The male orgasm explained

A man's orgasm draws on the brain, the nerves of the pelvis, hormones, the prostate and seminal vesicles, and the pelvic muscles. This guide covers what happens during orgasm and ejaculation, the refractory period, and the orgasm problems worth taking to a GP, using the NHS, the European Association of Urology (EAU) and published research.

What is an orgasm, and what does it feel like?

An orgasm is the peak of sexual pleasure. A 2015 review of the science in Fertility and Sterility (Alwaal and colleagues) describes it as an intense, short-lived peak of pleasure that creates an altered state of consciousness, and notes that there is no standard definition. Climax is another word for it: Britain's National Survey of Sexual Attitudes and Lifestyles (Natsal-3) asks people whether they reached "a climax (experience an orgasm)".

How intense it feels varies, the review says. It also lists the physical changes that come with orgasm: fast breathing (up to 40 breaths a minute), a faster heart rate, higher blood pressure and powerful, highly pleasurable contractions of the pelvic muscles. Levels of the hormones prolactin and oxytocin rise afterwards, though the significance of that rise isn't entirely clear.

What happens in a man's body during ejaculation?

Ejaculation happens in two phases, emission and expulsion, and is heavily controlled by the autonomic nervous system, according to the 2015 review.

1. Emission. First the neck of the bladder closes, so semen can't spill backwards into it. Fluid from the prostate, mixed with sperm from the vas deferens (the tubes that carry sperm, which a vasectomy seals, blocks or cuts), moves into the part of the urethra that runs through the prostate. Fluid from the seminal vesicles follows, and makes up 75% to 80% of semen.
2. Expulsion. Rhythmic contractions of the pelvic muscles push the semen out of the urethra (the tube that urine passes through). The bladder neck stays closed, which is why semen goes out rather than back into the bladder.

The review says there is no evidence that voluntary control plays a role in the expulsion phase. Oxytocin levels rise after ejaculation and are back to normal about 10 minutes later.

Are orgasm and ejaculation the same thing?

They usually arrive together, but they are two separate processes, and one can happen without the other. Men can still have the rhythmic contractions of orgasm with a "dry" ejaculation, for example after removal of the prostate, a 2015 review in Fertility and Sterility notes. The NHS says men with retrograde ejaculation, where semen goes backwards into the bladder, still feel an orgasm. It works the other way round too: the EAU guidelines describe anorgasmia, the perceived absence of orgasm, which can happen whether or not a man ejaculates.

What is the refractory period?

The refractory period is the temporary stretch after orgasm when another erection or ejaculation is held back. The 2015 review in Fertility and Sterility calls it a poorly understood phenomenon. Raised prolactin and serotonin after orgasm have been suggested as causes, but their exact role is still debated.

So how long should you wait for round two? The reviews we read give no reliable figure. A 2009 review in the Journal of Sexual Medicine (Levin) found the data on the refractory period in men remarkably thin, and pointed out that even the generally accepted idea that it gets longer with age had no published data behind it. For what the research says about frequency, see how often should a man ejaculate?

Common orgasm and ejaculation problems at a glance

	What you might notice.	What the NHS or the EAU says.
Coming too soon (premature ejaculation)	Ejaculating sooner than you or your partner would like	Occasional episodes are common and not a cause for concern; if it happens more than you would like and it is a problem for you, treatment might help
Delayed ejaculation	Being unable to ejaculate more than half the times you have sex, or only after a long delay	Causes include stress, relationship problems, some medicines and conditions such as diabetes; see a GP if it persists
Dry orgasm (can be retrograde ejaculation)	Little or no semen, and cloudy pee the first time you go after sex	Not a danger to health, but it can affect your ability to father a child
Painful ejaculation	Discomfort or pain in the penis, scrotum or the area between the anus and scrotum, during or after ejaculation	Possible links include STIs and prostatitis; see a GP
Blood in semen	Bright red (recent bleeding) or brown (older bleeding), sometimes with small clots	Not usually serious, but get it checked by a GP
A sudden, extremely painful headache, at any time including during sex	A "thunderclap" headache that does not go away	Call 999: it can be a sign of bleeding on the brain

From the NHS pages on ejaculation problems, blood in semen, prostatitis and subarachnoid haemorrhage, and the European Association of Urology (EAU) guidelines.

Why can't I orgasm or ejaculate?

Ejaculation problems are common sexual problems in men, the NHS says, and it lists both psychological and physical causes, from stress, depression and relationship problems to diabetes, some medicines, alcohol misuse and recreational drugs. Natsal-3 interviewed 15,162 people aged 16 to 74 in Britain between 2010 and 2012. Among sexually active men, 9.2% said that for at least 3 months in the past year they hadn't reached a climax, or had taken a long time to, despite feeling excited or aroused. The figure ranged from 7.9% to 10.6% across the age groups.

When it keeps happening, doctors call it delayed ejaculation, also known as male orgasmic disorder. The NHS says you may have it if you're unable to ejaculate more than half the times you have sex. The causes it lists include:

• psychological factors, such as relationship problems, stress or depression
• physical causes, including diabetes, spinal cord injuries, multiple sclerosis, surgery to the bladder or prostate, and increasing age
• medicines, including antidepressants (particularly SSRIs), beta-blockers for high blood pressure, and antipsychotics
• alcohol misuse and recreational drug use

For anorgasmia, where orgasm doesn't come at all, the EAU guidelines say psychological factors are considered responsible for 90% of cases, while noting that only a few studies have described anorgasmia alone. The NHS says sex therapy can help increase your enjoyment during sex and make ejaculation easier, and other medicines can be used if it's thought an SSRI antidepressant is the cause. Speak to your GP before stopping any prescribed medicine.

What does a dry orgasm mean?

A dry orgasm, with little or no semen, can be a sign of retrograde ejaculation, where semen travels backwards into the bladder instead of out through the urethra. The NHS lists its main symptoms as producing no semen, or only a small amount, and cloudy pee the first time you go to the toilet after sex.

Causes include prostate surgery, bladder surgery, diabetes, multiple sclerosis and alpha blockers, medicines often used for high blood pressure. Retrograde ejaculation isn't a danger to health and you still feel the orgasm, but it can affect your ability to father a child. If a medicine is the cause, normal ejaculation usually returns once you stop it, but speak to your GP before stopping any prescribed medicine. After surgery to remove the prostate, the NHS says some people have problems with orgasms, such as difficulty reaching orgasm or not ejaculating during orgasm.

Why does it hurt when I ejaculate?

Painful ejaculation ranges from mild discomfort to severe pain during or after ejaculation, felt in the penis, scrotum or the area between the anus and scrotum, according to the EAU guidelines. They list possible links with sexually transmitted infections (STIs), inflammation of the prostate, an enlarged prostate, prostate cancer, prostate surgery, pelvic radiotherapy and antidepressants. Psychological causes are possible too, especially if it doesn't hurt during masturbation.

Pain when you ejaculate is also one of the symptoms of prostatitis listed by the NHS, alongside pain or stinging when peeing, needing to pee more often, pain in your penis, scrotum, testicles or bottom, and a high temperature. See a GP if you have symptoms like these. Ask for an urgent GP appointment or get help from NHS 111 if you're unable to pee.

Is blood in semen serious?

Usually not, but the NHS says to get it checked by a GP just in case. Most of the time it isn't obvious what causes it, and it often goes away by itself within a few days or weeks. Common causes include an infection such as a urinary tract infection (UTI) or an STI, a recent procedure such as a vasectomy, and prostate problems such as prostatitis or an enlarged prostate.

Rarely, it can be a sign of cancer, such as prostate cancer. In one study of 342 patients with blood in their semen, cited in the EAU guidelines, cancers of the prostate or testis accounted for 3.2% of cases and inflammation or infection for 49.4%.

Is it normal to come too soon sometimes?

Yes. The NHS says occasional episodes of premature ejaculation are common and are not a cause for concern. In Natsal-3, 14.9% of sexually active men said they had reached a climax more quickly than they would like, for at least 3 months in the past year. Our guide to premature ejaculation covers what counts, the causes and when to get help, and how to last longer in bed sets out what the evidence says about each option.

When should you see a GP about orgasm problems?

See a GP if:

• you have a persistent problem with ejaculation, whether it comes too soon, too late or not at all
• you have blood in your semen
• it hurts when you ejaculate, or you have other symptoms of prostatitis

Ask for an urgent GP appointment or get help from NHS 111 if you're unable to pee.

Go to A&E or call 999 if you have symptoms of prostatitis and you suddenly feel confused, have slurred speech or are not making sense, have blue, grey, pale or blotchy skin, lips or tongue (on brown or black skin, this may be easier to see on the palms of the hands or soles of the feet), have a rash that does not fade when you roll a glass over it, or have severe difficulty breathing. The NHS says these may mean a serious infection or sepsis.

Call 999 if you, or someone you're with, gets a sudden headache that is extremely painful and does not go away. The NHS says this "thunderclap" headache is one of the main symptoms of a subarachnoid haemorrhage, a rare type of stroke that causes bleeding on the brain, which may be more likely when you're doing something like lifting something heavy or having sex. Don't drive yourself to A&E.

A GP will discuss the problem with you and may examine you or refer you to a specialist. If you think you may have an STI, go to a sexual health clinic; you don't usually need a GP referral. Try not to be embarrassed: as the NHS says, doctors are used to talking about these symptoms. For more plain answers, see men's sex questions, answered.