Q: Hi doc. Keep up the good work Please, I want to ask about something that is bothering me. Is it possible for ejaculation to not occur? For instance, we mate today around 1am and everything went well but we decide to go again after another five hours but ejaculation did not occur after trying. This is the second time it ‘s happening but he is not taking it serious. I just want to know if it’s not a serious problem or if there is anything he can do about it. Please Doc, I am counting on you for my reply. Thanks for your time.
A: Thanks for writing in.
There are 4 phases of the sexual response cycle: excitement, plateau, orgasm (climax) and resolution (when the body returns to its normal functioning). After resolution, men usually need recovery time. During this period (refractory period), the man cannot achieve another orgasm. This period may last for minutes, hours or even days…the older one gets, the longer the refractory period. So, this may very well be the issue here.
It is also possible that the issue is anejaculation. Anejaculation is a situation in which there is failure of ejaculation. It can be primary (in which case it is present at birth and is a lifelong condition) or it could be secondary, as appears to be the situation here. In secondary anejaculation, the problem is acquired.
The same conditions that cause retrograde ejaculation are also suspect here. Retrograde ejaculation (RE), refers to backward ejaculation. To understand this, a refresher course on how ejaculation happens is needed:
Usually, during ejaculation, the muscle at the neck of the bladder tightens ensuring that semen does not enter the bladder. In people with this problem, this muscle does not tighten enough to prevent backtrack of the semen into the bladder. So, in these people, their ejaculate during intercourse is usually very little (sometimes almost non-existent, even though they certainly know they have had an orgasm) or their urine after sexual intercourse cloudy as a result of the sperm going into the bladder and mixing with urine.
Retrograde ejaculation does not interfere with a person’s ability to enjoy sexual intercourse, have and maintain an erection or even climax. Usually, these people would show up in the clinic because of infertility.
RE and secondary anejaculation can start after a surgery on the bladder or prostate; it can occur as a side effect of some anti-hypertensive drugs (drugs used to treat hypertension), or as a complication of some surgeries or medical conditions like Diabetes Mellitus, multiple sclerosis or spinal cord injury. A few people are actually born with a weakness of this muscle that closes the neck of the bladder during ejaculation.
If RE or secondary anejaculation is caused by medications, your doctor may consider changing them or stopping them for a while. Otherwise, there are some drugs used to ensure the neck of the bladder is closed during ejaculation. Your doctor will weigh their side effects against their potential benefits in deciding whether to prescribe them to you or not. For those who desire babies, your doctor will also discuss options of ‘harvesting’ sperm to be used on your spouse.
For spinal cord injuries, the ejaculatory pathway may be intact or there may be need for penile vibratory stimulation depending on the level of the injury.
His doctor should be able to take a proper history, carry out a detailed examination and make a proper diagnosis.
Have a great evening, people 😀