I live in southwestern France and have been living with my boyfriend for 3 years now (I'm 40, he's 43).

In those 3 years, he's only been able to ejaculate twice when we've had sex. However, he's able to come when he masturbates alone without me being present. He went to see a sex therapist in St Jean de Luz (the only one in our area) 5 times, but it didn't help. To give you a little background, he had very little sexual experience prior to meeting me - he had only one other girlfriend when he was 30 - and that only lasted a year. He's able to give me an orgasm during intercourse, but I feel bad because he never comes. I've noticed on a daily basis (not during sex) that he has to pee quite frequently and is often tired. Could this be related to the problem? Any advice?
Due to this problem, we've had to turn to insemination to try and have a child together (he masturbates at the lab, then my doctor places the sperm inside me via a tube.)

I’m very happy to see that I am getting questions from all over the world. The Internet is truly amazing. I’m sorry that the sex therapist wasn’t able to help, because his problem clearly is one that should be handled by a sex therapist as it’s not a medical issue since he can ejaculate during masturbation. You asked about specific physical problems, and of course the first thing a sex therapist should do in such a case is send him off to see a medical doctor, just to be 100% certain, though as I said, I doubt strongly that there is a medical issue here.

Did the therapist advise him to use fantasy? That would be my first line of attack, to have him develop a fantasy that he found very erotic and to concentrate on that fantasy while having intercourse in order to push out whatever other thoughts have been keeping him from having an orgasm. You might also try the same approach substituting an erotic film that he could watch while he was having sex. You mention that he only seems to be able to masturbate successfully when you are not in the room. Have you tried it with you in the room but out of his sight, such as in a very dark room? Or you could be in the room but wearing a blindfold so you couldn’t watch him. In other words, try a step by step approach. If he could learn to masturbate with you in the room, then maybe you could advance to having him masturbate with you actually watching him, and then advance further from there until he could orgasm during intercourse. I would urge you to keep trying because it doesn’t sound like this is an impossible situation. Bonne chance.