Q. When I am fortunate enough to have an orgasm, very little ejaculate comes out. The problem is that after an orgasm, the ejaculate oozes out over the next five to 10 minutes. Without the discharge of semen, this reduces the intensity of the orgasm as well. I know that jumping up and urinating will solve most of the problem, but on occasion it will continue to ooze even after urination (though not in the same quantity). Can you offer any advice?

A. I have only seen one patient with the problem of orgasm without ejaculation (squirting of semen), followed by a slow release of semen. In that case, the man had a blockage, called a stricture, in the urethra (the tube in the penis that carries urine and semen out of the body). The semen was released, but it couldn’t get out of the penis during orgasm. Instead, it would slowly drip out afterward.

Such a stricture may also cause difficulty in urinating. The stream would be weak and may require straining to get started. In addition, my patient had urinary frequency (the need to urinate often) and a lot of dribbling.

Diagnosis of a stricture can be made either with an X-ray exam called a urethrogram or with a cystoscopy. The urethrogram consists of putting a tube in the opening in the tip of the penis and slowly filling the urethra up with a special fluid while taking X-rays of the penis. Cystoscopy involves putting a miniature viewing device into the opening and advancing it up the urethra looking for the blockage. If this is done in the operating room, then once the blockage is found it can be treated at the same time.

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