzer]

UNFORTUNATELY, THERE ARE NO EXCELLENT PHARMACOTHERAPIES FOR DELAYED ORGASM/ANORGASMIA, AND TREATMENT REVOLVES LARGELY AROUND ADDRESSING POTENTIAL CAUSATIVE FACTORS AND PSYCHOTHERAPY.

Are there even any reasonably good ones when SSRIs are involved? Wellbutrin not a help for me.

 

[boxcar]

So what are you saying?

I have no idea what causes it, but something with prolactin levels? maybe?

 

[Michael Scally MD]

Amphetamine/Dextroamphetamine Salts for Delayed Orgasm and Anorgasmia

Objectives: To describe our experience with amphetamine/dextroamphetamine salts (AMP) as a treatment for DO/AO.

Methods: We identified patients with DO/AO from 9/2017-9/2019. Baseline characteristics and patient-reported orgasmic latency time (OLT) were recorded. After extensive screening, patients were treated with AMP.

Validated questionnaires were administered including International Index of Erectile Function-5, quantitative Androgen Deficiency in the Aging Male and Adult ADHD Self-Report Scale. OLT change, adverse effects and patient satisfaction were assessed.

Baseline characteristics were compared using chi-squared test. OLT changes were compared with one-way ANOVA. Multivariable logistic regression was performed to identify predictors of treatment success. P<0.05 was statistically significant.

Results: 17 men received AMP-6/17(35.3%) for AO and 11/17(64.7%) for DO, with median follow-up 1.0yr (IQR 1.0 yrs). Amongst responders, AMP improved subjective experience of sex in 8/17 (47.1%) patients (2/6 with AO). Of those, 6/17(35.3%; 1/6 with AO) experienced reduced OLT or increased frequency of orgasm. Non-responders were older than responders, with median age 69.5(IQR 4.3) vs. 61.0yrs (IQR 12.3; p=0.024).

There were no other significant differences in baseline characteristics among responders. 6/8(75%) responders and 8/9(88.9%) non-responders failed other treatment modalities prior to AMP. Among responders with DO and improved OLT, mean OLT decreased by 72.3%(40.7 to 11.1 minutes, p=0.049) for intercourse. Minimal side effects were noted including insomnia and jitters in one patient each.

Conclusions: AMP as a treatment for AO/DO merits further investigation. Measurable improvements in OLT or frequency of orgasm occurred in >1/3 of patients. Larger prospective multi-center studies with strict inclusion/exclusion criteria are warranted.

Levine LA, Betcher HK, Ziegelmann MJ, Bajic P. Amphetamine/Dextroamphetamine Salts for Delayed Orgasm and Anorgasmia in Men: A Pilot Study [published online ahead of print, 2020 Apr 30]. Urology. 2020;S0090-4295(20)30502-1. doi:10.1016/j.urology.2020.04.081 https://www.goldjournal.net/article/S0090-4295(20)30502-1/pdf