A normal sexual response cycle involves four distinct steps: Sexual desire (libido), Sexual arousal (excitement), Sexual orgasm (pleasure), and Resolution. Men experience orgasm after sexual arousal and sexual activity. Typically, a male’s orgasm is about the ejaculation of semen through strong muscle contractions of the penis and perineum. The male climax might seem simple but it is a complex process. It occurs through a series of steps involving a combination of hormones, organs, blood vessels, and nerve transmissions. However, some men can experience difficulties in reaching orgasm, mostly stemming from interruption of emotional or physical processes. [1, 2]
Understanding the male orgasm
Primarily, testosterone is engaged in stimulating sexual desires (or libido) which is the key to commencing the process resulting in orgasms in males. Testosterone is a male sex hormone synthesized in a balanced supply by the testicles. The testicles even produce millions of sperms every day that gets mature and mixed with protein-rich, whitish fluids- collectively known as semen. Semen nourishes and supports sperms so that even after ejaculation they can survive for some time. At the time of male orgasm, the semen is moved through the urethra and out of the penis. Males feel the orgasm starting just before the semen first discharges and lasting till the ultimate semen is ejaculated. [1, 2]
What Happens at the Time of Male Orgasm?
There are two phases in which male orgasm takes place, emission and ejaculation. The emission stage is where men reach a “point of no return” called ejaculatory inevitability. In this phase, the semen settles at the top portion of the urethra and is ready to be squirted out of the penis. The next phase is ejaculation which happens in a series of rapid-fire contractions of the muscles of the penis and around the base of the anus. At this time, men might also experience involuntary pelvic thrusting. The nerves that signal muscle contractions now transmit messages of pleasure to the brain of men. 
The Problems Associated with Male Orgasm
Orgasmic disorder, Anorgasmia, or Coughlan’s syndrome is one such concern wherein an individual is not able to experience sexual pleasure even after having sexual stimulations. It is of two types: Primary and Secondary. In the former type of Anorgasmia, a person has never experienced orgasm throughout their life because of any interruption in the normal sexual process. Often, it is accompanied by other sexual dysfunctions such as premature ejaculation, erectile dysfunction, or low libido. Secondary or situational anorgasmia is when a person can feel orgasm only at certain times like while having oral sex or masturbation. The situation when people reach orgasm differs from one person to another. Psychological factors can often result in this condition and no other sexual function abnormalities. 
Reasons Behind Orgasm Problems in Men
Male orgasm can get affected by several things, often due to ejaculation problems, but that’s not always. The causes of male orgasm issues include:
- Delayed Ejaculation- It is a type of ejaculatory dysfunction characterized by too slow the release of semen out of the penis, long after sexual stimulation. This can occur due to medications, excessive drinking of alcohol, hypertension, sexual performance anxiety, hormonal imbalances, diuretics, and even low self-esteem in men.
- Premature Ejaculation- It is a condition where men experience too early or quick spurting out of semen from their penis before or very soon after their penis penetration. Various factors such as hormone levels, low sexual arousal, performance anxiety, and penile sensitivity can result in this ejaculatory dysfunction.
- Retrograde Ejaculation- It is also called dry ejaculation when there is no semen production and retrograde ejaculation is when a small amount of the ejaculation goes backward into the bladder instead of coming out of the penis during the male climax. However, the semen eventually comes out of the body during urination. This condition is often caused by the malfunctioning of the bladder neck muscle.
- Impotence or Erectile Dysfunction- It is a condition where men experience difficulty in getting and keeping a penile erection even after enough sexual activity. Many factors can cause this problem including stress, performance anxiety, depression, lack of stimulus from the brain, vascular disease, neurological disorders (such as multiple sclerosis), and injury/trauma.
- Anejaculation- It is a kind of ejaculatory dysfunction where some men may take an abnormally long time to ejaculate while other males reach orgasm without semen ejaculation. This disorder has various causative factors such as aging, hormonal abnormalities, medications (especially antidepressants like SSRIs- Selective Serotonin Reuptake Inhibitors), psychological problems, diabetes, blocked semen ducts, neurological diseases, and even certain surgeries like testicular and prostate cancer surgeries. [3, 4]
What are the Standard Measures to Treat Orgasm Problems in Men?
There is no one-step solution for anorgasmia or orgasmic disorder as each man is different and the causes differ from one person to another. Therefore, it’s recommended to consult a doctor regarding the orgasm problem without embarrassment as the doctor can help provide quick and appropriate treatment. As per the diagnosis of the male sexual condition and the identified cause of the male patient experiencing orgasm problem, the doctor might ask for certain lifestyle modifications or prescribe medications.
Some Options to Treat Male Orgasm Problems include:
- Testosterone replacement therapy
- Psychotherapy, physical therapy, and certain hormonal medications to treat premature or delayed ejaculation
- Couple therapies for couples having relationship issues affecting their sexual lives
- Therapy sessions for men who are having psychological issues such as anxiety, depression, or stress
- Therapies and counseling sessions to remove fears or false beliefs around sexual topics
- Sexual therapies involving yoga and mindfulness strategies
- Use of prescribed drugs such as dopamine and oxytocin antagonists to treat hormonal imbalances and promote orgasm. [2, 4]
Orgasm problems where there is reduced semen production or perceived ejaculate volume reduction (PEVR) can be treated by increasing semen production and sperm/ejaculation volume through the following measures:
- Not having sexual intercourse or masturbation for a few days at a time
- Delaying ejaculation at the time of the sex
- Avoiding smoking- It has been found that smokers produce low-quality sperms as compared to the non-smokers
- Getting a proper night’s sleep
- Indulging in routine moderate-level of exercises
- Taking supplements with antioxidant properties [3, 4]