Ask the Expert

Health Professional

Every month, Dr. Knowles answers your questions about erectile dysfunction. Email Dr. Knowles at with your question.

This week I would like to answer some interesting questions that have been asked by our visitors on the website. I get asked many of these questions on a routine basis in my practice a so they should be informative and helpful to many of you. Please continue to contact me with your questions. I'm sure that there are thousands and thousands of people who want to ask the same questions you want answered.

We can get warmed up with some anatomy on our first question. "Where does semen get stored before ejaculation?" ** Dr. Knowles:** The semen is stored in sack-like organs called the seminal vesicles which sit right behind the bladder and just above the prostate. Their sole purpose is the collection, storage, of semen prior to ejaculation and expulsion of semen during ejaculation. They are very similar to the bladder as they act as a reservoir for semen. There are very few diseases which affect the seminal vesicles. There can be problems if they become blocked. This can lead to infertility problems. They can occasionally become infected which is usually associated with and infection of the prostate, prostatitis. This can be painful and may require treatment with antibiotics. The seminal vesicles may also be invaded by prostate cancer which gives a poor prognosis to these patients.

Our second question is one that I get asked frequently outside the office by friends and acquaintances. "What happens to the semen after a very long foreplay, if there is no ejaculation? Are there any repercussions, if there is no ejaculation [after a very long foreplay including intercourse]?" ** Dr. Knowles:** Nothing really happens with the semen if you don't ejaculate after sexual stimulation. Prior to sexual stimulation, the seminal vesicles are already filled and ready for ejaculation. If you don't have an orgasm, the seminal vesicles don't contract in order to empty. So they simply continue to store the semen until a later date when the person ejaculates. During sexual stimulation there is some leakage of semen from the seminal vesicles into the urethra. This fluid can be expelled out of the penis without having an orgasm or ejaculation. This fluid contains sperm which can fertilize an egg. This is why rhythm method, withdrawal of the penis prior to ejaculation, is a poor for of birth control. What I believe this person is trying to get at is the commonly called "blue balls syndrome". This is the uncomfortable feeling that a man can have after being sexually stimulated and not having an orgasm. This discomfort is caused by continual contraction of the muscles of the urinary tract and the pelvis. These muscles contract and prepare for ejaculation during sexual stimulation. If the man is brought to orgasm, then these muscles contract and relax repetitively with great force. This is what causes ejaculation. After ejaculation, these muscles relax due to fatigue. If you don't ejaculate after being sexually excited, these muscles stay contracted for a period of time and cause pain or discomfort in the pelvic area. This pain is commonly felt in the testicles as a pressure or ache and thus the term "blue balls" was born. Contrary to popular belief, this does not cause any damage to the urinary or reproductive tracts but can be uncomfortable to the man.

Our third question is another problem I encounter commonly in my practice. "Hello, I am 22 year old and have a problem. I'm not really sure what's wrong, but I can't get an erection with my girlfriend. I can fine by myself. Sometimes I can get it up just fine with my girlfriend, but other times it never happens. And it's not like this problem just started, I've had this problem for a while. 2-3 years or so. I went to a urologist but he just told me I was too young for this type of problem and gave me my money back and made me leave his office. I don't know what to do, or who to turn to. Please help" ** Dr. Knowles:** This is a very common problem in young men. I see many patients in my office with the exact same problem. I never turn these patients away as the other urologist had. This problem with erections is often called situational ED and is more common than most men will admit. He doesn't appear to have primary ED because he is able to achieve normal and functional erections alone but is having problems with his partner. Situational ED is psychological and not physiological. This means that the problem probably lies within the head and not in the penis. The best place to start with treatment is to solve the underlying problem, the relationship with the sexual partner. There are many underlying causes why one may be having relationship issues with his sexual partner. One may be uncomfortable having sex with a particular partner or one may not have sufficient emotional sexual excitation with a partner. These psychological issues must be identified, addressed and resolved, which may be very difficult.

Unfortunately, experiencing problems with erectile function often compounds the problem. This can bring about even more psychological problems with erectile performance and only makes the problem worse. It is typically necessary to address the underlying psychological issues at play that are causing the emotional distress but medication can often help these patients. By using the oral ED medications for this problem the patients are often able to achieve satisfactory erections while still having these psychological problems. These medications allow the user to achieve an erection more easily without as much stimulation both physically and emotionally. As well by allowing the patient to regain his sexual ability, it will usually help eliminate the added problems associated with the erectile performance anxiety. In most cases, the patient is usually able to stop using medication and resume a normal, healthy sexual relationship with good erectile function without the medication after the emotional issues are identified and resolved. The medication should not be used without addressing the underlying psychological problems which are likely the main cause of the problem with erection.