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Q. My husband does not have a problem getting an erection, nor does he lack desire to have sex, but he almost never ejaculates. Is it possible for a man to feel satisfied by intercourse even though he does not ejaculate? I know he used to be able to ejaculate if he masturbated but cannot now. Can you help me out here? I enjoy sex and want to make sure he does too.

A. It's important to recognize the full extent of the male sexual response. The arousal phase marked by erection also includes other physiological changes including increase in heart rate and blood pressure, rate of breathing, flushing of the skin, increase in muscle tension, nasal congestion as the "erectile tissue" of the nasal cavity become engorged, lubrication of the urethra (producing a sticky discharge from the end of the penis), and a shifting of blood to the pelvic area. As orgasm approaches, all of these changes increase until the orgasmic release occurs.

Orgasm is most obviously signaled by ejaculation, the forceful emission of seminal fluid from the penis. This produces only a part of the pleasurable sensation of the orgasm. The contractions of the vas deferens and outer leg muscles in a rhythmic cycle; the intense muscular contraction of large muscle groups such as the buttocks, thighs, and abdomen; sweating, a respiratory response; and the relaxation that follows all contribute to the intense pleasure of orgasm. These may occur to varying degrees during a particular sexual experience.

Consequently, a man may have a satisfying experience without ejaculation. If the other aspects of arousal and orgasm are present, there may be no cause for concern. One explanation for this may be that he is having "retrograde" ejaculations. In this condition the seminal fluid is directed back up the urethra into the bladder rather than externally out of the penis. This is not a dangerous pattern, and a urological evaluation can identify whether this is the case.

It is also possible for ejaculation to be inhibited by psychological factors (such as fear of pregnancy or guilt over sexuality), physical factors (such as fatigue or alcohol use), or as side effects from some medications (such as tranquilizers and antidepressants).

From your question, we assume that you and your husband enjoy your sexual relationship and have not suffered from the lack of his ejaculatory response. Since many women find the "mess" of ejaculation to be a problem, you may have had an unusual blessing to celebrate. If your husband has in fact been frustrated or disappointed, a urologist should be able to identify the cause and reassure both of you that there is no serious reason for alarm.

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