Suzi Godson

The correct term for “loss of sensation at the point of orgasm” is “ejaculatory anhedonia”. Type it into Google and you'll get 11,700 pages of information on the condition. Most say the same thing. Namely, that loss of sensation may be caused by one or more of the following: hyperprolactinaemia - abnormally high levels of the hormone prolactin in the blood; hypoactive sexual desire disorder (inhibited sexual desire); low levels of testosterone; spinal cord injury; use of selective serotonin reuptake inhibitor antidepressants; drug addiction; fatigue or physical illness.

You'll be able to rule out one or more of these causes straight away, then you'll need to go back to your doctor for some blood tests and a referral to a urologist. It is vital that any underlying physical problems are taken seriously and investigated, although your doctor's diagnosis could be right.

Some psychologists believe that loss of sensation at the point of orgasm, penile anasthesia, is brought on by living in the fast lane or suppressed hostility towards a partner.

In his book Thrilled to Death: How the Endless Pursuit of Pleasure Is Leaving Us Numb, Dr Archibald D. Hart, a psychologist and professor at the Fuller Theological Seminary, in Pasadena, California, suggests that we are stuck on a hedonistic treadmill, where our addiction to excitement is over-stimulating the “pleasure centre” in our brain.

He blames masturbation, porn, cocaine, booze, stress, money, consumerism. “Our continuous pursuit of high stimulation is snuffing out our ability to experience pleasure,” he says.

Your dismissal of your doctor's opinion that the problem is psychological is a common response. There was a time when we all trusted doctors unquestioningly but one in four patients now doesn't trust his or her doctor's advice (at least according to a recent Johns Hopkins University study in the United States).

Not that long ago doctors were the only source of advice on medical problems, but the internet has demystified medicine to a great extent.

Last year a survey by Opinion Research Corporation established that 60 per cent of people in the US had looked for medical information on the internet. Google, the most popular search engine, is used for medical inquiries so often that last February the company set up Google Health, a subsite where people manage their health information.

It's a nightmare for doctors who whinge incessantly about people googling their headache and turning up at the surgery professing to have a brain tumour. Yet 60 per cent of doctors use the internet to help them to diagnose difficult conditions.

Two years ago Dr Hangwi Tang, from the Princess Alexandra Hospital in Brisbane, researched the accuracy of Google as a diagnostic tool. His study, which was published in the British Medical Journal, found that in 15 out of 26 cases, the search engine was able to accurately identify a condition based on three to five specific search terms.

Suzi Godson is the author of The Sex Book (Cassell, £16.99) and The Body Bible (Penguin, £16.99)

Dr Thomas Stuttaford

One of the strange features of medical practice is that although premature ejaculation is frequently a source of discussion between doctors and their patients, delayed, absent, or ejaculation that doesn't produce the usually pleasant sensations, are rarely mentioned.

This may be because problems with ejaculation don't figure prominently in the standard textbooks, in medical education or in written advice for patients. This lack of information may be because more women are disappointed by their partner's premature ejaculation, than by delayed, absent or non-pleasurable ejaculation.

The reasons for these experiences may occur because a man's penile sensitivity is not what it was. It could also arise because his partner no longer has such a tight vagina, possibly after childbirth. I have known cases in which the woman was so turned on that the lubrication prevented the penis being grasped. These problems can often be solved by changing to a rear-entry position to provide more tactile stimulation.

Just as some men lose their erection before they have an orgasm, others, especially if they have been deliberately prolonging sex, may find that when they want to ejaculate they have lost the ability. And as men get older it is normal to lose a certain amount of sensation in their penises.

Whenever doctors discuss delayed or absent ejaculation they divide possible causes into those with a predominantly physical or psychological cause. Often the pattern is a mixture of both. Exploring any psychological causes requires time and tact. The mechanics of ejaculation is a genital phenomena; the pleasure from it is entirely cerebral. Physical causes could either be the result of trauma, surgical or accidental, or by neurological damage after disease. A large number of drugs, including alcohol, can affect ejaculation. Perhaps some of the more common causes of ejaculatory failure are the result of taking antidepressants and tranquillisers. The side-effects of some of these drugs are made use of when treating premature ejaculation.

Doctors always take note of anorgasmia (no orgasm), anejaculation (no ejaculation) or retrograde ejaculation in patients as it is disturbing for many partnerships and can be symptomatic of other conditions. Retrograde ejaculation is when the orgasm propels the semen back into the bladder. This frequently follows surgery for benign prostate enlargement, whereas after radical prostatectomy the patient may have dry ejaculation, a normal orgasm except there is no fluid. Surgery or traumatic injury may so damage the pelvic nerves that a man when having an orgasm still has a contraction of his pelvic muscles, but can't ejaculate because the nerve supply to the muscles that propel the semen down the penis has been lost or damaged.

Some degree of delayed ejaculation is an advantage of having an older lover as it may enable him to time his orgasm so that he can climax just after, or simultaneously with, his partner. A problem may arise if a man is able to hold his erection but, after half an hour or more, is unable to have a complete orgasm. By this time his partner's thoughts have strayed to what she is missing on television.

Dr Thomas Stuttaford, the Times doctor, spent many years working in a genitourinary clinic

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