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Sexual failure
sexual-dysfunction-treatment

Several episodes of erective failure had developed during the last six months of the marriage. The man's severe levels of distraction, created by the ambiguity of his commitments, were obvious. The non ejaculatory pattern was one of first withholding voluntarily and then being unable to ejaculate on demand.

Virgin male
One man was single at the time of therapy, although he had been previously married for approximately one year. His marriage was annulled. His basic distress was simply that of fear of performance. Strangely, the performance fears did not arise from failed experience (he was a 29-year-old virgin at marriage), nor were religious, family, or homosexual influences of particular moment. He had been particularly insecure and introverted as a teenager.

Dating was not attempted until 19 years of age and was rarely enjoyed thereafter. Social interchange was a rarity with either male or female companions. His postgraduate degree was in Library Science, and in his obvious withdrawal from social reality books were his companions.

He met and married a 33-year-old woman with an almost identical background of withdrawal from social participation. The gavotte-like courtship consumed three years and confined sexual expression to kissing and handholding.

Although widely read on the subject of sexual functioning, the man had only attempted masturbatory release a half dozen times in his life and had failed to ejaculate on two of these occasions.

His guilt feelings about masturbation in general, and his grave concern with the two failed masturbatory performances in particular, tended to reduce any interest in overt sexual functioning.

Since he had a fairly regular pattern of pleasurable experience with nocturnal emission, his comparison of these two experiences led him to believe that he was inadequate in ejaculatory function when under the stress of conscious sexual stimulation.

The wedding night and a subsequent year of repetitive attempts at coital functioning proved him right in his assumption that he could not ejaculate with penile containment and under the stress of overt sexual stimulation. His wife took the fact of his ejaculatory incompetence to reflect personal rejection of her as a woman and, after a year of marriage, sought and was granted an annulment. His last attempts at sexual performance before the annulment were reported as partial or complete erective failures.

Seven months after termination of the marriage the man was referred for treatment. He was treated successfully with the aid of a partner surrogate.

Ejaculatory incompetence in youth
He was seen in therapy with a history of ejaculatory incompetence dating from age 18; he was surprised by the police in a local "lovers' lane" parking area while being manipulated to ejaculation by a young woman. The girl's terror and his overwhelming embarrassment and fear of public exposure left an indelible residual.

Although actual exposure did not occur, he was unable to ejaculate intravaginally through two subsequent engagements and numerous other coital opportunities. He had no homosexual history. Since he had been on the verge of ejaculating when surprised, he thereafter was always frozen by fear of observation when a similar level of excitation developed.

When seen on referral to the Foundation, he was voluntarily accompanied by a young woman to whom he was married a few days after termination of the acute phase of therapy. Since this is a unique situation, this couple has been listed in the general statistics as married rather than considered as a man with a replacement partner. They had planned to be married as soon as therapy proved successful and the possibility for future pregnancy was established.

Four of the 17 men referred for ejaculatory incompetence could and did ejaculate intravaginally both before and during marriage until a specifically traumatic event, psychosocial in origin, terminated their facility for or interest in intravaginal ejaculation.

  1. In the first instance, after six years of marriage the husband unexpectedly encountered his wife committing adultery. Her partner had just ejaculated and was withdrawing as the husband entered the bedroom. The traumatic picture of observing seminal fluid escaping his wife's vagina was his first fixed observation of activity in the bedroom. Forgiveness was begged and in time conceded. But when husband and wife coition was attempted, the mental imagery of seminal fluid escaping the vagina was sufficient to depress the husband's ejaculatory interest. He could not live with the concept of his seminal fluid mingling even symbolically with her lover's ejaculate.

  2. In the second instance, husband and wife were surprised in the primal scene by their two children, ages six and eight, bursting into the bedroom. They were in active coital connection without clothes or the protection of bedding. The husband, just in the act of ejaculating, could not stop. The children's observation of the continuing coital connection was infinitely more disturbing to him than to his wife. He was devastated by the interruption. For the next nine years, whenever ejaculation was imminent, no matter how well-locked the door, the fears of interruption and observation were such that this man could not ejaculate intravaginally.

  3. In the third instance, after 12 years of marriage and two children the wife insisted upon having a third child, which the husband neither wanted, nor personally felt was indicated for psychosocial and financial reasons. For nine months he controlled his ejaculatory urge whenever his wife, following her menstrual calendar, insisted upon coital connection.

Finally, agreeing to his terms for continuance of effective sexual function in the marriage, his wife instituted contraceptive protection to avoid pregnancy. However, ejaculatory incompetence had been established, and the husband continued incapable of intravaginal ejaculation during the subsequent four-and-a-half-year period before seeking consultation.

Contraceptive
Finally, in a marriage of just over 21 years duration. The husband had established a strong attachment to another woman and was having regular intercourse outside of marriage. His mistress made him aware that she had suffered through a previous illegitimate pregnancy and constantly expressed serious concern for any risk of conception; so he accepted the responsibility for contraception and chose to use condoms routinely.

On one occasion the condom ruptured just as he was ejaculating.

The young woman's initial screams of protest when she became aware of his transgression and the hysterical evidence of the severe levels of her pregnancy phobia were major blows. They never met again.

His traumatic reaction to her total rejection of him personally was of such magnitude that he was no longer able to ejaculate intravaginally with his wife. The memory of his failed commitment to contraceptive protection was so vivid and his sense of loss so painful that whenever ejaculation was imminent he would stop thrusting or withdraw.

His wife had no concept of the cause for the major reversal in his established pattern of sexual behaviour and took his state of voluntary ejaculatory incompetence as evidence of personal rejection. After four years of mutual misunderstanding they sought professional support.

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