When we talk about sexual dysfunction in men, the conversation tends to revolve around premature ejaculation or erectile issues. But a lesser-known, and often misunderstood, challenge affects a surprising number of men over 40: delayed orgasm. As reported in the New York Times article “Why Some Men Can’t Climax” by David Dodge, the condition, also called anorgasmia, affects up to 10% of men in this age group. For many, it turns intimacy into a frustrating and discomforting experience. But why does this happen? And could dopamine be the key to unlocking a better understanding?
The Brain Behind the Bedroom
Orgasms may feel like purely physical experiences, but they’re largely controlled by the brain and one neurotransmitter in particular: dopamine. Often called the “pleasure chemical,” dopamine is responsible for creating that feeling of reward and satisfaction we associate with everything from chocolate to a great workout to sex. When the brain doesn’t release enough of it, or if the body has trouble receiving it, reaching climax can become much harder, and for some even impossible.
In the New York Times article, urologist Dr. Rachel Rubin likens orgasm to a massive reflex requiring a “perfect genital-brain connection.” That connection is largely mediated by dopamine. It starts with stimulation and mental arousal and builds through increased dopamine release, ending in a cascade of pleasurable sensations. Disrupt any step in that process, and the result may be a delayed or absent orgasm. It’s why looking deeper into dopamine and men’s sexual health may help explain more than just occasional off nights.
Dopamine Disruptions
As men age, a variety of changes in the body can disrupt dopamine pathways. One of the biggest culprits is medication, particularly antidepressants known as SSRIs (selective serotonin reuptake inhibitors). While these drugs help regulate mood by increasing serotonin, they also suppress dopamine, raising the threshold for achieving an orgasm. SSRIs are sometimes prescribed to men with premature ejaculation for this very reason as they make it harder to climax.
But it’s not just antidepressants. Blood pressure medications, opiates, and even alcohol can dull the nervous system’s sexual response. This makes sense in the context of dopamine’s role. When pleasure and reward signals are muted, the brain struggles to activate the reflexive response that leads to orgasm. Additionally, conditions like diabetes, Parkinson’s disease, and multiple sclerosis all interfere with nerve pathways, often resulting in both decreased sensation and delayed sexual response.
Stress, Partners, and the Psychological Feedback Loop
While physical factors are significant, mental health can’t be ignored. In Dodge’s article, nearly half of men with moderate to severe delayed orgasms cited anxiety or stress during sex as a
major barrier. It’s easy to see how this forms a feedback loop: anxiety delays orgasm, which causes more stress, which further delays climax.
This issue often exists within a relational context. Differences in libido, expectations around performance, and even a partner’s physical comfort can contribute. The hesitation that can arise may inhibit dopamine release, especially if guilt or emotional disconnect is involved.
That’s why communication is key. Urologists increasingly emphasize asking not just about the man’s experience, but also his partner’s. Unspoken discomfort on either side can become a hidden obstacle in the bedroom.
What Can Be Done?
Currently, there are no FDA-approved treatments for delayed orgasm, but that doesn’t mean men are out of options. Several off-label medications, like bupropion and cabergoline, have shown promise for dopamine promotion in small studies. These drugs help restore the dopamine balance needed to improve orgasm response.
In addition to pharmacological tools, sex therapy can be a powerful intervention. A therapist can help men and their partners unpack performance anxiety, improve communication, and explore new pathways to arousal. Vibratory stimulation devices may also help increase physical sensation and shorten the time to climax by compensating for diminished nerve feedback. While there is not yet a conclusive medication to treat delayed orgasms, the current drug studies offer hope for men's sexual health.
Not Just About the Finish Line
Delayed orgasm can feel isolating, but it’s more common than many realize and oftentimes it is treatable. By looking closely at dopamine and men’s sexual health, we can move beyond surface-level fixes and toward a more holistic, science-driven understanding of sexual well-being.
For men experiencing changes in orgasm or other sexual functions, the help of a professional can provide science-based, practical solutions. At Philadelphia Urology Associates, we offer evidence-based, judgment-free care tailored to your needs. From dopamine-related issues to personalized treatment plans, we’re here to help you better understand your body and improve your quality of life. Schedule your confidential consultation today.