What would you recommend for a 73-year-old healthy man who has slowly progressive anorgasmia? All lab results are within normal limits. Psychotropic medications have not been helpful. The patient is taking no medications at all. His testosterone levels are normal on 600 mg of IM testosterone every month.
—James Mottice, DO, Clinton, Ohio

The inability to achieve orgasm can be caused by several neurologic problems, such as diabetic neuropathy, multiple sclerosis, and spinal cord injury. It can also sometimes be a side effect of antidepressants, especially the selective serotonin reuptake inhibitors, such as venlafaxine, escitalopram, paroxetine, fluoxetine, and sertraline. Psychological issues, such as performance anxiety, and the status of the marital relationship can be etiologic factors as well.
—David T. Noyes, MD (108-22)

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