Q. I am 18 and am unable to ejaculate. I can get and maintain an erection, but I cannot achieve orgasm by either masturbation or sexual intercourse with my partner. I have spoken about this with my doctor, but he does not consider it to be a serious problem at this stage. I do get “wet dreams” where semen is released in bed at night, so my GP says that my problem is likely to be psychological rather than physical. If this is the case, what can I do about it? Please help.

You are describing a condition called anejaculation This condition is usually diagnosed on the basis of the patient’s description of the problem. Men with anejaculation suffer total anorgasmia, an inability to climax and ejaculate during sexual activity. Some men with this condition are able to ejaculate with masturbation, but most are unable to reach climax under any circumstances while awake. Typically nocturnal emissions are present, as you have noticed.

As your GP has suggested, the cause can be somewhat complex and may be psychological. The best approach for you would be to see a urologist for a detailed history, physical examination, and if necessary nerve stimulation testing to correctly identify the cause. Some medical conditions that cause nerve damage (such as diabetes) may lead to anejaculation.

If you are diagnosed with a psychological basis for anejaculation, don’t worry. The results of behavioral modification therapy and counseling are excellent. Ask your urologist to refer you to a therapist experienced in this area.

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