Identification of the sexual response components involved in sexual dysfunction can significantly reduce the number of investigations required to identify the underlying etiologies. However, the exact contribution of each etiological category to the genesis of a given dysfunction may be difficult to establish, but the knowledge of its characterization is essential for treatment planning. For these reason, physicians should consider the context in which the sexual symptom develops, analyzing the partner‘s relationship, behaviour and diseases.
Male sexual dysfunctions could be classified into three classes: disorders of sexual function, disorders of sexual orientation, and disorders of sexual behavior. The disorders of sexual orientation and sexual behavior are believed to be entirely due to psychological etiologies. Thus, for the assessment of these disorders it is possible to refer to the Diagnostic and Statistical Manual of Mental Disorders – IV (DSM-IV) and to the International Classification of Disease – 10 (ICD-10).
In 1993 the National Institutes of Health Consensus Development Conference advocated that ― rectile dysfunction‖ must be used instead of impotence to describe disorders of male sexual function and defined the new terminology as the ― inability to achieve an erect penis as part of the overall multifaceted process of male sexual function‖. However, the use of the term ― erectile dysfunction‖ to refer to all the aspects of male sexual function would be inappropriate.
To better assess the clinical manifestation of every single male sexual dysfunctions, we will analyze them according to Walsh‘s classification.
Disorders of Orgasm
DSM-IV and ICD-10 defined the disorder of orgasm as a persistent or recurrent delay or absence of orgasm after a normal sexual excitement phase during sexual activity and not better accounted by other medical disorders, substance abuse or general medical condition. This disorder is more often frequent in female than in male. In the Global Study of Sexual Attitudes and Behaviours, a prevalence of 5 to 17% of difficulties of reaching orgasm in man between 40 and 49 years was reported.
Orgasm in men is often entwined with ejaculation: it starts from the prostate contraction and continues throughout semen ejection. During orgasm, people experience some pleasure sensation that resolves in sexual satisfaction. For this reason disorder of orgasm is often presented and disguised with disorders of ejaculation. Both the terms anorgasmia and anejaculation are used to refer to the same disorder.
Orgasm and sexual satisfaction are often determined by psychological conditions, i.e. relationship with partner, subjective health, socially compatible personality and lack of physical complaints. Thus, personal history is often crucial in reaching diagnosis.
The term “idiopathic” anorgasmia is used to indicate a condition when there are no demonstrable neurologic derangements to orgasm dysfunction. Several reports link inability to achieve orgasm in otherwise healthy individuals to other psychogenic issues, such as anxiety. Since some subjects are able to reach orgasm and ejaculate with masturbation but not during sexual intercourse, and since they can present nocturnal emission, a psychogenic origin is suggested.
Sometimes orgasm dysfunction is related to frequent masturbations or use of idiosyncratic masturbation techniques. Changing the stimulation technique and decreasing the frequency of masturbation have been successful in reversing the problem.
At the same time, most of the degenerative central nervous system diseases (such as Multiple Sclerosis, Parkinson’s disease, Huntington’s Corea), or some drugs acting on central nervous system (such as SSRI, I-MAO, tryciclic antidepressant), or the abuse of substances of addiction may produce disorder of orgasm. The pathophysiology of these neurological causes is mostly based on the altered somatosensory control, that can reduce the pleasure sensation, or on a dysregulation of the sympathetic autonomic system, that can demodulate the final ejaculation phase.