No Ejaculation (Anorgasmia)

Q. I’ve never been able to ejaculate or orgasm while awake. Every few months, I have a wet dream. I get strong erections, but they are almost “boring.” I’m not numb, but I don’t get a lot of feeling. Occasionally I get a fleeting twitch on the tip of my penis, with a lot of feeling, but that’s all. Sometimes I feel pain on the head of my penis and behind my pubic bone after an erection. Otherwise I’m a healthy 20-year-old. I’ve never had sex. My doctors have ruled out prostate cancer, prostatitis and testicular cancer. Can you suggest other problems my doctors might consider? I have had this all my life, so I know it’s not psychological. I really would like to enjoy what most men take for granted.

A. Based on your description, you have anorgasmia. Unfortunately, the most common cause for this condition is psychologic. The second most common cause is as a side effect of medications, particularly some antidepressants.

he third most common cause is diabetes, which can damage the nerves to the penis. This results in a lack of sensation in the penis, so the nerve reflexes for orgasm and ejaculation are not triggered. To test for diabetes, your doctor would check your blood sugar levels. Normally, when fasting, the amount of sugar in your blood should not exceed 120mg/dl.

In my practice, I always incorporate a therapist into the care plan for men with anorgasmia. Frequently, the men are frustrated, angry, embarrassed and often depressed about the issue by the time I get to meet them. Such mental factors will affect all aspects of my treatment, and without proper counseling, I will fail in my treatment goals.