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Urology/Erection without Ejaculation Cont.


Hi Dr. Leslie, I had a quick question about erections without ejaculations. I read Dr. Goldstein's response ( to this issue, and in the answer he said there are some individuals who are never able to orgasm possibly due to a malfunction in their brain. Like the person asking the question, I only ejaculate during nocturnal emissions but I can get erections lasting around 45-60 min., so I was wondering if my issue could still be the possible brain malfunction? Or since I have nocturnal emissions, would that rule that out? I saw a urologist, and they said everything was healthy, I had blood tests and all of my hormone levels were normal, and they suggested that I possibly have subconscious stress or anxiety and suggested wellbutrin, and I trust their judgement and I'm not saying that isn't a possibility, but it just seems strange since I don't consciously have any stress or anxiety and I've never had any difficulty getting an erection and keeping it. I've had this issue since puberty (but I've just realized it recently) and it's just odd that the diagnosis is subconscious anxiety/stress that has apparently been going on for 10 or so years without myself consciously knowing/experiencing the anxiety or stress. (Just to clarify, obviously I have been consciously stressed or anxious before, but nothing ongoing, and I've never been stressed or anxious about anything sexual.) Again, I know this is a possibility, but I was just hoping to hear your opinion, especially on the brain malfunction. Sorry about the question being so long, and thank you very much for your time.


A nocturnal emission is not an ejaculation.  Erections aren't your problem.  Most of the time, ejaculatory problems are due to medication side effects or psychological reasons.  Central nervous system problems such as a brain issue are possible but uncommon.  Here is a copy of one of the latest review abstracts on this issue.

Intern Med J. 2014 Feb;44(2):124-31. doi: 10.1111/imj.12344.

Management of ejaculatory dysfunction.

McMahon CG1.


Ejaculatory dysfunction is a common complaint and is often associated with a reduced quality of life for sufferer and partner. The spectrum of ejaculatory dysfunction extends from premature ejaculation (PE) to delayed ejaculation (DE) and anejaculation. Over the past 20-30 years, the PE treatment paradigm, previously limited to behavioural psychotherapy, has expanded to include drug treatment. Multiple well-controlled, evidence-based studies have demonstrated the efficacy and safety of selective serotonin re-uptake inhibitors in delaying ejaculation, confirming their role as first-line agents for the treatment of lifelong and acquired PE. More recently, there has been increased attention to the psychosocial consequences of PE, its epidemiology, its aetiology and its pathophysiology by both clinicians and the pharmaceutical industry. DE and anejaculation are probably the least common, least studied and least understood of the male sexual dysfunctions. However, their impact is significant as they may result in a lack of sexual fulfilment for both the man and his partner, an effect further compounded when procreation is among the couple's goals of sexual intercourse. The causes of DE, anejaculation and anorgasmia are manifold. Numerous psychotherapeutic treatments are described for the management of delayed or anejaculation. Although some appear to be effective, none has been properly evaluated in large-scale samples. Treatment of DE or anejaculation with pharmacotherapy has met with limited success. No drugs have been approved by regulatory agencies for this purpose, and most drugs that have been identified for potential use have limited efficacy, impart significant side-effects or are yet considered experimental in nature.  


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Stephen W. Leslie, MD


Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.


Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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