Doc, Where Did My Orgasm Go?

I really appreciate the candor of my patients. And the trust they imbue. Talking about sex can be a contorted experience for some people, twisting around their own curiosity and comfortability like a teenager on prom night. But so many of my patients are brave and intrepid and they fire away the questions anyway. Thank you for that.

Testosterone is king, or queen, and brings back your libido in ways that many could not even imagine. It sparks, or ignites rather, new fires in relationships. Couples report to me that they go from having sex on a monthly basis to wanting, and engaging, in sex almost daily. It is a stark difference.

Often, when patients experience this “kid in the candy store” phenomena, as I call it, they start gobbling up sex and all its sweetness, day after day, and then reveal that they are having new difficulties with orgasm. This is both women and men who tell me this. It is not gender specific. The no-orgasm cuts both ways.

Why is this happening? Is it some new medical condition that we are just learning about? There is a technical diagnosis called anorgasmia, or the inability to have an orgasm at all. But this is not what my patients generally tell me when they are having difficulties. Is it something to do with testosterone replacement therapy? Is it some other strange cause? Well, no. It is something much simpler and often not very obvious. This is a simple case of over use. You can only shake your money-maker so many times before things start to, well, not shake anymore.

Recently, a married man in his 50s explained to me that, since he and his wife started with the testosterone replacement therapy with me, he was worried that he when having sex he was sometimes having minimal erectile issues or sometimes having trouble achieving orgasm. He never had this issue before starting the therapy. After a long series of questions, where he was dodging me like a pro, I discovered that he went from having sex once a weekly to practically daily. He told me that his wife was literally attacking him right at the door after a long tiring day at work. Obviously it is not the worse problem to have a partner who is very happy and desiring you, but the body has its limits.

It is estimated that you burn about 85-100 calories with a moderate intensity in a single session. And that is the average. I have patients that are expressing to me very plainly that they are nearly hanging from the chandelier with their new-found libido. Additionally,   the ejaculate itself contains nutrients and fluid that the body must produce and then expel. This is more considerable for a man in general, but some women produce and expel a considerable amount of fluid with orgasm and ejaculation.

Sex takes energy, and orgasm is a huge surge of energy expenditure. In boxing, they always recommend to not have sex and an ejaculation prior to a fight. This is because it decreases your motivation and motivation is part of your psychological metabolism and energy. In eastern philosophies such as Traditional Chinese Medicine it is strongly recommended to withhold ejaculation to a limited amount of times per week or month. Over 50, it is about once a week. Ejaculation spends energy and can potentially exhaust you, in excess.

In most cases, patients believe that the sexual encounter should end with an orgasm. I have had many women tell me that they must have an orgasm for their partner to feel satisfied psychologically. In other words, if she does not orgasm then he feels bad about himself. This produces a tremendous amount of pressure on the woman and associates the act of orgasm with stress, which can further cause exhaustion. One option is to see sex being about intimacy and not just orgasm. See sex as an act of connection, a moment to focus yourself to your partner. Communicate and discuss what is mutually important in the entire act of sex. Make it about the journey and not just the destination.

Very often, once a woman has a new found libido from testosterone therapy, she may become the initiator of sex where before she never did. Men often believe that this would be great, and often it is for the man. But many times, the man gets a little sticker shock from his wife’s new found lease on life and has an increasing amount of pressure to perform, which can sometimes lead to erectile dysfunction and inability to achieve orgasm.

The answer really is the simple medical approach of, “Doc, it hurts when I move my arm.” “So stop moving your arm.” In many cases, simple rest is the solution. I have had many patients lessen the frequency of sex and the issue resolves itself naturally. The body is attempting to tell you something when orgasms start to lessen from over use, and you simply need to listen.

Here are a few tips to help navigate your orgasms and sexual health.

  1. Take the pressure off of your partner and yourself. Relax. Communicate.
  2. Again, simply limit the amount of orgasms to no more than once or twice a week.
  3. Practice having sex without having an orgasm. Yes, you can do it! Holding back can be wonderfully intimate. It makes you really “want” your partner and really wanting to get back to bed for the big moment. Have sex for a whole week without orgasm and then let it all go in one explosion of ecstasy!
  4. Keep your energy up with plenty of protein and good fats! Fats helps you recover! My diet suggestions for my patients for optimal general health come from a Traditional Diet, just the way our ancestors ate. This is the way my family and I eat and I encourage you to explore this for yourself. Explore this web page on the Weston A Price Foundation website about the Traditional Fertility Foods at
  5. Bring some spiritual spice into your relationship with some books by David Deida. He brings an eloquent and refreshing perspective on male and female dynamics both in and out of the bedroom.  Another great series of books focused on teaching you how to cultivate your own sexual energies are The Multi-Orgasmic Man, The Multi-Orgasmic Woman, and The Multi-Orgasmic Couple, all available on Amazon!

As a final note, it is very possible to have the condition called anorgasmia, which I mentioned earlier. This would be the condition of never, or almost never, being able to achieve orgasm. If you think this is more of the case, then please let me know.

Yours In Health,

Dr John A Robinson


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