Hi. Thanks for your query. Noted the history of semen discharge on defecation, towards the beginning when the rectal muscles are tightening, sometimes have trouble achieving orgasm with wife, can not seem to finish, wife feels that you are masturbating as the quantity of semen is less, which you do not. You are 44 and still plenty of energy. All the history you have provided is indicating towards prostatitis or any disease related to the prostate like cancer, inflammation. cyst, stone formation and so on. I would advise you the following: Per-rectal digital examination by a General Surgeon or an Urologist. Ultrasonography of the abdomen, particularly for genitourinary system. Tests of blood, urine and stool. Prostatic massage to get the prostate fluid and send the sample for gram staining, AFB staining, culture and sensitivity. PSA that is prostate specific antigen in blood. Biopsy if required. Long course of an antibiotic if there is infective pathology. If any other problem found, treatment accordingly.