We report on a 17-year-old young man with a diagnosis of Asperger’s disorder who complained of having intrusive sexual thoughts and urges. He was masturbating 25–30 times per day, resulting in penile ulcers. These symptoms were associated with severe anxiety and frustration, leading to suicidal thoughts and self-injurious behavior, including stabbing his penis with tweezers. The patient denied any concomitant mood or psychotic symptoms. He denied any substance use, and his urine toxicology screen was negative. The patient was currently on sertraline 200 mg, clomipramine 225 mg, and aripiprazole 10 mg daily. He has had previous failed trials on citalopram, fluvoxamine, fluoxetine, clonazepam, quetiapine, and risperidone.