The association of anxiety with sexual excitement has been noted since the early part of this century. The authors present case reports of a schizophrenic and a neurotic patient in whom no direct sexual precipitants of spontaneous ejaculation could be identified but in whom severe anxiety was evident. The central noradrenergic neurophysiology that anxiety may share with sexual excitement could provide a basis for spontaneous ejaculation during anxiety. The pharmacology of spontaneous ejaculation during opiate withdrawal is used to elaborate this central noradrenergic model.