Figure 1 How climax is stimulated
Ejaculation and orgasm can be sticky topics. There is much that we know, but much that we don’t. From wet dreams to hand creams, the triggers for orgasm and ejaculation in the male are varied and often mysterious. Newsstands are filled with magazines touting the latest and greatest orgasm technique for women, but rarely is any attention given to what makes men tick-tick-tick-boom. This chapter explains how come men come and why they come too soon, too late, or not at all.
When it comes to coming, two heads are better than one. The little head (between your legs) and the big head (on your shoulders) both generate key signals that jump from nerve to nerve, zipping along to meet in a specialized part of your lower spine known as the “spinal ejaculation center.” The spinal ejaculation center, as you might suspect, is what pulls the trigger to fire off the big guns. It’s like a launch key because only a very specific combination of signals can activate it successfully. Here’s what has to happen.
From the penis, sensations of touch, pressure, and vibration enter their “launch sequence”; this is compared with sequences generated by the rest of the sense organs sending information to the big head. Sight is one of the most important senses for arousing a man. Erotic images are not the same for all guys, either. From a close-up view of pulsating genitals to a chance glance at the nape of your partner’s neck, the visual cue that sets you off can be uniquely your own. Simultaneously, other sensory stimulation is flooding in: lusty, musty erotic smells (is that latex?), erotic touches (light brushes, deep massage, or perhaps a spanking), erotic sounds (breathing, moaning, or dirty talk), and erotic tastes (salty skin, wet lips, or perhaps some drizzled honey). But that’s just five simple senses. Add to the mix the fantasies, thoughts, and memories all bouncing around the cerebral cortex, making all kinds of interesting connections.1, 2
A deep part of the brain that functions without our conscious thought releases sex hormones and other specialized chemicals that are also a part of the launch sequence.
The hypothalamus and pituitary gland are deep-brain parts sitting below the cerebral cortex, near the center of the brain. If you rammed a pencil up your nose, you could hit them. They release hormones into the bloodstream that trigger the testicles to produce both sperm and testosterone. Testosterone circulates back to the brain, where it stokes the fire of sexual desire. It makes things look, smell, taste, feel, and sound sexier! It also triggers sexual thoughts and fantasies. This deep-brain center also releases a wonderful hormone called oxytocin. It’s often referred to as the “love drug.” Oxytocin makes people want to cuddle and bond. It reinforces positive feelings in the brain and it directly triggers the spinal ejaculation center. A third trigger from this brain center is dopamine. The more dopamine, the faster you recover after an ejaculation and can go for seconds or thirds (ah, youth!).
So all these signals and chemicals and hormones are promoting ejaculation. No wonder it can come on fast! But there is a part of the brain that puts on the brakes, and it sits at the very base of the brain, or its “stem,” just before it connects to the spine. This area, called the medulla, is so critical and so fundamental that it controls breathing and circulation and, interestingly, ejaculation. This is where serotonin gets released. Like oxytocin, serotonin makes you feel good, but in a different way. Unlike oxytocin, it blocks the spinal ejaculation center. Many antidepressants work by increasing the serotonin in your brain, which makes you feel happier but can have the side effect of interfering with sexual climax. 3, 4
Other shutdown signals include distracting stimulations or thoughts. For most people, once the train has left the station, it usually stays on track, but performance anxiety about reaching a climax can oversensitize the brain to distractions. An unexpected noise or an unwelcome smell may derail your speeding locomotive of love. An intrusive thought, perhaps about work, can pop up and turn the sizzle to fizzle. However, there is a point of no return that scientists call “ejaculatory inevitability.”5 At this point the sympathetic nerves running down the spine into the pelvis, take over and release adrenaline which is what actually “cleans the pipes.”
Figure 1 How climax is stimulated
Figure 2 Deep brain control of testosterone
Let’s get an up-close look at what happens during ejaculation (you might want to put on some safety goggles).
Semen, the elixir of life, is a cocktail made from a shot of sperm and two mixers. At only a fraction of the size of a red blood cell, sperm has only one purpose—to inject your DNA into an egg. Now, the little guys may not always get to serve that purpose, but they don’t have to know. Let them dream. Sperm is only about 10 percent or less of the volume of semen. Most of the fluid is actually from other glands next to the urethra called the seminal vesicles and the prostate. This combination of fluids is essential for the sperm on race day.6
Preparations for the big race actually start a couple of months beforehand, back in the testicles. The testicles are firm and smooth on the outside but soft and squishy on the inside, where they are filled with tiny tubes that act like miniature conveyer belts where sperm are assembled. The tubes are more than three football fields long if stretched out end to end. (I don’t recommend trying it—just take my word for it.) The freshly minted sperm move out of the testicle and into the “swimming camp” known as the epididymis. It’s a big class at 375 million new sperm a day. Camp Epididymis is a tightly coiled tube, like a silly straw. You can feel the epididymis through the scrotum. It feels like a lumpy, bumpy ridge on the back of the testicle. It’s a structure that many guys mistake for a cancer when they notice it for the first time. The sperm will take about 2 weeks to make it all the way through, transforming from couch potatoes to Olympians as a series of chemical reactions activates their tiny tails.
Once they learn to swim, the sperm emerge into the high-speed rail line of the vas deferens. The vas deferens is where the tube that was the epididymis gets a lot wider in diameter and becomes surrounded by dense muscle fibers. You can feel the vas deferens through the scrotum. It feels like a thick strand of al dente spaghetti. There can be a lot of long, squishy-feeling things in the scrotum but the vas deferens is distinctly firm and straight. The vas deferens has the most muscle for its size of any structure in the body. Instead of pumping iron, the vas deferens is pumping sperm. Those dense muscles surround and squeeze the tube in rapid waves to propel the sperm all the way up to the base of the urethra, where they enter through a small passage called the ejaculatory duct.7 (When the vas deferens is blocked by a vasectomy, the volume of ejaculation is only slightly less.) Also attached to this passageway are the seminal vesicles, small sacklike glands (vesicle is Latin for “sack”) under the bladder, next to the prostate. They make a yellowish fluid chock-full of power-ups for the sperm. These include amino acids, citrate, phosphorus, potassium, enzymes, flavins, phosphorylcholine, prostaglandins, proteins, vitamin C, and fructose. This Powerade accounts for about 70 percent of the volume of semen.8,9
The third ingredient of the semen cocktail comes from the prostate. The prostate is a walnut-sized gland that surrounds the urethra (the urine passageway of the penis), right outside the bladder. It’s like a thick tunnel. It is situated about midway between the anus and the back of the scrotum. It can be felt through the rectum. It’s a tough place to reach so it’s usually the doctor that checks it out during a rectal exam. This isn’t a lot of fun, but in the context of sex it can be quite the opposite. The prostate has been hailed as the male G-spot. It can be stimulated through the rectum or through deep pressure on the skin of the perineum, also known as the “taint” (‘tain’t the balls and ’tain’t the ass). The prostate produces watery whitish fluids that are dumped right into the urethra to join the sperm as well. The prostate secretion contains specialized ingredients that transform the semen from liquid to solid to liquid again. Acid phosphatase, citric acid, fibrinolysin, prostate-specific antigen, proteolytic enzymes, and zinc set off a cascade of reactions that cause the semen mixture to clump after it is spurted. This is a really amazing feature of semen, because by becoming gooey like snot, it won’t just run right out of the vagina when the woman stands up so it prevents the sperm from sliding out. About 15 to 30 minutes later, an even more amazing thing happens. The prostate fluid enzymes then cause the semen to liquefy once again so that the sperm, now closer to the egg, can once again swim free to the finish line.10,11
If semen is a cocktail, the maraschino cherry is the clear, sticky droplet that is secreted ahead of the ejaculation. It comes from the small sacks that dump into the urethra just past the prostate, right at the base of the penis. This secretion mixes with mucus from small ducts along the urethra of the penis known as Littre glands. This fluid is often referred to as “pre-cum.” I like to call it the scouting party. It probably provides a little lubrication.
The mixing of the semen cocktail in the urethra is called “emission.” It happens moments before the actual spurt of fluid out of the tip of the penis, and even though all three structures—seminal vesicles, vas deferens, and prostate—are squeezing their contents into the urethra, this is not why the semen spurts out of the tip of the penis. Rather, emission just gets the fluids into the base of the urethra for the next leg of the race—ejaculation. Okay, now it’s time to grab that hand towel. Here we go. There are muscles at the base of the penis that surround and squeeze the urethra to pump out the semen. These muscles are called the bulbospongiosus and the ischiocavernosus muscles, and they are triggered to squeeze and release, squeeze and release at a rate of a little less than once a second for only a few contractions. These contractions are what most men associate with a primary source of pleasure during orgasm. At the exact same time that these muscles are pumping the urethra, the bladder closes shut so the semen won’t be pumped the wrong way into the bladder but rather shoot out the urethra. This is why sometimes it can be hard to pee right after sex. The testicles also get pulled up high and tight as if in “sport suspension” mode, and occasionally it can be uncomfortable.12
As men pass the threshold of middle age, their pelvic floor muscles become weaker and less semen is ejaculated with less force—even down to none at all. Also, the seminal vesicles tend to empty less completely and may become partially blocked by the prostate gland as it enlarges. These are normal consequences of getting older.
Even in younger men, the force and volume of ejaculation are variable and depend on a few factors. General health, hydration, pelvic floor strength, hormone balance, and level of arousal all play a factor, but there is a natural variation from one man to another. Whether you are an Uzi or an oozer, the critical issue is getting the semen into the vagina—this is called “intromission,” not to be confused with “intermission,” which happens in my house when the kids come barging into the bedroom. Although the money shot so commonly depicted in pornography involves high-volume, high-pressure “glazing,” the pleasure of climax is typically not associated with the volume, force, or trajectory of ejaculation. Furthermore, there really is no way to directly control ejaculation as it is happening since it is a reflex. If you have both pleasure and a wet spot when you want it, don’t look a gift penis in the mouth. There are several conditions where this is not the case. For many it happens all too soon, for others it may not happen soon enough, or there may be pleasure but no ejaculation or ejaculation with no pleasure. Fortunately for most of us, ejaculation and orgasm go hand in hand, or penis in hand as is often the case, reminding us just how great it can be to be alive!
Figure 3 The pathway of semen
Figure 4 Pelvic muscles around the penis
By now, unless you have been living under a rock, you know that a lot of men suffer from erectile dysfunction. You’ve seen the ads on TV. But a whole lot more men actually suffer from another sexual ailment that’s not advertised on TV, and that’s rapid or “premature” ejaculation. Premature ejaculation is reaching a climax and ejaculating before you or your partner desire it, typically within just a minute or two of starting. It’s a widespread ailment that some men are born with and some men develop later on. It can be as infuriating as erectile dysfunction and in many cases it happens because of erectile dysfunction. The reason it happens is complex and can be physical, behavioral, or a combination.
In many cases a man’s spinal ejaculation center is simply wired for speed. Maybe in primitive times, when saber-toothed tigers roamed the land, ejaculating quickly allowed us to get in and get out before we got eaten. But these days sex isn’t just a matter of survival. So what’s a caveman to do? Well, fortunately there are several remedies ranging from behavioral “sexercises” that reset the nervous system to topical sprays that reduce oversensitivity of the penis to pills that work at the level of the brain and spine.
How fast is too fast? Studies indicate that the average duration of intercourse is about 5½ minutes.13 In case you were wondering, these studies are done with stopwatches held by the partner—now that’s what I call performance pressure. If sex is over in under 2 minutes and it bothers the couple, that’s too fast. This condition affects almost 1 in 4 men.14 Most men with lifelong premature ejaculation come within 1 minute or less. These guys may have an underactive response to the secretion of serotonin, which is the main chemical that puts the brakes on the spinal ejaculation center.15, 16
Some men become premature ejaculators later in life in order to finish before they lose their erections. Treatment of the erection problem can fix both problems. Anxiety itself can cause a guy to fire off too fast. Anxiety causes you to release adrenaline and noradrenaline, the very same chemicals that stimulate your seminal vesicles, prostate, and vas deferens to squeeze their parts of the semen into the base of the urethra. This sensation of squeezing and the pressure of semen building up in the urethra then can trigger the reflex to ejaculate. Guys with high levels of anxiety may improve with stress management techniques including meditation. An overactive thyroid mimics anxiety and this can also occasionally aggravate premature ejaculation.
Premature ejaculation may be improved with special exercises and techniques. The pelvic muscles that squeeze the base of the penis and urethra during ejaculation can be trained with Kegel exercises. A Kegel squeeze is simply clenching the muscles around your anus and urethra that you would clench when you are trying to stop yourself from urinating or defecating. But instead of waiting for that emergency, you do the squeeze on purpose and repeatedly. You may do bursts of quick squeezes in succession and you may do longer holds with more time in between. The more you work those muscles, the more in touch you may be with the sensations of impending ejaculation as those same muscles are being triggered. Getting an earlier warning may enable you to relax and bring yourself back from the brink. In a study with not only Kegel exercises but a pelvic physical therapist providing electrical stimulation to the area to squeeze the muscles directly, more than 80 percent of men were able to triple how long they could last, from an average of 39 seconds to an average of 146 seconds, and the results lasted long term.17
A very effective sexercise that can allow you to reset your reflex to take longer before you reach the point of no return is known as “stop-start.”18 The way this works is you or you and a partner stimulate your penis, make it hard, and get yourself close to coming but just before you reach that threshold you stop, cool down, and then try again. Over time you learn to last longer and longer and eventually graduate from the hand to the real thing. Here again, you practice going longer and longer, withdrawing just before the point of no return. It takes patience, understanding, and some degree of self-control. In some modifications of this technique you or your partner squeezes the head of the penis firmly to cause enough of a distracting sensation to bring you down from the precipice of climax before you go over the edge.19 If you are willing to stick it out (and in and out again), these techniques can be very helpful.
Not everyone has the patience or the partner for behavioral techniques, and even if they do, they don’t work for everyone. Medications can also be very effective. There are a few different options. The safest medications are sprays that are applied to the skin of the penis. These medications work by simply reducing the sensitivity of the nerves of the penis so less intense nerve signals are sent to trigger the spinal ejaculation center. There are many sprays available and they mostly use a nerve blocker like lidocaine. The goal with the sprays is not to make your penis numb—that’s no fun—but to take the sensitivity down a notch. But the skin does not absorb medication very well, so some formulas add ingredients that may improve the absorption of the lidocaine. Promescent is an FDA-approved formula that combines other ingredients that improve skin absorption. The more you spray on the penis, the more the effect. After 10 minutes you can wipe it off and you are ready to go. There is virtually no numbing effect on your partner. It’s available online without a prescription (Promescent.com) but often available over the counter in pharmacies or through urology offices.
There are also prescription medications for premature ejaculation. The most commonly prescribed and probably the most effective are actually antidepressants that boost serotonin levels in the brain, known as SSRIs (selective serotonin reuptake inhibitors). It’s not because guys with premature ejaculation are depressed, although it can be a depressing condition, but rather because serotonin suppresses the spinal ejaculation center. The common drugs in this class include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil). They are prescribed at low doses just to harness the side effect. They must be taken daily because they don’t work very well as an “on demand” pill the way medications like Viagra do for erections. The most common side effects include drowsiness but this usually stops within 2 weeks, which is about how long they take to start working. The medication may also interact with some other medications so it’s important to take it under a doctor’s supervision.
The FDA considered and rejected an SSRI named dapoxetine that was more effective for single-dose treatment. Dapoxetine is approved for use in Europe. Another single-dose medication that may boost serotonin is tramadol (Ultram). Tramadol is normally used as a prescription painkiller and is not as addictive as most. It’s not as effective head to head as Paxil but for many men, it’s good enough and it avoids the need to take a pill daily. Side effects include nausea and drowsiness and interactions with other medications.
For some guys, none of the techniques or medications can slow down the inevitable. In these cases, there is still a work-around. If we can’t help you hold back, we can still help you hold up. Normally, after an ejaculation, the erection goes down. This is because the adrenaline release that squeezes out your man juice also squeezes closed the blood vessels that pump up the penis. This is well and good if both parties are ready to call it quits and cuddle. When you are young, you tend to be able to “reload” relatively quickly, and the next time around you may last longer. But as you get older, the reload time, known as the refractory period, gets longer and longer, and then it’s too long for second chances. Prescription penis injections that contain prostaglandin can stimulate an erection so strongly that they can counteract the adrenaline rush and keep the penis pumped even after ejaculation so even when the big head is done, the little head can keep going. Pills like Viagra or Cialis, although not as strong as injections, may allow you a shorter refractory period and a second chance after all.
Everyone likes a happy ending, but not everyone gets one. Many men have difficulty reaching sexual climax. It’s like driving and driving but never arriving. It’s more common in older men because men lose nerve sensitivity in their penis with age. Men on certain antidepressants may suffer this side effect. Hormone imbalances including low testosterone can play a role. Pornography as well as certain idiosyncratic masturbation techniques can interfere with fully enjoying partnered sex. Although this ailment is less well understood, behavioral therapy and certain medications may help.
As men get older, nerve endings gradually disappear and it can take more stimulation to get an erection as well as to reach a climax. It’s important for them to understand that this is a normal change so they can reassure their partners that they are not to blame. Furthermore, many men accumulate other medical conditions that add up and take their toll.20
So who was it that said the golden years were golden? But you can still strike oil if you pay more attention to the remaining nerves. Sometimes more foreplay and more stimulation will get you where you need to go. Women are not the only ones who can enjoy vibrators. A vibrator applied to the head of the penis, especially the underside, in the area known as the frenulum, can help men with decreased sensitivity reach climax more successfully. One technique is to place a vibrator on the underside of the head of the penis for 1 minute on and 1 minute off three times in a row, then attempt intercourse with a more “amped-up” penis.21 There are now vibrators custom made for men that enclose the head of the penis and vibrate both the top and the underside. Kegel exercises may help a guy ejaculate with more strength and possibly more volume. Even though the ejaculation is a reflex that you don’t consciously control, the better tone those muscles have, the more they may be able to spring into action.
Sad to say, but one of the most common causes of delayed ejaculation is the use of antidepressants that work by increasing serotonin levels. For some men, the treatment may seem worse than the disease, but for most men with depression, antidepressants are critical to leading a more normal life. Some antidepressants have less of this effect than others, and changing prescriptions may be the solution in some cases.
The brain chemical dopamine stimulates the spinal ejaculation center. The pituitary gland releases a small amount of prolactin to bring a natural end to an orgasm. Medications used to treat psychiatric disorders often interfere with climax and ejaculation because they can lower dopamine and boost prolactin too much. Risperidone, clozapine, and olanzapine are on the short list of culprits. Quetiapine doesn’t boost prolactin as much and may have less of this side effect.22 Rarely, a man may have a tumor in his pituitary gland that overproduces prolactin. If the tumor is big, it has to be removed surgically. Prescription medications such as bromocriptine and cabergoline can lower the prolactin level and treat smaller tumors.23
Most men who have difficulty reaching climax have normal levels of prolactin, and even in these cases a prescription of cabergoline can be helpful. These men may be more sensitive to prolactin so reducing even normal levels may allow them to “break through.”24 Low testosterone and low thyroid can also be hidden causes of delayed orgasm. Testosterone raises the desire level in the brain and so increases the turn-on signal to the spine. It also helps stimulate the production of semen. The thyroid gland is a “master controller” and affects overall body metabolism. If the thyroid hormones are low, the whole body can be working in slow motion. Both low testosterone and low thyroid levels can be easily corrected by supplementing them, but in many cases there still will be more to the underlying problem.
Men who have never been able to ejaculate with intercourse often are affected by some sort of psychological or behavioral barrier. For some it’s an exaggerated sense of guilt or religious prohibition. It’s hard to ejaculate when “God is watching.” These men may not masturbate either, or may feel very conflicted during masturbation. Other affected men may masturbate in a way that is so specific and so intense in speed and pressure that an actual partner could never provide similar stimulation. I had one patient who could only ejaculate if he laid facedown on a wooden floor while thrusting rapidly. Studies find that men who masturbate very frequently are at higher risk of developing this difficulty, effectively stroking themselves into a corner. There are men, however, who simply prefer masturbation over sex with a partner. Behavioral psychologists who specialize in sexual issues are often able to help improve these situations so a guy can stop playing Solitaire and start playing Hearts.
Pornography has also played a significant role. The explosion of pornography since online streaming became available has coincided with a significant spike in erectile dysfunction and difficulty reaching climax. This is discussed in greater detail in Chapter 6. Also, the advent of pills like Viagra and Cialis has allowed men to have erections even though they may not be fully “into it.” With the drug stimulating bloodflow to the penis, they can still get a rock-hard erection, but in the end there isn’t enough stimulation in the big head to finish things off.
Orgasm and ejaculation do not always come together. If the sympathetic nerves that release adrenaline are damaged from surgery or disease, a man will not be able to ejaculate, but if the sensory nerves in his skin are not damaged, he can still experience a sexual climax. On the other hand, if the nerves that provide sensation can send signals from the penis to the spinal ejaculation center but not to the brain, they can trigger a reflex ejaculation without a feeling of climax.
Diabetes and multiple sclerosis can injure the sympathetic nerves and prevent ejaculation. Surgery to remove cancer in the pelvis can too. A guy with such a problem will notice that he can have an orgasm but no semen comes out. This may be due to “retrograde,” or backward, ejaculation, where the bladder is not closing properly. It may also be due to the vas deferens, seminal vesicles, and prostate not squeezing their semen fluids. Sometimes ejaculation returns with better sugar control. Medications that boost the adrenaline signal may improve ejaculation. The over-the-counter Sudafed brand cold remedy contains pseudoephedrine, which acts like adrenaline. Taking a double dose (120 milligrams) of Sudafed a couple hours before sex may allow ejaculation. It may work better if it’s taken every 8 hours for two or three doses to really amp up the system, but over time it actually loses its effect just as it does when used to treat nasal congestion. Midodrine is a prescription medication that works like Sudafed; it is most effective in men who have multiple sclerosis (MS).25
Other men cannot ejaculate because of surgery that removes the semen-producing structures, such as prostate cancer surgery. In either case, the man can still have an orgasm, and a normal one at that—just no wet spot. If a man has one or even both of his testicles removed, he still can have a normal orgasm and he still will ejaculate fluid from the other structures as long as his testosterone is normal or boosted to stay normal. This is true for men who have had vasectomies as well. None of these surgeries affects the sensation of the penis and all the other pleasure centers of the spine and brain that come into play.
Men who suffer injury to their spine lose sensation from their penis, as the nerves carrying the signal up the spine are interrupted by the injury. Furthermore, the eyes, ears, nose, and thoughts and fantasies in the brain cannot send stimulating signals down the spine past the injury. Even so, if the injury is above the level of the spinal ejaculation center, then an ejaculation can still happen due to a powerful reflex between the penis and the spine. The ejaculation center is in the spine just below the 10th vertebra. Any injury above this level keeps the reflex intact. The man won’t feel any sensation from his penis and he won’t experience an orgasm, but if his penis is stimulated enough he can have an erection and even ejaculate. The stimulation to cause an ejaculation has to be a lot stronger than what’s required to cause an erection, and this usually requires the use of a specialized vibrator that vibrates much more intensely than a regular vibrator—so strongly in fact that it would hurt a guy with normal sensation. This is used mainly for fertility purposes so that semen can be obtained for insemination (the turkey baster method). If an injury is below the spinal ejaculation center, then it cuts off the signals from the penis to the brain and once again there is no sensation and no orgasm, but it also cuts off the signal from the spine to the semen-producing structures and no ejaculation can occur no matter how much the penis is stimulated. Men with lower spine injuries can still father children by electrically stimulating the nerves to the semen-producing structures with a specialized probe that is placed in the rectum. No semen shoots out, but it does accumulate in the urethra, where it can be milked out and then used for insemination. This same technique can be used on a man who has had surgery that injured the nerves between the spine and the semen-producing structures.
Sometimes the problem is a blockage. This may be due to a cyst in the prostate that arises from birth and simply expands and squeezes shut the ejaculatory duct where sperm and other fluids all enter into the urethra to make semen. Sometimes a stone can grow right in that duct passageway and block off the fluids. A severe infection of the prostate can inflame and then scar closed the duct. The prostate fluid can still get through other ducts, so a man with an obstruction may still ejaculate a small amount. In some cases the blockage is painful, but in most cases it is not, and orgasm feels just as pleasurable. Sometimes surgery can fix these blockages, but if there is no pain, the side effects of surgery, which can include chronic infections or inflammation of the prostate or testicles, may not be worth it. A person can also be born without vas deferens or seminal vesicles. This is always the case in men with cystic fibrosis, which is due to genetic mutations that cause a chronic disease of the lungs and pancreas. Sometimes the gene mutations are less severe and only affect the vas deferens and seminal vesicle but not the lungs or pancreas.
For men who are trying to father a child but who have blockages that prevent semen or sperm from coming out, there is a work-around. Sperm can be taken directly out of the testicle with a minor procedure, and that sperm can be injected directly into eggs that are taken directly out of the woman’s ovary. The fertilized egg becomes an embryo, which is placed back in the woman’s uterus to make her pregnant. The sperm taken out of the testicle cannot be put into the woman’s uterus the way semen can because the sperm won’t function without all the other enzymes and proteins that are in normal semen.
Orgasm and ejaculation are hard to beat. They can be as natural as breathing or just about impossible. Understanding the how and why and taking care of your body and mind will help you to enjoy this gift as long as you desire.