Dear Doc | I'm a male, why can't I have an orgasm?

Q Doc, I am a 25-year-old male, and I have been having sex since the age of 14 or 15. I am now single and gainfully employed. However, I have a severe challenge. During all my years of having sex with these women, I have never had an orgasm. I am extremely confused and worried. Doc, what could possibly be the cause of this? I used to masturbate and I orgasmed perfectly then. I also still have wet dreams at my age - is that normal? My dreams comprise of both males and females, does this make me gay? During these dreams, I climax normally as I wake up to find my boxers or my bed wet.

I recently had sex, and I was so embarrassed when she asked me if had orgasmed. I lied and said yes. We used a condom and I hid it from her after. Do you think my inability to have an orgasm is some kind of psychological problem?

A Good day to you. Please be aware that the age of consent for sex in Jamaica is 16 years. The fact that you are able to experience an orgasm, and ejaculate from masturbation, suggests that your problem may be psychological rather than physical - fear of getting your partner pregnant, low self-esteem, and ambivalence re your sexual orientation are contributing factors. Having a discussion with a psychologist may help you. Wet dreams can occur at any age but are more common in the adolescent years.

Q I am 26 years old and I got circumcised on October 24. So far it seems to be healing well. I no longer feel any discomfort, but the problem is I don't like the way my penis looks. It seems like there is some skin there that has not gone back in place. I'm not sure how to explain it, but where the foreskin used to be, some of the flesh looks like a bump. Could you please tell me if this is normal? Or will it look better over time?

A Thank you for your question. This issue is fairly common, especially when the procedure is done as an adult. Having lived many years with the foreskin, many men are uncomfortable with the 'new look'. It takes time to become adjusted to. Provided you do not have keloid skin, the area should look better as time goes by. Perhaps you should pay your surgeon a follow up visit, and voice your concerns. He/she will examine you to determine whether further intervention is necessary.

Q I have a friend who is 19 years old. One day he came by my workplace, and while he was there, he started to shake. It was so hard and I was very scared. He was admitted to the hospital. Now that he is out, he has told me that he was born with it; the nerve is taking over his body. Doc, can you tell me if this is something that can be cured?

A Based on your brief description, the possibilities include the following:

- essential tremor

- seizure disorder

- autoimmune/demyelinating diseases such as multiple sclerosis.

Essential tremor can cause shaking all over the body, but it usually occurs in the hands and head. It is most commonly manifested in middle age, but can occur from birth. The exact cause is unknown, but there is a strong genetic component involved. At present there is no known cure, but moderate to severe cases can be managed with medication such as tranquilisers and anticonvulsants.

Classic seizure disorders may develop after brain/untreated ear infections during infancy/childhood and birth trauma during delivery. Still, almost 60 per cent of seizures are of unknown causes, and are possibly due to genetic abnormalities. These also currently have no cure, but can be controlled with medication. Hospitalisation may be required for frequent relapses.

The autoimmune/demyelinating group is characterised by destruction of the nerves by chemicals (antibodies) in the blood. Seizures (shaking) can occur depending on the part of the brain involved, and the level of nerve damage.This condition gets worse over time.There is no cure, but medication is used to control the symptoms, and the inflammation associated with it.

Despite the fact that no cure is currently available for the above-mentioned conditions, there are some triggers which must be avoided. These include:

- loud noise

- flickering lights

- caffeine

- excessive alcohol consumption

- fatigue

- stress

Your friend should be monitored by a neurologist (brain and nerve specialist) on a regular basis, so be a friend and ensure that he keeps his appointments.

Q In relation to your article published on November 26, titled 'Why can't I get pregnant', I can relate to your writer. I was married for five years before we decided to try to get pregnant, even with the thought of having PCOS for years. So at age 30 I decided to start preparing to conceive. I was on the Diane 35, and we went and spoke with our gynaecologist. I was asked to do an ultrasound, which showed that I have some small cysts on my ovaries. I wasn't too worried since I really believed that I could get pregnant. We tried for a month and nothing happened, then I was placed on Clomid, and after two months I was pregnant. As you told your reader, she must ensure that she loses some weight, and she needs to have a positive outlook - it can happen. My child is now 17 months old, and we are enjoying life. She can too.

A Thank you for those kind words. I am sure they will provide encouragement for women with similar challenges. Your feedback is appreciated. Clomid (clomiphene) is a 'fertility' drug used to stimulate ovulation. Many gynaecologists use it and it works in many cases, especially if the other factors, such as weight loss and a balanced diet, are addressed.

Email: deardoc@gleanerjm.com