The absolute worst thing you can do about sexual performance issues would be to over analyze them. Short of a medical condition, maybe you just haven't met the right persons or perhaps figured out the right position to get you off YET.
Orgasms are a natural part of life, though how you achieve them is very much individual. In years of making porn and photographing guys, I've seen guys do many seemingly odd or unusual things to get off, but it worked for them. The biggest issue I encounter is an inability to have orgasm while getting blown. This situation seems so common as to be normal. Some men can't cum while getting fucked or after getting fucked. In other words, there are many variables.
If your instincts tell you this could be medical, by all means go see someone. Also, look up tantric online and consider studying techniques such as tantric touch and breathing. I bet there is a practitioner of tantric in ABQ. Otherwise, my advice is avoid obsessing on this which, I appreciate, could be hard to do given how much importance we place on cumming.
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