Dear Dr G,

I am in my late 40s and hope to put Dr G on the spot for something quite peculiar that had happened to my sex life in the last three months.

As I am approaching my middle age in life, I succumb to the pressure from my wife to go for a medical check up.

Unsurprisingly, for being overweight with a sedentary lifestyle, my examination turned out to be rather suboptimal.

To be honest, I thought the results would be worse, but the doctor found that I have high blood pressure and an enlarged prostate.

As the blood pressure turned out to be rather high, I have agreed to start on the medication.

Since I started on the medication for the last three months, I noticed my sex life had changed completely.

I still manage to get the libido and erection. But when I climax, my semen is just getting less and less.

I initially thought it’s all my imagination, but when I masturbated last week, I don’t see any ejaculate at all!

I am rather puzzled and bemused, as I have just been accused of faking an orgasm.

Can Dr G tell me what has happened to my semen? Do men just get “dried up” when reaching late 40s?

Can this be the complication of the medication?

Is lack of emission harmful to me?

Lastly, what can I do to have the return of the “happy ending”?


Unhappy Climax

The delivery of sperm and the emission of the semen is a complex and intricate machinery of evolution ensuring maximal amount of gametes reaching the female reproductive tract for procreation. During sexual arousal, sperm are released from the epididymis (adjacent to the production house of testicles), travel via the vas deferens, and mixed with the prostatic fluid (providing nourishment and lubrication for sperms) awaiting ejaculation.

During climax, the coordinated tightening of the muscles in the bladder neck and the powerful contraction of the prostatic musculature ensures propulsion of semen to exit via the urethra, which is the path with the least resistance. The lack of ejaculation occurs when the semen that would have been ejaculated forward to the outside world, instead, is redirected backwards into the urinary bladder. The directional reversal of sperm emission is called retrograde ejaculation, and oftentimes referred as dry orgasm.

In general, retrograde ejaculation is harmless, as it does not affect the libido, erectile rigidity or the degree of orgasm. As the semen go backwards into the bladder instead of outside the penis, men may notice the urine to be slightly cloudy after orgasm. Apart from the frustration of being accused of faking an orgasm by the sexual partner, the only other health issue men with retrograde ejaculation may encounter would be infertility.

The etiology of retrograde ejaculation is generally easily identifiable. The causes of bladder neck muscles weakness that renders the backward flow of the semen are well diagnosed to be neurological, and may require surgery or medications.

Nerve damage caused by medical diabetes, multiple sclerosis and Parkinson’s disease are generally recognised but completely irreversible. Surgical interventions for prostate enlargement and prostate cancer are also well described in medical literature to be the irreversible causes of retrograde ejaculation. The only reversible cause of unintended backward flow of semen into the bladder would be the undesired side effects of medications such as anti-depression, anti-hypertensive and prostate enlargement medications such as alpha blockers.

As the mechanism of the medication as muscle relaxant eases the flow of blood flow and urine, the unintended effects such as dizziness and retrograde ejaculation tend to emerge. The cessation of the drugs will generally recover the sexual function with no long-term implications.

George Orson Welles, the American writer and director with the innovative work in Citizen Kane once said: “If you want a happy ending, that depends, of course, on where you stop your story.” The manifestation of retrograde ejaculation is normally a sign the integrity of neurophysiology of the sexual organs are being challenged. The mere identification of cause is usually sufficient in changing the course of the future. As we venture into the new dawn of 2019, it is healthy to reflect on the past year and the challenges our body endures.

Getting a healthy New Year resolution and keeping the momentum is often the key to sustain a healthy overall and sexual health. Dr G’s advice is: “The happily ever after of course is possible when you maintain a healthy lifestyle and keep the medicine away!”

On that note, Happy 2019 to all!

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