Diagnostic Features
The essential feature of Male Orgasmic Disorder is a persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. In judging whether the orgasm is delayed, the clinician should take into account the person’s age and whether the stimulation is adequate in focus, intensity, and duration (Criterion A). The disturbance must cause marked distress or interpersonal difficulty (Criterion B). The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (including medications) or a general medical condition (Criterion C). In the most common form of Male Orgasmic Disorder, a male cannot reach orgasm during intercourse, although he can ejaculate from a partner’s manual or oral stimulation. Some males with Male Orgasmic Disorder can reach coital orgasm but only after very prolonged and intense noncoital stimulation. Some can ejaculate only from masturbation. An even smaller subgroup have experienced orgasm only at the moment of waking from an erotic dream.
Subtypes
Subtypes are provided to indicate onset (Lifelong versus Acquired), context (Generalized versus Situational), and etiological factors (Due to Psychological Factors, Due to Combined Factors) for Male Orgasmic Disorder.
Associated Features and Disorders
Many coitally inorgasmic males describe feeling aroused at the beginning of a sexual encounter but that thrusting gradually becomes a chore rather than a pleasure. A pattern of paraphilic sexual arousal may be present. When a man has hidden his lack of coital orgasms from his wife, the couple may present with infertility of unknown cause. The disorder may result in the disturbance of existing marital or sexual relationships. Males can usually reach orgasm even when vascular or neurological conditions interfere with erectile rigidity. Both the sensation of orgasm and striated muscle contractions at orgasm remain intact in males who lose their prostate and seminal vesicles with radical pelvic cancer surgery. Orgasm also can occur in the absence of emission of semen (e.g., when sympathetic ganglia are damaged by surgery or autonomic neuropathy).
Differential Diagnosis
Male Orgasmic Disorder must be distinguished from a Sexual Dysfunction Due to a General Medical Condition. The appropriate diagnosis would be Sexual Dysfunction Due to a General Medical Condition when the dysfunction is judged to be due exclusively to the physiological effects of a specified general medical condition (e.g., hyperprolactinemia). This determination is based on history, laboratory findings, or physical examination. Sensory threshold testing may demonstrate reduced sensation in the skin on the penis that is due to a neurological condition (e.g., spinal cord injuries, sensory neuropathies). If both Male Orgasmic Disorder and a general medical condition are present but it is judged that the sexual dysfunction is not due exclusively to the direct physiological effects of the general medical condition, then Male Orgasmic Disorder, Due to Combined Factors, is diagnosed.
In contrast to Male Orgasmic Disorder, a Substance-Induced Sexual Dysfunction is judged to be due exclusively to the direct physiological effects of a substance (e.g., alcohol, opioids, antihypertensives, antidepressants, neuroleptics). If both Male Orgasmic Disorder and substance use are present but it is judged that the sexual dysfunction is not due exclusively to the direct physiological effects of the substance use, then Male Orgasmic Disorder, Due to Combined Factors, is diagnosed.
If the orgasmic dysfunction is judged to be due exclusively to the physiological effects of both a general medical condition and substance use, both Sexual Dysfunction Due to a General Medical Condition and Substance-Induced Sexual Dysfunction are diagnosed.
Male Orgasmic Disorder may also occur in association with other Sexual Dysfunctions (e.g., Male Erectile Disorder). If so, both should be noted. An additional diagnosis of Male Orgasmic Disorder is usually not made if the orgasmic difficulty is better accounted for by another Axis I disorder (e.g., Major Depressive Disorder). An additional diagnosis may be made when the orgasmic difficulty predates the Axis I disorder or is a focus of independent clinical attention. Several types of Sexual Dysfunction (e.g., ejaculation but without pleasurable orgasm, orgasm that occurs without ejaculation of semen or with of semen rather than propulsive ejaculation) would be diagnosed as Sexual Dysfunction Not Otherwise Specified rather than as Male Orgasmic Disorder.
Occasional orgasmic problems that are not persistent or recurrent or are not accompanied by marked distress or interpersonal difficulty are not considered to be Male Orgasmic Disorder. As males age, they may require a longer period of stimulation to achieve orgasm. The clinician must also ascertain that there has been sufficient stimulation to attain orgasm.
Diagnostic criteria for 302.74 Male Orgasmic Disorder
A. Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking into account the person’s age, judges to be adequate in focus, intensity, and duration.
B. The disturbance causes marked distress or interpersonal difficulty.
C. The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
Specify type:
Lifelong Type
Acquired Type
Specify type:
Generalized Type
Situational Type
Specify:
Due to Psychological Factors
Due to Combined Factors
