When pharmacotherapy for delayed ejaculation is under consideration, it is important to eliminate iatrogenic causes, including medications (eg, alpha-adrenergic blockers, other antihypertensives, antidepressants, and antipsychotics). In the case of antidepressant-induced inhibited male orgasm, consideration may be given to switching to bupropion (also used as adjunctive therapy, mirtazapine, or nefazodone (withdrawn from the US market), which have fewer sexual side effects than selective serotonin reuptake inhibitors (SSRIs) do.
Adjunctive therapies should be considered. Alpha sympathomimetics (eg, ephedrine or a combination of chlorpheniramine maleate and phenylpropanolamine hydrochloride [withdrawn from the US market]) have been used successfully in patients with retrograde ejaculation.
Anorgasmia is a female sexual orgasmic disorder in which there is persistent and consistent inability to achieve orgasm after adequate stimulation that causes personal distress. Approximately 15% of women report difficulties with orgasm, and approximately 10% of women in the United States have never climaxed.