He can’t have an orgasm
Dear Dr Mitchell,
My boyfriend has been unable to ejaculate inside my vagina. During our five-month relationship he has only ejaculated twice. He is 54-years-old and has a condition known as Addison’s Disease. Could this be caused by his disease? If so, is there something he can do to have an orgasm?
Failure to ejaculate (anejaculation) is the inability to ejaculate semen despite stimulation of the penis by sexual intercourse or by masturbation. It is a common problem and can be a source of major stress in a relationship, especially in a couple trying for a child.
Failure to ejaculate may be total or situational. Situational anejaculation is a condition in which the man is able to ejaculate in some situations but not in others. Your partner seems to have situational anejacualtion since he does ejaculate sometimes, even though it is quite infrequent. In a lot of cases, this is stress induced. In total anejacualtion the man is never able to ejaculate semen consciously, either during intercourse or by masturbation. In this condition, there may be no associated orgasm or he may in fact have an orgasm but does not ejaculate.
In men who do not have an orgasm and do not ejaculate, there is no orgasm either by masturbation or by sexual intercourse. However, there is usually no physical defect and failure to ejaculate is usually due to some physiological problem. Some men also need to have a great amount of stimulation to have an orgasm.
In orgasmic anejaculation, men reach and experience an orgasm but do not ejaculate either due to a blockage in the tubes that carry semen from the penis or damage to the nerves. There may also be a flow of semen back into the bladder due to weakness at the bladder neck.
Viagra may help situational anejaculation by helping the man to achieve an erection and make it easier to masturbate. Failure to ejaculate and also have an orgasm is difficult to treat and the help of a psychologist may be necessary. The use of vibration to provide a strong stimulation for a long duration to the penis is the main treatment. This is successful in approximately 60 per cent of men. For those men who do not respond to the use of a vibration then the use of electrical stimulation of the nerves can be done. This is successful in 75 per cent of the patients, but this form of treatment is usually undertaken if fertility is decreased and a semen sample is required.
Addison’s Disease is a hormonal disorder and occurs in all age groups. It affects men and women equally. It is characterised by weight loss, muscle weakness, fatigue, low blood pressure and darkening of the skin, in areas exposed to the sun and non-exposed parts. This occurs when the adrenal glands do not produce enough of the hormone cortisol and in some cases aldosterone. The most important function for control is to help the body to respond to stress. It also helps to maintain proper arousal and sense of well-being.
The fact that he has Addison’s Disease could actually contribute to his reduced ability to achieve an orgasm and even a reduced interest in sexual activity. It is essential for him to have his cortisol level done. If the test shows reduced hormonal levels of cortisol, then he will need to increase his intake of hydrocortisone tablets.
Other cause of failure to ejaculate such as diabetes mellitus and multiple sclerosis should be ruled out. Consult your gynaecologist or family physician who will advise you further.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions and comments via email to allwoman@jamaicaobserver.com or fax to 968-2025. We regret that we cannot supply personal answers.
