There is a multiplicity of factors that can force development of ejaculatory incompetence. In addition to the primary influence of religious orthodoxy, male fear of pregnancy, or lack of interest in or physical orientation to the particular woman are major etiological factors.
The usually underlined etiological factors of unopposed maternal dominance or homosexual orientation were present but quite in 'the minority in this small series.
Frequently, one particular event, one specifically traumatic episode, has been quite sufficient to terminate the individual male's ability to, facility for, interest in, or demand for ejaculating intravaginally. Occasionally a man may lose ejaculatory facility subsequent to a physically traumatic episode, but usually the only trauma is psychological.
Thus, ejaculatory incompetence, the clinical opposite of premature ejaculation, is indeed a specific dysfunctional concern separate from impotence. Since current conceptualization of this sexual dysfunction varies considerably from prior approaches, the clinical entity has been documented exhaustively.
A sidelight to the clinical picture of ejaculatory incompetence is the level of orgasmic response of the female partner. In some instances, grossly misinterpreting the causal factors in their husband's sexual dysfunction, wives have felt personally rejected when husbands could not or would not ejaculate.
Yet most of these women, despite a real concept of personal rejection, have known many occasions of multi orgasmic response during their marriages. Even those wives rejected by their husbands as physically unappealing occasionally were multi orgasmic during their coital opportunities.
Two of the four wives whose husbands had no problem in regularity of ejaculatory response during marriage prior to the specifically traumatic episode that turned them into incompetent ejaculators were multi0rgasmic before the destructive experience. All four wives were multi orgasmic after onset of their husband's pattern of ejaculatory incompetence.
The major exception to the pattern of rut 1 female response in husband and wifes contending with ejaculatory incompetence developed, as would be expected, in the five couples with religious orthodoxy as a background. Only two of the five wives reported occasional orgasmic return, during coition, regardless of frequency or duration of coital exposure, and neither of these women described multi orgasmic experience.
Seven pairs with the psychosocial complaint of ejaculatory incompetence initially were referred to the conceptive inadequacy section of the Foundation in the past 22 years. Four of the seven units have conceived by artificial-insemination procedures, using the husband's seminal fluid produced by masturbatory techniques.
They were not treated for the clinical symptoms of ejaculatory incompetence. Three of the seven units have conceived during routine coital exposure after therapy for their sexual dysfunction.
As previously stated, the incompetent ejaculator presents clinical symptoms that are on exactly the opposite end of the ejaculatory continuum from those of the premature ejaculator.
The premature ejaculator usually has no difficulty in achieving erection during the initial years of his distress. His concern has to do with maintaining the erection before, during, and for a significant period after the mounting process.
He may become so excited sexually during precoital sex play that he may ejaculate before any attempt is made to insert the penis into the vaginal barrel; or the stimulation inherent in the actual act of penetration may suffice to cause ejaculation.
If the premature ejaculator should survive these two precipices in sexual adventure, usually the ultimate in stimulative activity for any male, the onset of female pelvic thrusting will stimulate an ejaculatory response in but a few seconds.
The only physiological parallel between the incompetent ejaculator and the premature ejaculator is that neither has any difficulty in achieving an erection. As opposed to the premature ejaculator, the incompetent ejaculator can maintain an erection indefinitely during coital sex play, with mounting, and not infrequently for a continuum of 30 to 60 minutes of intravaginal penile containment.
The incompetent ejaculator's only sexual difficulty arises from the fact that he cannot or will not ejaculate during periods of intravaginal containment.
The two variants of ejaculatory dysfunction each demonstrate one correlation with the classic concepts of impotence, but their causations are diametrically opposed. The premature ejaculator frequently loses his erection during or immediately after penetration, as does the impotent male.
However, the premature ejaculator's loss of erection usually is on a physiological basis (post ejaculation), while the impotent male's erective loss is primarily psychogenic in character. The incompetent ejaculator's inability to ejaculate intravaginally is usually on a psychogenic basis.
The impotent male does not ejaculate intravaginally on a physiological basis. He usually cannot physically accomplish intravaginal ejaculation when he has no erection.
Thus, on the opposite ends of the spectrum of male sexual dysfunction there is the volatile male, the premature ejaculator, and the non reactive individual, the incompetent ejaculator. Neither of these entities should be confused with the basic concerns of primary or secondary impotence either from theoretical or practical points of view, or when dealing with the restrictive clinical approaches to diagnosis and treatment.