My boyfriend, age 52, cannot reach orgasm during intercourse and both of us work very hard to achieve this. It usually takes about 30 minutes of masturbation after sex and oral sex. His penis is somewhat cobra shaped and just a little bent. Frequently during intercourse or oral sex he will lose his erection. What could be causing this?

There are potentially quite a few factors which could contribute to this problem. With regard to the configuration of the penis, it may be that he has a congenital curvature resulting in the cobra shape or he may have acquired some scarring, particularly if rather vigorous intercourse and/or masturbation is used to accomplish orgasm. He may also have Peyronie’s disease. It is doubtful that the shape of the penis is responsible for the difficulty with orgasm. Delayed orgasm is a very complex problem and not well understood. The most common etiology is a low testosterone and/or a sensory deficit of the penis. Sensory deficits can occur as a result of underlying medical problems such as diabetes or neurological disorders including stroke and multiple sclerosis. Most frequently though, there is no clear reason for the delayed orgasm. Occasionally this can be a behavioral problem, meaning that the man has conditioned his sexual response to a certain type of stimulation and if this is not achieved, then orgasm will not occur. Basically, the best advice would be to see a physician who has a strong interest in sexual dysfunction to do a proper evaluation and consider evaluation by a sex therapist as well.