Q: I am 39 and just got married. My problem is that I’m having difficulty ejaculating or reaching an orgasm. I really want to impregnate my wife, but I just cannot. Do you have any suggestions?
Possible Physical Causes
A: Sexual function problems can involve difficulty with erection, failure to maintain it, problems achieving orgasm, or issues with ejaculation. These can arise from several physical or psychological causes. A medical evaluation is essential to identify the root cause.
Difficulty achieving or maintaining an erection may result from problems affecting the nervous system or blood flow. Common medical contributors include diabetes, spinal disk disease, multiple sclerosis, or certain prostate or bowel surgeries. Once diagnosed, your physician might recommend medications such as Viagra or similar PDE5 inhibitors to help maintain erectile function. If you’re unsure about combining medications, see Is Viagra OK with Cholesterol Drug? for safety guidance.
Psychological and Emotional Factors
Sometimes, physical causes are ruled out, and the problem is psychological. If you can achieve orgasm through masturbation but struggle during intercourse, performance anxiety, stress, or relationship dynamics may be contributing factors. In such cases, professional counseling or sex therapy can be highly beneficial. Learning to manage stress and body awareness can help restore natural sexual rhythm—see Improving Man’s Sex Drive for holistic ways to enhance sexual confidence.
When Ejaculation Fails Completely
Failure to ejaculate may suggest retrograde ejaculation, caused by weakness in the bladder neck muscles that normally close during orgasm. When this sphincter doesn’t function properly, semen travels into the bladder instead of exiting through the urethra. While harmless to overall health, it prevents conception. This condition is best treated by collecting sperm from the bladder for use in artificial insemination or IVF with ICSI (intracytoplasmic sperm injection). For detailed discussion, see No Semen Comes Out During Intercourse.
If the underlying issue is neurological—such as spinal cord injury or nerve damage—medical techniques like electroejaculation can retrieve sperm under anesthesia. Alternatively, sperm can be extracted directly from the testicle for use in assisted reproduction.
Additional Expert Resource
For a reliable overview of ejaculatory disorders and treatment approaches, the U.S. National Library of Medicine provides an excellent resource through its NCBI Bookshelf entry on male sexual dysfunction.
Key Takeaways
- Difficulty ejaculating or reaching orgasm may stem from vascular, neurological, or psychological causes.
- Testing for hormonal or nerve issues is recommended before assuming psychological causes.
- Retrograde ejaculation is treatable and doesn’t prevent fatherhood with assisted methods.
- Modern reproductive and psychosexual therapies offer effective solutions for most men.