I've never ejaculated — Do I have a serious problem?

Dear Reader,

Difficulties involving ejaculation are common and take many different forms. When ejaculation is problematic, not happening, or only occurring after much effort and time has taken place, it is called delayed ejaculation. Lack of or difficult ejaculation/orgasm may be a medical or psychological issue. Medical causes may include diabetes, nerve damage, vascular disease, hormonal factors, alcohol or other drug use, and side effects of certain medications (e.g., antidepressants) or surgical procedures (e.g., prostate or bladder surgery). Psychological causes may include mood disorders, stress, anxiety, guilt, anger, relationship difficulties, and past traumatic events.

A health care provider or urologist can evaluate you for medical causes and suggest appropriate treatment, if necessary. If there is no medical cause, then you may find comfort talking to a sex therapist. To find a sex therapist, look at the American Association of Sexuality Educators, Counselors, and Therapists (AASECT) web site and click on the "Locate a Professional" link.

Regarding the emission you notice during bowel movements, most likely it is simply a result of excess seminal fluid in your prostate, which can build up if it is not being released during ejaculation. Muscular contractions during bowel movements can put pressure on the prostate gland, pushing the excess fluid to the surface. If this happens occasionally, it's perfectly healthy. On the other hand, if the dribble is a regular visitor, you need to have your health care provider or urologist check for other possible problems, such as prostatitis or kidney stones.

To address your last concern, difficulty with ejaculation will not prevent you from fathering children as long as your sperm are healthy and viable. If ejaculation is problematic or impossible during sexual intercourse, as a last resort, sperm can be retrieved and inserted medically for conception to occur. Putting pressure on yourself to ejaculate can actually make it more difficult to come. If you are concerned about your lack of ejaculation, you can visit a health care provider, but you could also decide to experiment with different techniques to see if what strokes really get you going — some might say that's a okay problem to have.