When the first erective failure occurs, the involved man certainly should not immediately be judged secondarily impotent. Many men have occasional episodes of erective failure, particularly when fatigued or distracted. However, an initial failure at coital connection may become a harbinger, and, as apprehension increases during episodes of erection, a pattern of erective failure subsequently may be established.
Finally, erective inadequacy may become a relatively constant companion to opportunities for sexual connection.
When an individual male’s rate of failure at successful coital connection approaches 25 percent of his opportunities, the clinical diagnosis of secondary impotence must be accepted. The sexual dysfunction termed premature ejaculation has been labeled by various textbooks as a form of sexual impotence.
It is difficult to accept this dilution of the clinical picture of both primary and secondary impotence, because the dysfunctions of impotence have in common the specter of male conceptive inadequacy as well as those of erective inadequacy.
The physiological and psychological limitations of conceptive inadequacy do not apply to the premature ejaculator, nor, for that matter, is there any difficulty in attaining an erection. There is difficulty, of course, in maintaining an erection for significant lengths of time, but in opposition to the concerns of impotence, when the premature ejaculator loses his erection he does so as part of the male’s total orgasmic process.
If the impotent male succeeds in attaining erection and then loses it shortly before or shortly after penetration, he usually does so without ejaculating.
The premature ejaculator characterishcally functions with a high degree of reproductive efficiency and, unfortunately for the female partner, with little waste of time.
Previously, the man with ejaculatory incompetence has not been separated from clinical concepts of impotence, and such separation is indeed long overdue. From a clinical point of view, ejaculatory incompetence is diametrically opposed to premature ejaculation in the kaleidoscope of male sexual dysfunctions.
While the male with ejaculatory incompetence parallels the impotent male in reflecting clinical concerns for conceptive inadequacy, such a man could never be accused of the erective inadequacy so frustrating for both primarily and secondarily impotent men. There is essentially no time limitation to maintenance of erection for the man with ejaculatory incompetence.
He simply cannot ejaculate intravaginally.
The premature ejaculator arbitrarily is excluded from the categorical diagnosis of impotence, even if on occasion he may not be able to achieve penetration with success.
Frequently the sexual stimulation of coital opportunity, or of any form of precoital sex play, will cause him to ejaculate either before he can accomplish vaginal intromission or immediately after coital connection has been established.
The clinical difference between the two types of inadequate coital function (premature ejaculation and secondary impotence) lies in the fact that acquiring ejaculatory control is more a matter of physiological than psychological orientation, while reconstituting the ability to attain or maintain an erection quality sufficient for effective coital connection requires psycho logical rather than physiological reorientation.
The man with incompetent ejaculation arbitrarily is excluded from a categorical diagnosis of impotence, even though both types of inadequate coital function have a multiplicity of etiologies almost entirely psychological rather than physiological in character.
Their basic variation is that the incompetent ejaculator functions most effectively from a purely physiological point of view as a coital entity, while the impotent man does not.