Delayed or absent orgasms and ejaculation

Sexual difficulties, including difficulty reaching orgasm, are relatively common in men with MS. Sexual issues often result from a complex interaction of physical, social, psychological and emotional factors.

You may find it awkward or embarrassing to talk about sex, but there is support available. The key to managing sexual issues is your willingness to discuss any problems.

What are delayed or absent orgasms and ejaculation?

Orgasms and ejaculation usually happen at the sexual climax. Orgasm causes the muscles around your genitals to contract, and is often accompanied by feelings of pleasure or euphoria. Ejaculation is the emission of semen from your penis in a series of muscular contractions or spurts.

Although ejaculation and orgasm usually occur at the same time, they are separate processes. The occurrence of one without the other tends to result in a less satisfying sexual experience.

Despite being able to achieve and maintain an erection, experiencing sexual desire and being stimulated, you may find that it's difficult or impossible to reach a climax.  Alternatively you may find that although you can still reach climax, your orgasms don't feel as intense as before.

What causes delayed or absent orgasms and ejaculation?

There are a number of possible causes for difficulties with reaching orgasm and ejaculating.

  • MS nerve damage - multiple sclerosis can interrupt or block nerve messages in the spinal cord, making ejaculation more difficult.
  • Other MS symptoms - reduced concentrationpainnumbness or fatigue can make it more difficult to reach the level of stimulation you need to orgasm and ejaculate. Being anxious about losing control of your bowels or triggering a spasm during sex might also distract you.
  • Emotional or psychological issues - psychological issues can also cause delayed ejaculation. These concerns might relate to MS and its effect on your confidence or self-image, though other unrelated worries can also be to blame. Anxiety about your performance and focusing on orgasm as the ultimate end result of sexual activity can have a negative effect - particularly if you've had difficulties reaching climax in the past.
  • Causes unrelated to MS - problems with orgasm and ejaculation are very common in the general population, so the cause of symptoms may be totally unrelated to your MS. Factors that can affect sexual response include lifestyle factors - such as drinking too much alcohol, taking drugs, being overweight or smoking - and other medical conditions, including heart disease, diabetes, high blood pressure or kidney problems

How many people have absent orgasms and ejaculation?

Difficulties with orgasm and ejaculation are common in the general population with as many as one in three men affected at some point in their life, with the most common problem being premature ejaculation. For men with MS it's more usual to experience difficulties with reaching climax, even if your ability to achieve and maintain an erection is unaffected. Research suggests that between a quarter and half of all men with MS will experience difficulty reaching orgasm or ejaculation.

What can I do if I have absent orgasms and ejaculation?

The most important starting point for managing sexual issues is a willingness to talk about them. Read more about talking about sexual problems.

Management involves trying to find other ways to approach sex and intimacy.

  • Seeing sex as a pleasurable, sensual experience rather than solely focusing on penetration and orgasm can reduce your anxiety about performance.
  • Some men find it easier to reach orgasm through masturbation, whether by themselves or with a partner. If there is numbness or reduced sensation in the penis, masturbation can allow you more control over sensation, tightness and speed than intercourse does.
  • Some people find that sex toys and vibrators are helpful as they can intensify sensual feelings and may be enough to help you reach orgasm.
  • Some men find anal stimulation helps them to reach orgasm, although others may find this painful or just don't like the idea of it.
  • If MS symptoms or other health or psychological issues are affecting your sexual performance, finding the right treatment for these may make it easier to achieve orgasm and ejaculation

There are no medications licensed in the UK for ejaculation difficulties.

Zorzon M, et al.
Sexual dysfunction in multiple sclerosis: a case-control study. I. Frequency and comparison of groups.
Multiple Sclerosis 1999;5(6):418-427.
Summary (link is external)
Lew-Starowicz M, Rola R.
Sexual dysfunctions and sexual quality of life in men with multiple sclerosis.
Journal of Sexual Medicine 2014;11(5):1294-1301.
Summary (link is external)
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