It is a specific form of male sexual dysfunction that can be considered either primary or secondary in character. From diagnostic and therapeutic points of view, it is easier and psycho physiologically more accurate to consider this form of sexual inadequacy as a clinical entity entirely separate from the classical concepts of impotence.
In the spectrum of male sexual inadequacy, symptoms of ejaculatory incompetence should be assessed clinically as the reverse of premature ejaculation.
A man with ejaculatory incompetence rarely has difficulty in achieving or maintaining an erection quality sufficient for successful coital connection. Clinical evidence of sexual dysfunction arises when the afflicted individual cannot ejaculate during intravaginal containment.
Frequently this inability to ejaculate intravaginally occurs with first coital experience and continues unresolved through subsequent coital encounters. Some men contending with the dysfunction of ejaculatory incompetence experience such pressures of sexual performance that they may develop the complication of secondary impotence. If this natural progression in dysfunctional status occurs, the man with ejaculatory incompetence parallels the man with premature ejaculation.
There have been 17 males seen in therapy in the last 11 years with the complaint of ejaculatory incompetence. Fourteen of these men were married and with their wives sought relief from this specific distress. One man had been divorced for 18 months, and another was seen seven months after a year old marriage had ended in annulment. The remaining man had never married.
Twelve of these men, including the two males with divorce or annulment in their backgrounds had never been able to ejaculate intravaginally during coition with their wives. One of the 12 men had ejaculated intravaginally with another woman outside of marriage, and a second man ejaculated effectively in homosexual encounters. The single man had two engagements and numerous sexual encounters in his background, but had never been able to ejaculate intravaginally.
The remaining four men, all married, had no historical difficulty with coital function before or during marriage (marriages ranging from 6 to 21 years' duration) until a specific episode of psychosocial trauma blocked their ability to ejaculate intravaginally. Thereafter they were unable to maintain ejaculatory effectiveness within the marriage, but one of the four men could and did ejaculate with female partners outside of marriage.
Hence, the possibility arises of considering the dysfunction of ejaculatory incompetence as either primary or secondary in character. Actually, this form of sexual dysfunction has been encountered so infrequently that the clinical entity does not warrant separation into delimiting categories at this time.
In view of the relative rarity of this form of ejaculatory incompetence, skeletonized clinical pictures of the 17 men referred for treatment will be resented. Hopefully, clinical identification will become easier with a broader concept of etiological background.