Dear Dr G,

My partner and I have been sexually active for a few years and throughout our time together, I have been unable to climax via intercourse.

While it has been helpful in prolonging our time in the bedroom, it leaves me rather concerned and frustrated about the next stage of our lives together, mainly conceiving a child.

I have read that an excessively tight grip during masturbation can be a cause of an inability to climax during intercourse. What do you think about it?

I would like to put Dr G on the spot and to find out the causes of the inability to ejaculate. Is there any remedy for my unfinished business between the sheets?

Thank you
Marathon Man

P.S: I recently came across your column and have found it to be hugely entertaining while still being educational. Looking forward to your next column.

The inability to ejaculate despite repeated sexual stimulation is a form of sexual dysfunction known as anejaculation.

Although the exact prevalence of such condition is not well studied, inability to ejaculate is well recognised in medical literatures and among sexual health specialists.

Anejaculation can be classified into total or situational, orgasmic or non-orgasmic in nature. Total anejaculation is faced by men who are unable to climax under any circumstance, either through intercourse or masturbation.

Total anejaculation can also be divided into orgasmic or non-orgasmic. While the orgasmic anejaculation is mostly related to retrograde ejaculation (backwards flow of semen during orgasm), the non-orgasmic form is mainly associated with neurological defects such as multiple sclerosis or spinal cord injury.

Situational anejaculation, on the other hand, is when a man can ejaculate and attain orgasm in some situation but not in others. Understandably, a man who is required to provide “samples on demand” for semen analysis, may be self-conscious and anxious, resulting in the inability to ejaculate.

I think most men would encounter situational anejaculation, when asked to produce an outcum in a “broom cupboard” of the fertility centre, with a watchful nurse in waiting!

Technically, this is a situational anejaculation that can be easily overcome by providing the sample in a more relaxed environment in close proximity, and deliver the sample at the soonest convenience.

On the other hand, it is also well recognised that a man may be able to attain orgasm and ejaculate when having penetrative sex with one partner, but fail to do so with others.

Some men also reported the ability to climax and ejaculate during masturbation, but face the frustration of anejaculation with vaginal intercourse. In such scenario, the men can go on as long as the stamina allows, or the frustration of the partner kicks in!

One would consider the “marathon sex” of situational anejaculation must be the envy of all men. However, the unfinished business between the sheets may also be the source of irritation and tension in the bedroom.

Hence, the inability to ejaculate may lead to “faking of orgasm”. Sadly, men cannot get away with such falsification as easily as women!

The exact etiology of situational anejacuation is not well understood, however, most are associated with psychological causes, instead of physical disability. Some studies have implicated frequent masturbation and style of masturbation as the main causes of situational anejaculation.

The evidence of such studies is not robust, as most man really cannot recall how frequent they ejaculate the prior month, let alone the frequency of ejaculation in the earlier years.

As far as heavy-handed approach of masturbation resulting in anejaculation, rest assured the manhood is a robust organ that can certainly withstand such manhandling!

Situational anejaculation will not require treatment unless the condition results in infertility or emotional distress.

With the advent of Artificial Reproductive Technology (ART), the retrieval of the sperms for the purpose of procreation is easily achieved.

The utilisation of stimulatory vibrators, electro-stimulatory devices and operations to retrieve sperms, can easily bypass the role of penetrative sex to make a baby! On the other hand, sexual counselling may be also helpful to derive that penultimate outcome!

Marathon runner Halle Gebrselassie, who won two Olympic gold medals once said: “When you run the marathon, you run against the distance, not against the other runners, and not against time.”

When Dr G is put on the spot on men who cannot ejaculate on demand, his response is: “When it comes to sex, it’s not a race against the others and definitely not against time. Serve your purpose for fatherhood, then take time to explore the true sexual experience. You never now, the unfinished business may eventually lead to a happy ending!”

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