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Sexual anhedonia, also known as pleasure dissociative orgasmic disorder, is a condition in which an individual cannot feel pleasure (see anhedonia) from an orgasm. It is thought to be a variant of hypoactive sexual desire disorder.

Overview

Normally, humans feel pleasure from an orgasm; upon reaching a climax, chemicals are released in the brain, and motor signals are activated that will cause quick cycles of muscle contraction in the corresponding areas of both males and females. Sometimes these signals can cause other involuntary muscle contractions, such as body movements and vocalization. Finally, during orgasm, upward neural signals go to the cerebral cortex and feelings of intense pleasure are experienced. People with this disorder are aware of reaching an orgasm, as they can feel the physical effects of it, but they experience very limited or no sort of pleasure.^[1]

Causes

It is thought that people with sexual anhedonia have a dysfunction in the release of the chemical dopamine in the nucleus accumbens, the brain's primary reward center. This part of the brain is thought to play a role in pleasurable activities, including laughter, exercise, and music. Additionally, it is thought that depression, drug addiction, high levels of prolactin, low testosterone, and uses of certain medications might play a role in inhibiting dopamine. A spinal cord injury or chronic fatigue syndrome might also occasionally cause this disorder.^[2] Age may also be a cause of this disorder.^[3]

A sudden-onset sexual anhedonia can also be a symptom of sensory neuropathy, which is most commonly the result of pyridoxine toxicity^[4] (e.g., from large doses of vitamin B6 supplements). In this case, the sexual dysfunction promptly resolves spontaneously once the B6 supplementation is stopped.^{[citation needed]}

Increased serum prolactin (PRL)^[5] concentration in patients' brains from psychiatric medicine can also affect sexuality.^[6] Psychiatric medicine is known to cause the brain to form more dopamine receptors for the dopamine blocking effect. The normal amount of dopamine released during sex is insufficient to stimulate the larger number of dopamine receptors.^[7]^[8]^[9]^[10]^[11]

Treatment

Several treatment methods have been devised to help patients cope. Exploration of psychological factors is one method, which includes exploring past trauma, abuse, and prohibitions in the cultural and religious history of the person. Sex therapy might also be used as a way of helping to realign and examine the patient's expectations of an orgasm. Contributing medical causes must also be ruled out and medications might have to be switched when appropriate. Additionally, blood testing might help determine levels of hormones and other things in the bloodstream that might inhibit pleasure. This condition can also be treated with drugs that increase dopamine, such as oxytocin, along with other drugs. In general, it is recommended that a combination of psychological and physiological treatments should be used to treat the disorder.^[12]

Other drugs which may be helpful in the treatment of this condition include dopamine agonists, oxytocin, phosphodiesterase type 5 inhibitors, and alpha-2 receptor blockers like yohimbine.^[13]

References

^ Perelman MA (2011). "Anhedonia/PDOD: Overview". The Institute For Sexual Medicine. Archived from the original on March 20, 2012. Retrieved 14 February 2011.
^ Perelman MA (2011). "Anhedonia/PDOD: Causes". The Institute For Sexual Medicine. Archived from the original on April 15, 2013. Retrieved 14 February 2011.
^ Comprehensive Textbook of Sexual Medicine By Kar, page 18
^ Schaumburg, Herbert; Kaplan, Jerry; Windebank, Anthony; Vick, Nicholas; Rasmus, Stephen; Pleasure, David; Brown, Mark J. (1983). "Sensory Neuropathy from Pyridoxine Abuse — A New Megavitamin Syndrome - NEJM". New England Journal of Medicine. 309 (8): 445–448. doi:10.1056/nejm198308253090801. PMID 6308447.
^ Peuskens J, Pani L, Detraux J, De Hert M (May 2014). "The effects of novel and newly approved antipsychotics on serum prolactin levels: a comprehensive review". CNS Drugs. 28 (5): 421–53. doi:10.1007/s40263-014-0157-3. PMC 4022988. PMID 24677189.
^ Konarzewska B, Szulc A, Popławska R, Galińska B, Juchnowicz D (2008). "[Impact of neuroleptic-induced hyperprolactinemia on sexual dysfunction in male schizophrenic patients]". Psychiatria Polska. 42 (1): 87–95. PMID 18567406.
^ Whitaker L, Cooper S (10 July 2014). Pharmacological Treatment of College Students with Psychological Problems. Routledge. ISBN 9781317954453. Retrieved 17 April 2018 – via Google Books.
^ Tupala E, Haapalinna A, Viitamaa T, Männistö PT, Saano V (June 1999). "Effects of repeated low dose administration and withdrawal of haloperidol on sexual behaviour of male rats". Pharmacology & Toxicology. 84 (6): 292–5. doi:10.1111/j.1600-0773.1999.tb01497.x. PMID 10401732.
^ Martin-Du Pan R (1978). "[Neuroleptics and sexual dysfunction in man. Neuroendocrine aspects]". Schweizer Archiv für Neurologie, Neurochirurgie und Psychiatrie = Archives Suisses de Neurologie, Neurochirurgie et de Psychiatrie (in French). 122 (2): 285–313. PMID 29337.
^ Dominguez, Juan M.; Hull, Elaine M. (2005). "Download Limit Exceeded". Physiol. Behav. 86 (3): 356–368. CiteSeerX 10.1.1.325.3090. doi:10.1016/j.physbeh.2005.08.006. PMID 16135375. S2CID 12493855.
^ de Boer MK, Castelein S, Wiersma D, Schoevers RA, Knegtering H (May 2015). "The facts about sexual (Dys)function in schizophrenia: an overview of clinically relevant findings". Schizophrenia Bulletin. 41 (3): 674–86. doi:10.1093/schbul/sbv001. PMC 4393701. PMID 25721311.
^ Perelman MA (2011). "Anhedonia/PDOD: Treatment". The Institute For Sexual Medicine. Archived from the original on 23 July 2010. Retrieved 14 February 2011.
^ Goldstein I. "Orgasmic Anhedonia/ PDOD: Treatment". The Institute for Sexual Medicine. Archived from the original on 5 July 2013. Retrieved 15 July 2014.

Bibliography

Csoka AB, Csoka A, Bahrick A, Mehtonen OP (January 2008). "Persistent sexual dysfunction after discontinuation of selective serotonin reuptake inhibitors". The Journal of Sexual Medicine. 5 (1): 227–33. doi:10.1111/j.1743-6109.2007.00630.x. PMID 18173768.
Courtois F, Charvier K, Leriche A, Vézina JG, Côté I, Raymond D, Jacquemin G, Fournier C, Bélanger M (Oct 2008). "Perceived physiological and orgasmic sensations at ejaculation in spinal cord injured men". J. Sex. Med. 5 (10): 2419–30. doi:10.1111/j.1743-6109.2008.00857.x. PMID 18466272.
Soler JM, Previnaire JG, Plante P, Denys P, Chartier-Kastler E (December 2008). "Midodrine improves orgasm in spinal cord-injured men: the effects of autonomic stimulation". The Journal of Sexual Medicine. 5 (12): 2935–41. doi:10.1111/j.1743-6109.2008.00844.x. PMID 18422493.
IsHak WW, Berman DS, Peters A (April 2008). "Male anorgasmia treated with oxytocin". The Journal of Sexual Medicine. 5 (4): 1022–1024. doi:10.1111/j.1743-6109.2007.00691.x. PMID 18086171.