Who’s faking orgasm and why? The answer might surprise you.

With more and more men taking prescribed medications, it’s time to talk about sexual side effects and what may be happening (or in this case not happening)in the bedroom.

We’re all familiar with the now-infamous orgasm scene in "When Harry Met Sally." Meg Ryan is sitting across the table from Billy Crystal and launches into a full-blown orgasmic performance to demonstrate -- over corned beef and rye --- that, yes, women fake orgasm and men often have no idea.

But what about when the tables are turned?
Most women assume they can spot a faker by, well, a lack of a wet-spot afterwards. After all, in most cases a guy’s expression of orgasm is more tangible than a woman’s because he ejaculates. However, if you think of a couple who’s using condoms, the idea of orgasm evidence goes out the window. A guy can fake it until the cows come home if he’s using condoms and no one will ever know. The condom, in a strange way, evens out the orgasm-faking playing field.

I believe that another trend may be playing an equally important role: the staggering rate of anti-depressant use. Anti-depressants are the most common drug prescribed by doctors, with nearly 120 million prescriptions written each year.

As more and more guys take anti-depressants like Prozac, Zoloft and Paxil to boost serotonin levels, they may reap a greater sense of calm or steady mood, but the price they pay is decreased libido and delayed ejaculation. The combination often hits men like a double whammy: they feel inadequate that they can’t reach orgasm...and then they worry about how they will explain it to a partner. Most people, and men especially, for better or worse, simply aren’t comfortable discussing that they’re depressed or on medication with a new partner. Still other guys may not even be aware delayed orgasm and low libido are side effects of anti-depressants.

However, it’s also possible that men (on anti-depressants or not) fake orgasm for the same reason that women do — a sense of pressure, too much stress or an inability to communicate about things that might be bothering him, whether in bed or in his relationship. A guy may feel distant or not want to hurt a partner’s feelings, just as women do.

Ultimately, the key to great orgasms is good communication and, maybe, switching your medication if your doctor thinks it’s appropriate. Here’s a Quick 5 for the Big O that applies to men and women alike:

1.  Consider a switch
If you find that since going on an anti-depressant your libido, your orgasm ability or both have suffered, explore other options with your doctor. Wellbutrin may have a lower risk of sexual side effects.

2.  Make it, don’t fake it
When you’re not feeling up for sex, tell your partner you want to cuddle or focus on his or her pleasure. Don’t force yourself to have sex when you don’t want to and have it when you do.

3. De-stress
We all need to power down before we can get into the zone for sex. Start a new ritual of turning off the Blackberry and the computer when you get home at night so you can tune into your partner.

4.  Discuss
Tell your partner that you need to change up the old bedroom routine if it’s just not working for you anymore! Talk in terms of your fantasies and desires — not criticism. Sometimes both people are harboring the desire for better sex and it just takes one person to speak up.

5.  Easy does it
You’re not a porn star, so give yourself a break. Every one goes through sexual ebbs and flows. Give yourself some time and try, as difficult as it may be, not to focus all of your energy on your orgasm.

SOURCE:  Ian Kerner, Ph.D., Sex therapist and relationship counselor, TODAYShow.com contributor

Ian Kerner is a sex therapist, relationship counselor and New York Times best-selling author of numerous books, including the recently published “Sex Detox: A Program to Detoxify and Rejuvenate Your Love Life.” He was born and raised in New York City, where he lives with his wife, two young sons and plump Jack Russell terrier.