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Should pleasure dissociative orgasmic disorder or orgasmic anhedonia cause personal distress, a combined psychologic and physiologic sexual medicine evaluation should be considered.
Psychologic approaches to improving orgasmic function focus on the man exploring psychologic factors such as hypoactive sexual desire disorder, depression, poor arousal, anxiety, fatigue, emotional concerns, past trauma and abuse history, cultural and religious prohibitions feeling excess pressure to have sex, or a partner's sexual dysfunction such as genital pain. Sex therapy involves teaching the use by couples of manual or vibrator stimulation during intercourse. Sex therapy may focus on mindfulness strategies and yoga exercises. Sex therapy also assist the man to examine and realign expectations of orgasm. Emotional intelligence, or a knowledge of one’s own mood or sense of being is important for orgasm function.
Physiologic approaches to improving orgasmic function focus on ruling out contributing medical causes, such as switching medications if appropriate. Blood testing should be considered for sex hormone levels such as testosterone, sex hormone binding globulin, dihydrotestsoterone, LH, FSH, estradiol, prolactin, and TSH. These blood tests will assess testicular function, pituitary function and thyroid function. Medications that may help with orgasm function include dopamine agonists (drugs that raise dopamine), oxytocin, phosphodiesterase type 5 inhibitors and alpha-2 receptor blockers such as yohimbine hydrochloride.
In many cases the combined psychologic and physiologic approaches to resolving the pleasure dissociative orgasmic disorder or orgasmic anhedonia make the most sense.
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