Male orgasmic disorder: comprehensive diagnostic and therapeutic approach from primary care with emphasis on the Latin American context. A narrative review

Trastorno orgásmico masculino: enfoque diagnóstico y terapéutico integral desde la atención primaria con énfasis en el contexto latinoamericano. Una revisión narrativa

Male orgasmic disorder (MOD) is an underdiagnosed sexual dysfunction characterized by absence, delay, or significant reduction in orgasm following adequate stimulation, present in 75–100% of sexual encounters for a minimum of six months, with a global prevalence of 0.4–3% (1.6–2.8% in the Latin American population). Conceptual differentiation between orgasm and ejaculation is fundamental, as they represent separate neurophysiological processes that can dissociate pathologically. Multifactorial etiology includes organic components (endocrinopathies, neuropathies, pharmacological iatrogenesis: selective serotonin reuptake inhibitors (SSRIs) with odds ratio (OR) 7.0 for delayed ejaculation), psychological factors (performance anxiety, idiosyncratic masturbatory techniques, cognitive distortions), and relational factors (unresolved conflicts, loss of attraction). Primary care physicians play a crucial role in early detection through a structured evaluation protocol (directed sexological history, physical examination, selective laboratory workup: testosterone, prolactin, thyroid-stimulating hormone (TSH)). Effective therapeutic options include structured sexual psychotherapy (65–78% improvement), pharmacological modification (SSRI switch to bupropion: 58–72% resolution), couple therapy, and penile vibratory stimulation (72% orgasm recovery). A pragmatic diagnostic-therapeutic algorithm applicable in any primary care setting is proposed, with specific discussion of implementation challenges in Latin American health systems, particularly Colombia, Brazil, and Mexico.

Resumen

El trastorno orgásmico masculino (TOM) es una disfunción sexual infradiagnosticada caracterizada por la ausencia, el retraso o la reducción significativa del orgasmo tras una estimulación adecuada, presente en el 75–100% de los encuentros sexuales durante un mínimo de seis meses, con una prevalencia global del 0.4–3% (1.6–2.8% en la población latinoamericana). La diferenciación conceptual entre orgasmo y eyaculación es fundamental, ya que representan procesos neurofisiológicos distintos que pueden disociarse patológicamente. La etiología multifactorial incluye componentes orgánicos (endocrinopatías, neuropatías, iatrogenia farmacológica: inhibidores selectivos de la recaptación de serotonina (ISRS) con odds ratio (OR) 7.0 para eyaculación retardada), factores psicológicos (ansiedad de desempeño, técnicas de masturbación idiosincrásicas, distorsiones cognitivas) y factores relacionales (conflictos no resueltos, pérdida de atracción). Los médicos de atención primaria desempeñan un papel crucial en la detección precoz mediante un protocolo de evaluación estructurado (historia sexológica dirigida, exploración física, análisis de laboratorio selectivos: testosterona, prolactina, hormona estimulante de la tiroides (TSH)). Entre las opciones terapéuticas eficaces se incluyen la psicoterapia sexual estructurada (mejora del 65–78%), la modificación farmacológica (cambio de ISRS a bupropión: resolución del 58–72%), la terapia de pareja y la estimulación vibratoria del pene (recuperación del orgasmo en el 72%). Se propone un algoritmo diagnóstico-terapéutico pragmático aplicable en cualquier entorno de atención primaria, con un análisis específico de los desafíos de su implementación en los sistemas de salud latinoamericanos, en particular en Colombia, Brasil y México.

Sexual dysfunctions; Anorgasmia; Orgasm; Ejaculation; Diagnosis; Therapeutics; Primary care

Palabras Clave

Disfunciones sexuales; Anorgasmia; Orgasmo; Eyaculación; Diagnóstico; Terapéutica; Atención primaria

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