Ask An Expert: Erection but No Climax

Question:

I am a 59-year-old male. I can get and maintain an erection, but cannot climax. This is starting to affect me emotionally. What could cause this problem and what can be done about it?

Answer:

Male sexuality is complex. Successive stages of desire, arousal, erection, ejaculation, orgasm and relaxation are involved. To be successful, a man's hormones, nerves, blood vessels and mind must all be in sync.

It sounds like you have no problem with the first three stages of sex. Although most men lump ejaculation and orgasm together under the term "climax," they are actually separate events, and each can be thrown off by medical or psychological difficulties.

Delayed ejaculation can result from alcohol, medications (especially some antidepressants and antihypertensives), lack of sufficient sexual stimulation, or stress and worry — including worry about sex itself. Retrograde, or "dry" ejaculation occurs when semen is propelled back into the bladder; diabetes and medical and surgical treatments for prostate disease are the leading culprits. Failure to ejaculate can be caused by any of the factors that can delay ejaculation as well as by spinal cord conditions and prostate surgery.

Although ejaculation is almost always accompanied by the pleasurable sensation of orgasm, orgasm may lose much of its intensity. In addition, some men can experience orgasm without erections or ejaculation. All of the problems that inhibit ejaculation can also impair or prevent orgasm; medication, alcohol and psychosocial factors are most common.

The first thing to do is to evaluate your medications — but even if you suspect a drug is to blame, don't make changes without your doctor's cooperation. You can, and should, work on alcohol if drinking is a problem. If you are generally healthy, a specific serious medical problem is unlikely, so you can try to help yourself by relaxing about ejaculation and experimenting with sexual stimulation. If problems persist, ask your doctor about seeing specialists in medical and psychological aspects of sexuality.

Harvey B. Simon, M.D. is an Associate Professor of Medicine at Harvard Medical School and a member of the Health Sciences Technology Faculty at Massachusetts Institute of Technology. He is the founding editor of Harvard Men's Health Watch (www.health.harvard.edu) and the author of six consumer health books, including The Harvard Medical School Guide to Men's Health (Simon and Schuster, 2002) and The No Sweat Exercise Plan. Lose Weight, Get Healthy and Live Longer (McGraw-Hill, 2006). Dr. Simon practices at the Massachusetts General Hospital; he received the London Prize for Excellence in Teaching from Harvard and MIT.