Dear Dr Mitchell,
Is there a problem if a man is able to have an erection, which he can maintain for hours, but just cannot discharge? He simply loses the erection at the end of the sex act... Also, can he get a woman pregnant?
Curious, Kingston

I know that the problem you now experience is quite frustrating for both you and your partner. The problem your partner has is anorgasmia or anejaculation. Anejaculation is the inability to ejaculate semen despite stimulation of the penis during intercourse or by masturbation. This is a common problem and can contribute to significant stress in a couple trying to become pregnant. This condition may be stress induced and tend to occur only in some situations. It may be total, in which case the man is never able to ejaculate under any circumstance. Men who never ejaculate may also never have an orgasm. This is called ANORGASMIC ANEJACULATION.

Some may experience an orgasm but do not ejaculate semen, either because there is failure of the semen to come out due to a block in the tubes or damage to the nerves or because the semen flows back into the bladder due to weakness of the bladder neck (retrograde ejaculation). Men who do not have an orgasm and do not ejaculate can be difficult to treat. If there is a history of a traumatic sexual episode in the past, this needs to be discussed with your doctor who will refer you to a sexologist or a psychologist.

The use of a vibrator is the main treatment. This provides a strong stimulus to the penis for a long duration. This allows the man to reach an orgasm and ejaculate. This is successful in 60% of men. If the vibrator fails then electroejaculation can be performed. This involves direct electrical stimulation of the nerves to the penis. This requires general anaesthesia and is only used if repeated sessions with the vibrator fail.
Men who have an orgasm but do not ejaculate usually have a physical problem and the treatment will depend on the type of problem. If the nerves are damaged then medicine may help. If this fails then vibrator stimulation or electroejaculation may help to obtain a sample of semen for fertilization. If there is a block in the tubes due to infection this can sometimes be cleared by surgery. If surgery is not successful then the sperms may be aspirated and used to fertilize the eggs by in-vitro fertilization thus achieving a successful pregnancy.
Consult your family doctor who will refer you to a urologist for the necessary examination and evaluation.
Best wishes.

Dr Sharmaine Mitchell is an Obstetrician and Gynaecologist. Send questions or comments via e-mail to allwoman@jamaicaobserver.com; fax to 968-2025; or call 511-2502 to leave a 30-second message. We regret we cannot supply personal answers.

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