Hello and welcome to Healthcare Magic. Thanks for your query.

From the description of your boyfriend's problem it appears that he seems to be suffering from an orgasmic dysfunction. Now, there can be various causes for this problem - both psychological causes as well as medical causes:
1) Psychological causes
- Inadequate arousal
- Performance anxiety
2) Medical causes like hormonal problems, diabetes, blood flow problems, vitamin deficiencies, etc.

So, the first and most important step in management is proper evaluation. This will include a detailed medical, sexual, personal and social history, a thorough physical examination and certain investigations, as per the necessity.

Firstly, any medical causes need to be ruled out and for this, he may need to undergo a few lab tests. Having said this, I would also like to let you know that in more than 80% of cases of orgasmic dysfunction, psychological factors also play a major role in causing or aggravating the problem. Stress, anxiety, fears and doubts regarding sexual performance, feelings of sexual inadequacy, self-doubts, guilt, past negative sexual experiences, etc. can all affect sexual functioning and the ability to reach orgasm.

Treatment is targeted according to the findings on evaluation. If there are any underlying medical problems, then those problems have to be first treated. If the problem is more psychological, then understanding and supporting the person, relieving his anxiety and stress regarding this, and inproving his confidence levels will be beneficial.

So, I would advise him to consult a sexologist in person, to have a detailed assessment, so that further treatment can be planned accordingly.

Wish you all the best.

Regards,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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Hello XXXXXXX

Thank you for the clarifications. Since you say that both of you have not faced this problem before and this problem was not there during the first two times when you were together, it is unlikely that he is suffering from an orgasmic dysfunction. The problem could be more likely related to the sexual technique, where he feels that his organ is not getting stimulated enough during intercourse.

The female vagina is a very elastic structure and so, it can usually adjust itself even if there is a variation in organ sizes. If you feel that your sizes are not compatible or that you are too small for him, this can be overcome by changing or modifying the sexual technique or position.

Many men feel that their organ is well stimulated in certain particular sexual positions only. So, one suggestion could be that you can try multiple positions during sexual intercourse. Maybe, you can take turns in alternating positions with with each person is more sexually aroused. When your partner wants to climax, it would be a good idea to allow him to chose a position where he can control the rythm and depth of penetration, for example the 'doggy-style' position or the "man-on-top" position. This way he will be able to get the adequate amount of friction and stimulation necessary to climax.

Another common problem why men feel that they are not getting the right amount of organ stimulation is "lubrication". Inadequate lubrication can make complete penetration and intercourse difficult. This is quite important especially when the woman feels she is too small for the male partner. Good lubrication will allow the vagina to expand properly and be more pleasurable to the male partner also. So, another suggestion would be to engage in a lot of foreplay before starting intercourse. This will allow the vagina to secrete adequate amounts of secretions as well as become flexible and expand.

Another suggestion would be to take tiny breaks during the intercourse to intermittently spruce up his sexual arousal with other sexually stimulating acts. Sometimes, continuous friction due to thrusting movements can make the penis less sensitive temporarily, and this can be a reason why he finds it difficult to reach climax. So, by taking a little break inbetween and engaing in other sexually arousing acts will not only restore back the sensitivity of the penis but also arouse your partner more, so that he can reach climax easily.

I hope this helps...

Best wishes,
Dr. Jonas Sundarakumar
Consultant Psychiatrist & Sexologist

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