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Suggest Treatment For Anorgasmia

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Posted on Wed, 3 Jun 2015
Question: Hello Doctor,

I am 32 years old male, recently married. We are planning to have a baby. My problem is that I don't ejaculate inside my wife's vagina even after intense intercourse and my erection stands for a longer time. One time I was able to get it released during an intimate moment but outside of vagina. I generally don't masturbate but ejaculate in dreams at nights. Is there any technique or advise to get it released during intercourse? Do I have to look for home insemination methods? I wanted to have the semen analysis test but not sure if I will be able to ejaculate at the clinic. Is there any device that can help to get semen for the test?

Thanks in advance.
doctor
Answered by Dr. Chintan Solanki (44 minutes later)
Brief Answer:
your problem is treatable, need more information from your side

Detailed Answer:
Hello,

Thanks for writing to us.

I can understand your concern. Your problem is you are not able to release semen in wife's vagina during sex probably due to longer erection(delayed ejaculation).As you were able to ejaculate once and at night ejaculation occurs there is no problem of retrograde ejaculation. You are recently married since 3 months so no need to worry much.In many newly married couples initially sex problem occurs. You have passed almost 3 months married life(you narrated in other question that you got married in February).

I need to know some information to guide you in right direction.

- What is your frequency of sex ?

- Until now how many times you were able to have successful intercourse(you and your wife both reach to orgasm and your semen ejaculated in her Vagina)?

- What happens when your erection stays longer during sex?Do you withdraw your penis or ejaculate outside manually?


- Since when night fall problem is there?

- Did you have any experience of masturbation in past?Describe some details.

- Are you using any medicine for anything currently?

- Do you have any problem in urination?

- Do you have nay backache or spine problem?

From given history in my opinion there is no need of semen analysis at this point and no need of any artificial technique of insemination.


Waiting for your reply to help you further.

Regards,
Dr.Chintan Solanki.
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (37 minutes later)
Thanks Dr XXXXXXX Please see my reply inline.

- What is your frequency of sex ?
We do it almost everyday. Mostly early morning time.

- Until now how many times you were able to have successful intercourse(you and your wife both reach to orgasm and your semen ejaculated in her Vagina)?
Not a single time. But, I ejaculated once outside of vagina when I was rubbing my penis on her backside intensely.

- What happens when your erection stays longer during sex?Do you withdraw your penis or ejaculate outside manually?
I used to withdraw and tried masturbating but no ejaculation. During intercourse or foreplay, I used to see some clear white liquid coming out of my penis, presuming it is pre-cum. Does pre-cum contain sperm by any chance?

- Since when night fall problem is there?
I think Wet dream problem is there from earlier times, as I don't masturbate. I used to think wet dream is also just a body's way of getting the sperms out if no masturbation occurs. Please tell me how much of the problem it is.

- Did you have any experience of masturbation in past?Describe some details.
No, I don't masturbate. Didn't ejaculate at couple of times when I tried to get it out using masturbation. My ejaculation always happened in night or morning sometime, when I was asleep with some erotic dreams to wake me up.

- Are you using any medicine for anything currently?
No.

- Do you have any problem in urination?
No. Just after pre-cum, if I pee, I use to sense some irritation sometimes but not all the time.

- Do you have nay backache or spine problem?
No.
doctor
Answered by Dr. Chintan Solanki (2 hours later)
Brief Answer:
is there orgasm in your case without ejaculation?

Detailed Answer:
Hello,

Thanks for important information.

First of all I want to clarify about night fall. Yes you are right it is body's mechanism to expel the sperms when they are in excess in body. It is not at all problematic.

From your answer, " During intercourse or foreplay, I used to see some clear white liquid coming out of my penis, presuming it is pre-cum. Does pre-cum contain sperm by any chance?" I want one clarification from your side.

Thick(like ghee-butter) white somewhat sticky substance coming out around one teaspoonful(2-5 ml) from penis after erection and with orgasm(a different unique enjoyable relaxing feeling in mind) is called SEMEN while watery clear (not white)somewhat sticky fluid coming out from penis just after excitation or erotic feeling is called precum.
- Please clarify what you presume is precum or semen?

Precum can contain sperms in 1% cases but that are also very low in quantity than that of semen.Precum helps in lubrication.

If your sex or masturbation ends with orgasm but without ejaculation possibility of retrograde ejaculation is there.In this semen expels back in to urinary bladder when ejaculation occurs. However this semen comes out in urine later on.

- So do you have orgasm but no ejaculation? or no ejaculation and no orgasm after sex/masturbation?

- Anytime do you feel haziness in urine or whitish substance in urine after sex?

Considering your history of daily sex and foreplay I assume that you do not have any problem with wife as well as any specific stress in your life and you both enjoy the sex.As these are sometime responsible for delayed ejaculation.

I would give further comments after your answers.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (43 minutes later)
Thanks Doctor for pondering over this with clear questions and answers. Please see inline for my response.

Thick(like ghee-butter) white somewhat sticky substance coming out around one teaspoonful(2-5 ml) from penis after erection and with orgasm(a different unique enjoyable relaxing feeling in mind) is called SEMEN while watery clear (not white)somewhat sticky fluid coming out from penis just after excitation or erotic feeling is called precum.
- Please clarify what you presume is precum or semen?

I presume watery (not white, sorry) clear liquid as precum. I get the thick white sticky substance (semen) which usually comes in large quantity(say 1-3 teaspoons), when I ejaculate in dreams or at that single time when I had foreplay with my wife. Before marriage, I used to wet dream in 2-4 days interval.

Precum can contain sperms in 1% cases but that are also very low in quantity than that of semen.Precum helps in lubrication.
OK.

If your sex or masturbation ends with orgasm but without ejaculation possibility of retrograde ejaculation is there.In this semen expels back in to urinary bladder when ejaculation occurs. However this semen comes out in urine later on.

I think I don't reach orgasm during intercourse, as I don't get the same feeling when I ejaculate. Now this begs some important Questions -
1) is night fall(wet dream) possible for a person with retrograde ejaculation?
2) Any remedy for retrograde if that is the case?
3) if at all, is it possible to filter sperms out of urine in that case?

- So do you have orgasm but no ejaculation? or no ejaculation and no orgasm after sex/masturbation?

I think the later is true.

- Anytime do you feel haziness in urine or whitish substance in urine after sex?
I understand your question. No, I don't think I have seen any whitish substance after sex, may be little burning/irritation sense sometimes.

Considering your history of daily sex and foreplay I assume that you do not have any problem with wife as well as any specific stress in your life and you both enjoy the sex.As these are sometime responsible for delayed ejaculation.

You are right.
doctor
Answered by Dr. Chintan Solanki (4 hours later)
Brief Answer:
No symptoms of retrograde ejaculation are there

Detailed Answer:
Hi,

Thanks for clarification.

From your history it seems that there is no retrograde ejaculation.

In some patients with retrograde ejaculation night fall is possible as it is different mechanism of expulsion of semen than that of during sex.

No we cannot separate sperms from urine.

Your problem is likely delayed ejaculation and/or anorgasmia. From your history there are no probably psychological causes of such problem. You should go for testosterone level, thyroid level, urine routine micro examination and semen analysis.
There is also need of routine physical examination, check-up of blood pressure and diabetes.
I hope you can give semen simple. You need to maintain abstinence from sex for at least 4 days before giving sample. This will help.
You should also visit a psychiatrist for couple sex therapy and counselling as it may help in diagnosing the problem.

Hope this answer is helpful.

Feel free to discuss further.

Take care.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Chintan Solanki (2 days later)
Thanks Doctor. I haven't so far tried giving semen in a clinic. Not sure If I would be able to get it out. is there any technique or device (like PVS) help there? i heard PVS(penile vibratory simulator) is known for raising BP? can that be done safer?
doctor
Answered by Dr. Chintan Solanki (1 hour later)
Brief Answer:
other options are there,but try manually first

Detailed Answer:
Hello,

Thanks for follow up.

Apart from masturbation and sex there are options to collect semen for analysis. As you have never tried, do not be nervous. Keep your mind relax and make an attempt, you can succeed.

Penile vibratory stimulation (PVS) and electroejaculation are two other alternatives for men with anejaculation due to spinal cord injury specifically.The penile vibratory stimulator is a plier-like device that is placed around the glans penis to stimulate it by vibration, and provides the first-line method for sperm retrieval in spinal cord injury patients with anejaculation.In your case no spinal cord injury so I would not recommend PVS as first line approach.There are no any major specific side effects have been found in studies.No effects on blood pressure which can cause any harm.

Electroejaculation, which involves electrically stimulating the rectum via electrodes to obtain semen, may be successful in patients who do not respond to or cannot use vibratory stimulation due to autonomic dysreflexia.

Surgical extraction, if for example a blockage in the vas deferens is suspected to impede fertility, semen can be taken directly from the epididymis. Such a collection is called per cutaneous epididymal sperm aspiration (PESA).
Alternatively, the testicular tissue itself, instead of the sperm produced can be investigated. Then, the collecting method is called testicular sperm extraction (TESE).
A Cochrane review found insufficient evidence to recommend any specific surgical sperm retrieval technique for men with azoospermia undergoing intracytoplasmic sperm injection (ICSI).

Hope I have answered your query.
If still any query there, I will be happy to answer.
If not, you can close the discussion and give your feedback which can help me to improve service.

In future you can contact me directly if you wish with this link:
http://bit.ly/drchintansolanki


All the best.
Note: For further guidance on mental health, Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
Answered by
Dr.
Dr. Chintan Solanki

Psychiatrist

Practicing since :2007

Answered : 2406 Questions

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Suggest Treatment For Anorgasmia

Brief Answer: your problem is treatable, need more information from your side Detailed Answer: Hello, Thanks for writing to us. I can understand your concern. Your problem is you are not able to release semen in wife's vagina during sex probably due to longer erection(delayed ejaculation).As you were able to ejaculate once and at night ejaculation occurs there is no problem of retrograde ejaculation. You are recently married since 3 months so no need to worry much.In many newly married couples initially sex problem occurs. You have passed almost 3 months married life(you narrated in other question that you got married in February). I need to know some information to guide you in right direction. - What is your frequency of sex ? - Until now how many times you were able to have successful intercourse(you and your wife both reach to orgasm and your semen ejaculated in her Vagina)? - What happens when your erection stays longer during sex?Do you withdraw your penis or ejaculate outside manually? - Since when night fall problem is there? - Did you have any experience of masturbation in past?Describe some details. - Are you using any medicine for anything currently? - Do you have any problem in urination? - Do you have nay backache or spine problem? From given history in my opinion there is no need of semen analysis at this point and no need of any artificial technique of insemination. Waiting for your reply to help you further. Regards, Dr.Chintan Solanki.