In the clinical progression of moving toward secondary impotence from an established pattern of premature ejaculation, there is an intermediate step that frequently can be underscored by careful history-taking. A man transitionally may become such an uncontrolled premature ejaculator that he episodically will ejaculate with partial or minimal erection.
Occasionally the ejaculatory process may develop totally without penile erection. This syndrome of seepage of seminal fluid, reflecting little ejaculatory pressure, usually is accepted by the distressed couple as the ultimate in masculine humiliation. The obvious next step in male sexual inadequacy is complete secondary impotence.
There is no surety of progression toward secondary impotence from the syndrome of premature ejaculation. Most rapid ejaculators probably remain so without ever developing secondary impotence. They have little awareness of or no basic concern for the sexual needs of their female partners, and there is little or no questioning of their own masculinity.
In contrast, there are an increasingly large number of men with lack of ejaculatory control who, questioning the effectiveness of their sexual function and accepting their share of responsibility for their wives' sexual pleasure, create fears of performance which move them inexorably toward secondary impotence.
As opposed to other forms of both male and female sexual dysfunction, in premature ejaculation no specifically related environmental background, religious orientation, or pattern of parental dominance could be delineated from the histories of the couples referred to the clinic for treatment.
The first few ejaculatory experiences predispose a man to the development of premature ejaculation regardless of his pre pubertal and post pubertal environmental background.
As more sex information becomes available, as more acceptance of a single standard of sexual expression for man and woman develops in our culture, the sense of shared responsibility for female sexual release is assuming equal stature with, and presumably soon will supplant, the time-honoured concept of the woman's subservient role in her mate's sexual gratification.
With both a sense of responsibility and sufficient knowledge of effective sexual function must come major socio cultural improvement in the male capacity for ejaculatory control.
The most important step in the treatment of the premature ejaculator is taken during discussion. The couple must be and is assured unequivocally that a complaint of premature ejaculation can be reversed successfully.
If marital partners are not so traumatized by the multiplicity of prior failures that they lose all interest in each other as individuals or as sexual partners, and if there is full cooperation from the female partner and an inherent interest in pattern reversal, there is negligible chance of therapeutic failure to reverse the male's rapid ejaculatory tendencies.
Before becoming too involved in therapeutic techniques for ejaculatory control, it might be well to review briefly the two stages of man's orgasmic experience.
The first stage:
Termed "ejaculatory inevitability," is an interval before seminal fluid emission; the male feels the ejaculation coming and can no longer control the process. This first stage is specifically a 2 to 4 second time interval created by regularly recurring contractions by the prostrate gland and questionably the seminal vesicles.
When any man reaches the stage of ejaculatory inevitability he cannot control his ejaculatory demand. Once started the male moves through both first and second stages of his orgasmic experience without voluntary control. With the stage of "ejaculatory inevitability" comes loss of voluntary control of the total ejaculatory process.
The second stage:
The male orgasmic process has onset with involuntary expulsion of seminal fluid content from its collection point in the prostatic and membranous portions of the urethra throughout the length of the penile urethra and culminates with expulsion of the seminal fluid bolus from the urethral meatus.
During the sensate-focus phase of the therapeutic program, when direct approach is first made to the pelvic organs, the wife is encouraged to employ any acceptable form of effective pelvic stimulation.
This is, of course, in direct opposition to the usual husband and wife pattern of "don't touch," when relating to the wife's approach to her husband's genital organs. It is the no touch concept that therapists wish to avoid.