Q: I’m a male, aged 29 years. Why do I experience orgasm when I am fast asleep but I do not release sperms? It happens monthly. Looking forward to your reply.

A: Thanks for writing in. Not releasing sperm could be due to a condition known as anejaculation. There is failure of ejaculation in this situation. It can be primary (in which case it is present at birth and is a lifelong condition) or it could be secondary, as appears to be the situation here. In secondary anejaculation, the problem is acquired. The same conditions that cause retrograde ejaculation are also suspect here. Retrograde ejaculation (RE), refers to backward ejaculation. To understand this, a refresher course on how ejaculation happens is needed:

Usually, during ejaculation, the muscle at the neck of the bladder tightens ensuring that semen does not enter the bladder. In people with this problem, this muscle does not tighten enough to prevent backtrack of the semen into the bladder. So, in these people, their ejaculate during intercourse is usually very little (sometimes almost non-existent, even though they certainly know they have had an orgasm) or their urine after sexual intercourse cloudy as a result of the sperm going into the bladder and mixing with urine.

Retrograde ejaculation (RE) does not interfere with a person’s ability to enjoy sexual intercourse, have and maintain an erection or even climax. Usually, these people would show up in the clinic because of infertility.

RE and secondary anejaculation can start after a surgery on the bladder or prostate; it can occur as a side effect of some anti-hypertensive drugs (drugs used to treat hypertension), or as a complication of some surgeries or medical conditions like Diabetes Mellitus, multiple sclerosis or spinal cord injury. A few people are actually born with a weakness of this muscle that closes the neck of the bladder during ejaculation.

During the refractory phase of the sexual response cycle, it is also not possible for a man to achieve orgasm. To better understand this, a quick class  There are 4 phases of the sexual response cycle: excitement, plateau, orgasm (climax) and resolution (when the body returns to its normal functioning). After resolution, men usually need recovery time. During this period (refractory period), the man cannot achieve another orgasm. This period may last for minutes, hours or even days…the older one gets, the longer the refractory period.

If RE or secondary anejaculation is caused by medications, your doctor may consider changing them or stopping them for a while. Otherwise, there are some drugs used to ensure the neck of the bladder is closed during ejaculation. Your doctor will weigh their side effects against their potential benefits in deciding whether to prescribe them to you or not. For those who desire babies, your doctor will also discuss options of ‘harvesting’ sperm to be used on your spouse.

For spinal cord injuries, the ejaculatory pathway may be intact or there may be need for penile vibratory stimulation depending on the level of the injury.

Your doctor should be able to take a proper history, carry out a detailed examination and make a proper diagnosis.

All the best!