Amy M. Pearlman, MD, presents “Delayed or Absent Orgasm and Pleasure Optimization.”

How to cite: Pearlman, Amy. “Delayed or Absent Orgasm and Pleasure Optimization.” Grand Rounds in Urology. Published September 25, 2025. Accessed Mar 2026. https://grandroundsinurology.com/delayed-or-absent-orgasm-and-pleasure-optimization/

Delayed or Absent Orgasm and Pleasure Optimization – Summary

Diane K. Newman, DNP, ANP-BC, FAAN, FAUNA, BCB-PMD, Urology and Pelvic Floor Nurse Specialist, University of Pennsylvania, Philadelphia, Pennsylvania, and Adjunct Professor of Surgery, Division of Urology, Perelman School of Medicine Emerita, introduces Amy Pearlman, MD, Prime Institute, Coral Gables, Florida. Dr. Pearlman addresses delayed ejaculation (DE) and anorgasmia, highlighting the lack of standardized definitions, limited guidelines, and the absence of FDA-approved treatments. Current American Urological Association (AUA) guidance recommends mental-health referral, sexual practice modification, and addressing reversible contributors such as selective serotonin reuptake inhibitors (SSRIs) or low testosterone. However, many men present without clear etiologies, requiring creative, multimodal care.

Dr. Pearlman reviews modern adjuncts in sexual medicine:

  • Penile vibratory stimulation: Devices such as the Pin Point Massager restored orgasm in ~75% of men with anorgasmia in one trial (36 subjects).
  • Masturbation trainers (e.g., Myhixel®): One case report suggests benefit for DE when combined with structured exercises mimicking intercourse sensations. 
  • Disposable training cups (e.g., TENGA®): Used in stepwise programs, either narrowing or widening internal size to prolong or hasten climax. In one 10-patient series, seven achieved ejaculation with a trainer; two progressed to partner ejaculation.
  • Medication considerations: dopamine agonists, oxytocin, flibanserin, and bremelanotide, though none are FDA-approved and results may vary.

Dr. Pearlman emphasizes tailoring therapy to individual goals—some men seek pregnancy, others pursue pleasure optimization. Success often requires months of retraining, multidisciplinary input (sex therapy, pelvic floor PT), and framing DE within a lifelong continuum of sexual habits and aging.