As Meg Ryan proved in When Harry Met Sally, not all orgasms are the same. When the stars are aligned, an orgasm can produce pleasure beyond belief, and a sense of relaxation. An orgasm can help create a feeling of well being, and emotional intimacy. On the other hand, it can be elusive, and a source of frustration. It's pursuit can bring couples together, or tear them apart. To help quantify the orgasm, researchers developed the orgasmometer https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0202076 . While Meg Ryan's performance might have been worthy of an Academy Award, sadly, her reputed orgasms lacked far behind.
There are five stages to an orgasm, memorialized by the pneumonic DEPOR. (Desire, excitement, plateau, orgasm, and resolution.) Each of these steps can create a roadblock.
Post Orgasmic Illness Syndrome (POIS)
Fortunately, this is a very rare condition. The affected individuals physically get sick after having an orgasm. They have a flu-like syndrome, and can even develop muscle aches, and confusion. Some of these patients respond to anti-histamines.
Delayed Ejaculation
Believe it or not, this can be every bit as frustrating as premature ejaculation. While the emission of the ejaculate is partially voluntarily controlled, the subsequent expulsion is not. This is a very complicated process that involves the autonomic nervous system, and hormones. While a host of medications have been used, the success rate is variable.
Anorgasmia or anhedonic ejaculation
There are those men who never experience an orgasm, or if they do have no associated pleasure, or sense of completion. This affects up to 8% of the population. Some men will respond to psychotherapy, or behavioral therapy. Some patients may respond to a dopamine-promoting drug, like cabergoline. Others become avid Dungeons and Dragons players.
Premature ejaculation
This is the single most common cause of sexual dysfunction. Fortunately, there are a number of readily available solutions which include behavioral techniques, local anesthetic creams, and medications.