Author: The Beauty Nation

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Ejaculatory Incompetence

Sexual Failure

sex partner, sexual dysfunction, impotence, sexual replacement, partner surrogate

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. c) 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

Categories
Ejaculatory Incompetence

Poor Sexual Performance

sex partner, sexual dysfunction, impotence, sexual replacement, partner surrogate

One of the men handicapped in sexual performance by strict adherence to fundamental Protestantism developed symptoms of erective inadequacy after three years of marriage. The three marriages averaged seven and one-half years’ duration before the husband and wifes were seen by authority. Two of these units were referred initially for conceptive inadequacy rather than ejaculatory incompetence.

Three men offered dislike, rejection, or open enmity for their wives as sufficient reason for failure to ejaculate intravaginally.

In the first instance

A man married a distant relative whom he found totally objectionable physically. The advantages of the marriage were of monetary and social import.

It probably mattered not whom the man married, as his sexual commitment was of homosexual orientation. He was able to function coitally with his wife from an erective point of view, but after .penetration he was repulsed rather than stimulated by her demanding pelvic thrusting and delighted in denying to her the ejaculatory experience.

After six years of marriage and continuation of his homosexual commitments, he decided that children should be a part of his marriage’s image to the community. But the established pattern of voluntary restraint was so strong that he could not ejaculate for conceptive purposes.

After three years of involuntary ejaculatory constriction and a total of nine years of marriage, the unit was seen in treatment. The presenting complaint was not a request for relief of the ejaculatory incompetence or for treatment of the homosexual commitment, but rather was for the concerns of conceptive inadequacy.

In the second instance

The marriage was of convenience, with no respect, interest, or admiration for the woman involved. Intercourse was initially considered an unpleasant duty by the husband, to be indulged in reluctantly and only when confrontation no longer could be avoided. The husband was so physically repulsed by his wife that, although erections were maintained, he rarely reached sufficient levels of sexual tension to approach ejaculation.

On those few occasions when ejaculation seemed imminent, he would arbitrarily terminate coital connection to deny his wife consummation of the marriage. His great pleasure was to pretend he had ejaculated and then to enjoy her frustration when she ultimately discovered that he had not succumbed to her driving demand to consummate her marriage.

He was consistently involved with other women outside of marriage with, of course, no ejaculatory difficulty. Despite her full knowledge of the degree of her husband’s rejection of her as a person, she still wanted her marriage to survive, and the unit was referred for therapy.

The third couple

Depicting rejection of the wife as an individual resulted from the marriage of a 28 year old man and a 25 year old woman who had been raped as a teenager by 2 Negroes. She had not told him of the episode until their wedding night. Why she chose this particular time to confide in her virginal husband she could not say.

He was overwhelmed by the story. He considered her contaminated, and, although there were a few episodes of coition, he could not ejaculate intravaginally. Their six-year marriage, unconsummated by intravaginal ejaculation, ended in divorce. Eighteen months after the legal separation, the husband was referred by his local physician because he could not ejaculate intravaginally with subsequent sexual partners. His rejection of intravaginal ejaculation had carried over to other women. Of interest is the fact that his former wife joined him as a replacement partner. This unit is reported in the marital statistics.

There have been two examples of male fear of pregnancy among members of couples seeking relief from ejaculatory incompetence:

  1. A 19-year-old boy
    Who had impregnated a girl of whom he was very fond. A criminal abortion was performed under the most brutal of circumstances and massive infection resulted. The girl was ill for many months, almost losing her life.Ultimately, she would have nothing to do with the man who had caused her pregnancy and who had insisted upon the abortion that nearly cost her life. Since he had insisted upon the abortion rather than accept marriage as a face-saving mechanism, his levels of guilt knew no bounds.

    Five years later in another community and with another girl, a marriage was established. When attempting consummation, the husband found himself completely unsuccessful in ejaculating intravaginally and continued to be so for the next three years until seen in therapy.

    His was an overwhelming fear of causing pregnancy and of the possibly unfortunate complications thereof. Contraceptive practices offered him no real sense of security. His wife’s mere suggestion of raising a family was sufficient to produce a severe anxiety attack. Since his wife had no knowledge of the historical onset of her husband’s pregnancy phobia, she presumed personal rejection as the primary factor in his ejaculatory incompetence. The marriage was headed for legal separation when husband and wife were seen in therapy.

  2. One man simply did not want children
    His wife, although giving verbal support to his rejection of parenthood, would not practice contraception for religious reasons nor allow her husband to take contraceptive precautions. Consequently, he voluntarily refused himself the pleasure of intravaginal ejaculation in the early years of the marriage. In due course he found no difficulty with control and eventually could not respond with ejaculation to masturbatory practices. Although the marriage existed 11 years before professional aid was sought, and coital connection was generally one to three times a week, this man initially would not and ultimately could not ejaculate intravaginally.
  3. The final example
    Not one of fear of, but of rejection of pregnancy, has a familiar clinical orientation. Inevitably, there has to be the expected clinical picture of a totally dominant mother essentially choosing a wife for her only son.The mother had been in full control of the son’s every major decision until his marriage. Following his parents’ legal separation, the son’s father was never in the home. Throughout his teenage years his mother insisted upon total control of his social commitments.

    She chose his school, his college, and his clothes. She also chose his female companions by the simple expedient of being so abhorrent to those she did not approve that they soon sought other company. Time and again she embarrassed her son by her obvious demand for dominance. He grew to hate his mother but lacked the courage to let her know his level of rejection.

    Particularly was he careful not to offend her too deeply, for she controlled a considerable amount of money and he was all too aware of the advantages this could bring.

    Finally, there was a girl, grudgingly acceptable to his mother, that he could tolerate, so at age 27 he became engaged and in short order married the girl whom he knew only as a quiet companion who never objected to anything he wanted to do.

    Presumably, her contrast to his mother was her only redeeming grace in his eyes. His constant fantasy was of revenge upon his mother. Since she had been coyly describing her anticipation of becoming a grandmother, he vowed she would be frustrated in this one area, if no other. There would be no children.

    The thought never occurred to him that his wife might be frustrated, feel rejected, or fail to endorse his plan for revenge upon his mother. However, after marrying him she began to express her own requirements. After two and one-half years of increasing levels of mutual antagonism, the husband and wife was referred to the Foundation for treatment.

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Ejaculatory Incompetence

Ejaculatory Incompetence Treatment

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Treatment of ejaculatory incompetence follows the basic approach described for treatment of premature ejaculation. Once the couple interest in sensate focus has been secured, the next step is direct approach to penile stimulation.

Instead of using the squeeze technique to avoid ejaculatory response as with the premature ejaculator, the female partner is encouraged to manipulate the penis demandingly, specifically asking for verbal or physical direction in stimulative techniques that may be particularly appealing to the individual male.

Care should be taken to employ the moisturizing lotions to avoid penile irritation.

The first step in therapy for the incompetent ejaculator is for his wife to force ejaculation manually. It may take several days to accomplish this purpose.

The important concept:

There is no rush for sex. The mere act of ejaculation accomplished with the aid of the female partner is a long step in the right direction. Once he has ejaculated in response to any form of stimulation acceptable to her, the male no longer will tend to withdraw psychologically from her ministrations.

When she has brought him pleasure, he identifies with her, for the first time in the marriage as a pleasure symbol rather than as a threat or as an objectionable, perhaps contaminated, sexual image.

Three of the 17 men had never been able to masturbate to ejaculation before entering therapy. For the remainder, masturbation had been the major form of sexual tension release, but the men had infrequently included their wives as contributors to their release mechanisms (4 of 17). By denying their wives the privilege of participating in the ejaculatory experience, even if occasioned manually, they further froze the possibility of a successful sexual relationship.

As might be expected, some of the wives had no real interest in relieving their husbands through means other than successful intercourse connection. Although only three men constrained their ejaculatory processes to frustrate their wives, many more were accused of this motivation by their partners.

Since ejaculatory incompetence is a relatively rare clinical entity, few members of the general public have heard of it. When wives did not understand that their husbands were involved in a form of sexual inadequacy, as evidenced by their ejaculatory incompetence, they were reluctant to participate in any sexual approach designed, in their minds, only as a means for male relief.

Masturbatory Techniques

The tremendous advantage of dealing with both members of the husband and wife in approaching the concerns of sexual dysfunction has no better example than in treating ejaculatory incompetence. If one dealt only with the hush, and, and the wife received her information second-hand, if at all, her rebellion would continue in a large percentage of cases.

For the husband to suggest specific manipulative techniques at the direction of his therapist does not carry the weight of authority or enlist the degree of wifely cooperation that an adequate explanation can elicit when given to both members of the husband and wife as equal participants in the therapeutic program.

Inevitably, since education is always the procedure of choice, the husband and wife must be dealt with directly. When these techniques of direct confrontation are employed, the wife’s cooperation improves immeasurably.

Sexual Stimulation

Once the wife has been made fully aware of techniques that simultaneously tease and stimulate her husband, great variation is available in measures to relieve the problem of ejaculatory incompetence. As a first step, the husband should be encouraged to approach his wife sexually in order to provide her with release from sexual tensions accrued during the stimulative sessions she has conducted for her husband.

The basic give-to-get apply to the concerns of the incompetent ejaculator. He must feel not only the stimulation of his wife’s sexual approach, but, in addition, he must be stimulated sexually by her obvious pleasure responses to his direct sexual approaches.

Every possible advantage should be taken of this multiplicity of sexually stimulative physiological and psychological influences in order to achieve regularity of ejaculation for males faced with ejaculatory incompetence.

After establishing competence in ejaculatory function with masturbatory techniques, the next step toward intravaginal ejaculatory response is in order. Male partners are stimulated to a high degree of sexual excitation by their wives’ direct physical manipulation of the penis.

As the male closely approaches the first stage of orgasmic return (the stage of ejaculatory inevitability), rapid intromission of the penis should be accomplished by the wife in, the female-superior position. She should continue penile stimulation during the attempted intromission.

Once the coital connection is established, a demanding style of female pelvic thrusting against the captive penis should be instituted immediately. Usually this teasing, technique is sufficient to accomplish ejaculation shortly after intromission. If the male does not ejaculate shortly after intromission under the designated circumstances, pelvic thrusting should cease.

The wife should terminate the coital connection and return to the demanding manual stimulation. As the husband, now conditioned to masturbatory response, reaches the stage of ejaculatory inevitability, he should notify his wife.

She should remain in the female-superior position while demandingly manipulating the penis, and from this positional advantage quickly reinsert the penis into the vagina at her husband’s direction.

It matters not if she is a little too late in her intromission efforts. If the stage of inevitability has been reached and some of the ejaculate escapes during the intromissive process the first few times the technique is employed, there is no cause for concern.

Even if but a few drops, of ejaculate are accepted intravaginally, the mental block against intravaginal ejaculation, will suffer some cracks. Every partial success at intravaginal ejaculation should be underscored in a positive fashion, and rite obvious therapeutic progress should be emphasized in all discussions with the distressed husband and wife.

In short order most of the ejaculate will be delivered within the vagina and the husband’s mental block neutralized or removed.

With the first intravaginal ejaculatory episode, the marriage has been consummated. This is a moment of rare reward for the wife of any man suffering from ejaculatory incompetence. Some wives referred to the Foundation have waited more than ten years, to consummate their marriages.

Their levels of psychosexual frustration during these barren years are beyond comprehension, despite their relative facility at multi orgasmic release of sexual tensions during their coital patterning.

Whether or not the wife is particularly stimulated sexually at this stage of the therapeutic program is of little or no importance. She has had her moments in the past of pure tension release, and she has much to gain if her husband’s ejaculatory block can be obviated. The important fact is that the unit, with full communication, works well together.

Proper application of effective stimulative techniques, the incompetent ejaculator usually has been enabled to consummate his marriage. After three or four such episodes of rapid intravaginal penetration as the male is ejaculating, confidence in intravaginal ejaculatory performance will have been established. Then every effort is made to increase female partner involvement by including a period of voluntarily lowered levels of male sexual excitation before coital connection is initiated.

In this way, a lengthened period of intravaginal penile containment is encouraged, for it has a specific purpose. The male’s fears of continuing as an incompetent ejaculator have been dimmed or negated, both in view of his recent intravaginal ejaculatory success and the fact that he is controlling his ejaculatory response voluntarily to accommodate and not frustrate his wife.

Needless to say, her fears for his facility of sexual performance disappear even more rapidly than do his performance concerns after the initial episode of intravaginal ejaculation.

The male usually experiences high levels of sexual excitation in the therapeutic sequence as opposed to feeling very little sexual interest during prior experience with involuntary ejaculatory incompetence. Taking advantage of his pleasure in these subjective changes and acceptance of the therapeutic program as devoted to his psychosexual security, every professional effort should be directed toward reconstitution of the marriage on a healthy, communicative basis.

Weaponry necessary to reinstitute the destroyed channels of communication within the marriage is described, and its usage is supported by direct exchange between cotherapists and patients at every session.

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Ejaculatory Incompetence

Ejaculation Incompetence and Impotence

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The most effective communication of all, a functional marriage bed, has been made immediately available and the security of intravaginal ejaculatory response has been established for both partners. The fact of an ongoing consummated marriage in itself immeasurably facilitates marital communication.

Symptoms of Secondary Impotence

Five men diagnosed as incompetent ejaculators developed symptoms of secondary impotence as their ejaculatory dysfunction continued without symptomatic relief over an average period of eight years. Three of the five men were handicapped by the psychosocial dominance of severe religious orthodoxy.

Symptoms of Erective Incompetence

Also developed for the man refusing ejaculatory experience to his wife in order to prevent the possibility of pregnancy and accomplish revenge against a dominant mother. The man whose marriage had been annulled because he was afraid to bring himself to ejaculate intravaginally, was the fifth male with symptoms of impotence developing as an involuntary component to longstanding ejaculatory incompetence.

Inevitably, when impotence develops as a complication of either premature ejaculation or ejaculatory incompetence, the concerns of the impotent state must be treated before those of the ejaculatory dysfunction. When therapy for the impotent state is successful and erective adequacy is secured, the individual male again returns clinically to his prior status as premature ejaculator or incompetent ejaculator.

Symptoms of Sexual Dysfunction

Must be treated in their turn, but always secondary to the primary attack on the state of impotence.

In all five instances, the symptoms of impotence developing secondary to those of an incompetent ejaculator were relieved with application of standard therapeutic techniques. Again, it is interesting to note the parallel between premature ejaculation and ejaculatory incompetence when existent for long periods of time. When a man’s sexual competence is questioned over an extended period by a woman demanding sexual satisfaction, symptoms of ejaculatory dysfunction may retrogress toward impotence under the pressure of fears of performance.

Ejaculation Treatment

There were three episodes of failure to reverse the symptoms of ejaculatory incompetence among the 17 cases referred to the Foundation. This is a failure rate of 17.6 percent, which certainly should be improved with more experience in dealing with this relatively rare syndrome.

The first failure was that of the orthodox Jewish male overwhelmingly traumatized in his premarital years by his one fall from grace during which he sexually approached a menstruating woman. The symptoms of secondary impotence that had developed after years of ejaculatory incompetence were relieved during therapy and have since continued under control, but he has not been able to ejaculate intravaginally.

His haunting fear of vaginal menstrual contamination and his reflex response of ejaculatory rejection could not be neutralized.

The second couple to fail to reverse the symptoms of ejaculatory incompetence was that of the husband surprising his wife in the physical act of adultery. Subsequently, whenever attempting to ejaculate intravaginally, he was faced with the vivid but castrating mental picture of the lover’s seminal fluid escaping his wife’s vagina.

Therapeutic effort could not reduce the rigidity of this man’s concept of the intravaginal ejaculatory process as a personally demeaning event. To ejaculate intravaginally during coition with his wife carried with it an implication that he was voluntarily mixing his seminal fluid with that of his wife’s lover. He could not or would not, forgive and forget.

The final clinical failure to reverse the symptoms of ejaculatory incompetence involved the man with no personal regard for, no interest in, and no feeling for his wife. His refusal to ejaculate intravaginally was a direct decision to deprive her of the pleasure of consummating the marriage.

This man historically had numerous successful sexual encounters outside marriage. This unit had escaped the culling protection of the screening process as described. They should not have been seen in therapy, as there really was no specific ejaculatory dysfunction. This was only a case of a man’s complete rejection of the woman he married.

Once the depth of the husband’s personal rejection of his wife was recognized, the unit was discharged from therapy. Divorce was recommended to the wife, but her immediate reaction was to hold on to her concept of a marriage.

Of interest is the fact that of the 17 men with ejaculatory incompetence, there were only 3 cases in which steps toward legal separation were taken, and in one of these 3 cases therapy reunited the marital partners. One of the men had been divorced for a period of eighteen months before both former husband and wife agreed to be seen as a unit in therapy.

His wife remarried him shortly after termination of a successful therapeutic experience. This husband and wife currently has two children. The man with a year-old marriage plagued by the symptoms, of ejaculatory incompetence leading to an annulment was treated with the aid of a partner surrogate. This man ultimately married another woman, and for the past three years has conducted himself as a sexually functional male in a successful marriage.

Those with religious orthodoxy as an etiological handicap (4 of the 5 men) acquired intravaginal ejaculatory function. Follow-up records report pregnancies for three of these five couples. There was no increase in the levels of sexual responsivity of the three non orgasmic wives in this group.

Two of the three units with male rejection of his female partner as the primary factor in the development of ejaculatory incompetence were reversed in therapy. Of interest in this group is the husband and wife with the homosexually oriented husband.

Successful Intravaginal Ejaculation

Once intravaginal ejaculation was accomplished, the husband continued to function effectively in this manner with his wife while also maintaining his own homosexual commitment with her full knowledge and consent. There have been two children born of this marriage.

Three of the four men developing ejaculatory incompetence after years of successful sexual functioning in marriage were returned to effective ejaculatory performance during therapy. These marriages have continued in a successful vein after termination of the acute phase of the therapy. One pregnancy has ensued.

It is obvious that the incompetent ejaculator can be treated effectively if both husband and wife wish reversal of this clinical dysfunction. This clinical syndrome of ejaculatory incompetence will be explored in depth in years to come as more material becomes available.

Previously, ejaculatory incompetence has been considered a variant of erective inadequacy. Now there is sufficient knowledge to categorize the syndrome as the direct counterpart of premature ejaculation. Neither of these forms of ejaculatory dysfunction should be considered an integral part of the clinical picture of impotence because neither is necessarily associated with erective incompetence.

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Ejaculatory Incompetence

Ejaculation Incompetence Development

There is a multiplicity of factors that can force the 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.

They usually underlined etiological factors of unopposed maternal dominance or homosexual orientation were present but quite in ‘the minority in this small series.

Male ability

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.

Multi-orgasmic

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 the regularity of ejaculatory response during the 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 the 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.

Sexual exposure

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 an 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.

Ejaculation anxiety

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.

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Ejaculatory Incompetence

Ejaculatory Incompetence

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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.

Categories
Ejaculatory Incompetence

Cause of Ejaculation Incompetence

Ejaculation, Incompetence, Ejaculation Incompetence, Ejaculatory, Incompetence, Ejaculatory Incompetence

In a case of 12 men never able to ejaculate intravaginally with their wives, five were tense, anxious products of severe religious orthodoxy: one of Jewish, one from Catholic, and three with fundamentalist Protestant backgrounds.

  1. The Jewish man
    He was of orthodox belief. One night, at the age of 24 years, totally breaking with traditional behaviour for the first and only time in his life, he not only forced physical attention upon, but tried to penetrate a young woman somewhat resistant to his approach. She stopped him with a plea that she was menstruating. He was devastated with this information, left her company as soon as physically possible, and never saw the woman again.As a result of this experience the subsequent two years were spent in psychotherapy.

    Four years later, this man married a young woman of similarly restrictive religious and social background. The courtship was severely chaste. In the marriage both husband and wife rigorously adhered to orthodox demands for celibacy within menstrual and postmenstrual time sequences.

    Every intercourse experience was potentially traumatic because, even with full erection and long-continued coital connection, the husband was unable to ejaculate intravaginally. His concept of the vagina as an unclean area had been reinforced by his traumatic premarital sexual experience. Such was his level of trauma that during marital coition, whenever the urge to ejaculate arose, and the mental imagery of possible vaginal contamination drove him to withdraw immediately.

    A marriage of eight years had not been consummated when this husband and wife was seen in therapy. During the two years before therapy, this man experienced an increasing number of instances of erective failure with coital opportunity as his fears for sexual performance increased.

  2. A 36-year-old man
    He was referred to the Foundation was one of six siblings in a family devoted to Catholic religious orthodoxy. Two of his sisters and one brother ultimately committed their lives to religious orders. At the age of 23, he was surprised in masturbation by his dismayed mother, severely punished by his father, and immediately sent to religious authority for consultation.Subsequent to his lengthy discussion with the religious adviser, the semi hysterical, terrified boy carried away the concept that to masturbate to ejaculation was indeed an act of personal desecration, totally destructive of any future marital happiness and an open gate to mental illness. He was assured that the worst thing a teenage boy could do was to ejaculate at any time.

    This youngster never masturbated nor experienced a nocturnal emission again after the shocking experience of being surprised in auto stimulation.

    Twelve years later with marriage, these fears for and misconceptions of the ejaculatory process were sufficient to deny him such experience. Whenever he was stimulated toward ejaculatory response by active coital connection, prior trauma was sufficient to deny him release.

    He continued without ejaculatory success for 11 years of marriage. Finally, as evidence of secondary impotence developed, the husband and wife was referred for evaluation.

    The three men with fundamentalist Protestant backgrounds provided such individual variations that no single etiological factor was found for the ejaculatory incompetence. Arbitrarily; one history has been selected to provide balance to the chapter, but either of the remaining two histories would be as representative.

  3. 33 years old inexperience man
    When seen by therapy, were of extremely puritanical family backgrounds and of deeply restrictive religious beliefs. Their religious dogma was a mass of “thou-shalt-nots,” declared or implied. As little communication as possible with the outside world was the procedure of choice on Sundays. He was an only child.With one exception, the subject of sex was never mentioned in the home. All reading material was censored before it was made available to the boy. Neither mother nor father was ever observed in any stage of undress by their son.

    Total toilet privacy, including locked door demand, was practiced, and swimming or athletic events that might terminate in public showers were forbidden due to the possibility of physical exposure to his peers. For the same reasons, he was never allowed to visit a friend’s home overnight.

    At age 13, the first occasion of nocturnal emission was soon identified by his mother. His father whipped him for this “sin of the flesh,” and thereafter his sheets were checked daily to be sure that he did not repeat this offence. He was not allowed to participate in heterosexual social functions until age 18, and then, returning from the most chaperoned of dating experiences, he was quizzed in minute detail by both mother and father as to the young lady’s actions in order to be sure no effort had been made to entice their son into any overt form of sexual expression.

    Although there were sufficient family funds, and the young man had very effective grades, college attendance was restricted to a small hometown college so that he could continue to live at home, avoid the debasing influence of dormitory life, and be available for a full day of church-oriented activity on Sundays.

    The one exception to the taboo status for all material of sexual connotation, as mentioned, was a diatribe launched by his father when the son was 18 years of age. His father decried any pleasurable return from sexual function as a major sin, explaining that the ejaculate was dirty, equally degrading to both men and women and that coition should only occur when conception was desired.

    It also was pointed out that no good woman would dream of having intercourse unless conception specifically was the goal.

    Finally, a young woman 27 years old, socially acceptable not only to the now 26-year-old man but far more important, to the rigid standards of his family, married him after an extremely chaste and thoroughly chaperoned nine-month courtship, during which three brief episodes of handholding were highlighted as the total of their premarital sexual experience.

    On their wedding night, when the penis entered the vagina easily, the young man was surprised and shocked because he had been told by friends and by the minister before the ceremony that intercourse was always very painful to the virginal bride. He withdrew immediately and questioned his wife relentlessly as to the possibility of past sexual exposure.

    Under duress, the wife admitted intercourse with a young man she was engaged to marry three years before she met her husband. He was gravely distressed to learn not only of the existence of the previous engagement but also that the male in question had actually ejaculated intravaginally when pregnancy obviously had not been desired. How a good woman, represented by his wife, could possibly have permitted such a transgression was inexplicable to him.

    The honeymoon was one of mutual anguish. Forgiveness for past sins was repeatedly implored by the wife and finally conceded by the husband approximately two months after marriage. During the emotional bath of the reconciliation scene, the tearful young couple moved together toward the bed. Vaginal penetration again was easily accomplished, but the young husband could not ejaculate intravaginally.

    Time and time again successful coital connection was established, but ejaculation was impossible. His concern was for prior contamination.

    During the following seven years the wife became multi-orgasmic during coition, much to her husband’s initial concern, for he felt such obvious sexual pleasure on his wire’s part might be evidence that her previous sexual exposure had left some scar on her character.

    Actually, as time passed he began to enjoy her frequent, rather intense, response pattern, however, despite an estimated average of 15 to 30 minutes of intravaginal containment with most coital experiences, there was consistent failure to ejaculate intravaginally. Noteworthy in the remaining two cases of religious orthodoxy are the few following facts.

Categories
Aging Male Sex

Male Sex Steroid

male sex

Little is known of the male climacteric.

When does it occur, if it develops? Is it a constant occurrence? What is the specific symptomatology? Should sex-steroid-replacement techniques be employed? What, if any, are the patterns of sexual responsivity engendered by these replacement techniques? So little is known of the male climacteric.

Now that these definitive laboratory studies can be done with some confidence, relative rapidity, and at not too staggering a cost, much more will be known of the male climacteric within the next few years.

There will be more basic information on the effects of steroid replacement not only upon the aging male’s sexual response cycle per se but also, and infinitely more important, upon the total metabolic function of the climacteric male.

Without the gross advantage of fully supportive laboratory data, tentative clinical conclusions have been drawn regarding the influence of steroid-replacement techniques upon the aging male’s sexual functioning.

These conclusions may have to be restarted or even possibly abandoned in the not-too-distant future as more definitive information is accrued from the healthy combination of clinical and laboratory evaluations.

When the male notices alteration of his orgasmic response pattern from the usual two-stage to a one-stage process, when he consistently responds during the orgasmic experience with the loss of seminal fluid volume without significant ejaculatory pressure, when the average ejaculatory volume is cut at least in half, and when none of these reactions develop under the extenuating circumstances of a long-continued plateau phase of voluntary ejaculatory control, he may be experiencing the physiological expression of reduced production of male sex-steroid to metabolically dysfunctional levels.

Occasionally prostatic pain develops from spastic contractions of the organ during the ejaculatory process.

These spastic contractions create a continuing sense of ejaculatory urgency that may last through the entire orgasmic experience until full expulsion of the seminal-fluid bolus has occurred.

With the subjectively painful evidence of physiological prostatic spasm recurring with most ejaculatory experiences and no obvious pathology of the prostate gland demonstrable to adequate urological examination, sex-steroid replacement also may be indicated.

Until there is a more reliable laboratory definition of a general metabolic need for testosterone replacement and until the clinical existence of the male climacteric can be defined with security during treatment of older men for sexual dysfunction, individual eases must be treated empirically.

If the sexually dysfunctional male describes physiological or psychological symptomatology that appears to indicate the clinical need for the sex-steroid replacement and if the general physical and laboratory evaluations are negative, there is no professional hesitancy to institute such replacement techniques.

However, sex-steroid-replacement techniques are not employed routinely for the 50 to 70 year age group man referred for therapy.

Steroid replacement concepts and specific techniques, together with indications and contraindications for the aging male will be presented in more complete form by the Foundation in monograph format in the future.

Erection Response In Aging Male

The sexual myth most rampant in our culture today is the concept that the aging process per se will in time discourage or deny erective security to the older-age-group male. As has been described previously, the aging male may be slower to erect and may even reach the plateau phase without full erective return, but the facility and the ability to attain erection, presuming general good health and no psychogenic blocking, continues unopposed as a natural sequence well into the 80 year age group.

The aging male may note delayed erective time, a one-stage rather than a two-stage orgasmic experience, reduction in seminal-fluid volume, and decreased ejaculatory pressure, but he does not lose his facility for erection at any time.

Sexual Advantages

If this concept can be presented to and accepted by the general population, one of the great deterrents to the sexual functioning of the aging male will have been eliminated. When the conceptive ability is no longer important and reduction in seminal fluid volume and total sperm production no longer is of consequence, the aging male is potentially a most effective sexual partner.

He needs only to ejaculate at his own frequency and not based on uninformed socio-cultural demand.

There are even some sexual advantages that accrue as the male ages.

He has increased ejaculatory control and can; if he wishes, serve his female partner deftly and with full erective security. His sexual effectiveness is based not only upon his prior sexual experience but also upon the specific element of increased physiological control of the ejaculatory process.

If the aging male does not succeed in talking himself out of effective sexual functioning by worrying about the physiological factors in his sexual response patterns altered by the aging process, if his peers do not destroy his sexual confidence, if he and his partner maintain a reasonably good state of health, he certainly can and should continue unencumbered sexual functioning indefinitely.

Categories
Aging Male Sex

Ejaculations, Seminal Fluid

Ejaculations, Seminal, Fluid, Seminal Fluid

Seminal-fluid volume is gradually reduced during the aging process.

In the younger man with 24-36 hours of prior ejaculatory continence, the total, seminal-fluid volume averages 3-5 ml, while with a similar continence pattern, an output of 2-3 ml is within normal limits for the post 50 male.

These definitive physiological changes seem not to detract from the aging male’s orgasmic experience, subjective interpretation of which usually is one of extreme sensate pleasure.

The orgasmic episode is fully enjoyed, regardless of whether the first stage is altered significantly or even totally missing from the experience.

Obvious reductions in ejaculatory pressure and volume do not alter the male’s basic focus upon the sensate pleasure of the experience. The clinical concern that develops with the advent of these physical changes in the cycle of sexual response occurs when aging males do not understand the physiological appropriateness of their altered sexual response patterning.

If a man who experiences a brief one stage orgasmic episode and ejaculates a reduced seminal fluid volume under little or no pressure does not understand that these altered reaction patterns are naturally occurring phenomena after voluntarily prolonged excitement or plateau phases of sexual tension, he may become extremely concerned about his sexual functioning.

He may be frightened by the fallacious concept that he is in the process of losing his ability to function in a sexually effective manner.

The fact

On the very next occasion for a coital connection, there may be very rapid progress from excitement through the plateau to a two-stage orgasmic process, significant ejaculatory pressure, and an adequate seminal-fluid volume does not appease the anxious male.

He has noted specific physiological variants in aging sexual functioning on at least one occasion and is aware of no logical explanation for their development.

It never occurs to him that during the first episode, when there was a marked alteration of his usual response pattern, the marital partners were selectively directing themselves to the wife’s pleasure, while during the second experience the sexual partners had turned the tables and obviously were intent upon deriving male release and sexual satiation.

Following the usual dictates of our culture, when any alteration occurs in the structuring of man’s sexual response pattern that he does not understand, he falls into the psychosocial trap of the cultural demand for the constancy of male sexual performance and worries about the possible loss of masculinity.

The resolution phase of the older man’s sexual response cycle also evidences marked physiological alteration from his previously established response patterning. As the male ages, his refractory period, the period following ejaculation, during which the male is biophysically unresponsive to sexual stimuli, extends in a parallel fashion.

The refractory period of the younger man usually continues for but a matter of minutes before he can return to full erection under the influence of effective sexual stimulation.

The refractory period for the aging male occasionally may continue for a matter of minutes, but usually, it is a matter of hours before return to full erection is possible.

Again, if this phenomenon is understood by women as well as by men, the older man will not worry about being unable to respond to a repetitive mounting opportunity as he could when in the 20 to 40 year age group.

Neither he nor his wife will be creating fears for sexual performance if there is no attempt to force erective return when he is in a physiologically extended refractory period. It also should be pointed out that, as opposed to the younger man;

The aging male may lose his erection after ejaculation quickly.

There may not be a two-stage loss of erection as in the younger man’s natural response pattern.

Frequently, the older man’s penis returns to its flaccid state in a matter of seconds after ejaculation, instead of the younger man’s pattern of minutes or even hours.

The informed older man will not be concerned by his response variants if educated to understand that the variants are natural results of physiological involution. But should he not have this information, the penis’s literally falling from the vagina immediately after ejaculation can stimulate real fears for the adequacy of performance.

When an uninformed older man endures the first experience of losing an erection so rapidly, he immediately may wonder whether he will be able to achieve a fully effective erection the next time there is a coital opportunity.

When he worries about erective capacity, he tends to try to force or will an effective erection with subsequent coital exposure. Then he is in difficulty.

A plea must be entered for the wide dissemination of information on the natural physiological variants of the aging male’s sexual response cycle, to support not only the men but also the women in our society.

The wife of the 50 to 70-year-old man also must understand the natural evolutionary changes inherent in her husband’s aging process. Once she appreciates the continuing male facility for sexual expression regardless of the changed response pattern, she will be infinitely more comfortable about importuning her husband sexually.

She will not worry about his delayed erection time when fully aware that it does not mean that he no longer finds her attractive. The less than fully erect penis sometimes present in the plateau phase can be readily inserted by a perceptive woman with the sure knowledge after successful intromission that her husband’s first few penile strokes will aid in the full development of the erection.

An informed wife will not hesitate to be sexually demonstrative when she realizes that once the coital connection has been established her husband has increased facility for ejaculatory control.

Confident of her own and her husband’s facility to respond successfully, even though the typical response patterns of their younger years have been altered, the concerned wife can meet her husband freely without the usual cultural reservations.

This security of sexual performance for the aging man and woman comes only from the wide dissemination of information from authoritative sources.

Categories
Aging Male Sex

ED in Aging Male

ed, erectile dysfunction, sexual dysfuntion

Composite case studies have been selected to identify and illustrate the dysfunctional characteristics of the male aging process.

Both Mr. and Mrs. A were 66 and 62 years of age when referred to the Foundation for sexual inadequacy. They had been married 39 years and had three children, the youngest of which was 23 years of age. All children were married and living outside the home.

They had maintained reasonably effective sexual interchange during their marriage.

Mr. A had no difficulty with erection, reasonable ejaculatory control, and, aside from two occasions of prostitute exposure, had been fully committed to the marriage. Mrs. A occasionally orgasmic during intercourse and regularly orgasmic during her occasional masturbatory experiences had continued regularity of coital exposure with her husband until five years before referral for therapy.

Mr. A had recently retired from a major manufacturing concern. He had been relatively successful in his work and there were no specific financial problems facing man and wife during their declining years.

Both members of the marital unit had enjoyed good health throughout the marriage. At age 61, he had taken his wife abroad on a vacation trip which entailed many sightseeing trips with a different city on the agenda almost every day.

They were chronically tired during the exhausting trip, but because they were on vacation and away from home there was a definite increase over the established frequency of coital connections. Mr. A noted for the first time slowed erective attainment.

Regardless of his level of sexual interest or the depth of his wife’s commitment to the specific sexual experience, it took him progressively longer to attain a full erection. With each sexual exposure his concern for the delay in erective security increased until finally, just before termination of the vacation trip, he failed for the first time to achieve an erection quality sufficient for vaginal penetration.

When the coital opportunity first developed after return home, erection was attained, but again it was quite slow in development. The next two opportunities were only partially successful from an erective point of view, and thereafter he was secondarily impotent.

After several months they consulted their physician and were assured that this loss of erective power comes to all men as they age and that there was nothing to be done. Loath to accept the verdict, they tried on several occasions to force an erection with no success. Mr. A was seriously depressed for several months but recovered without apparent incident.

Approximately 18 months after the vacation trip, the couple had accepted their “fate.” The impotence was acknowledged to be a natural result of the aging process. This resigned attitude lasted approximately four years.

Although initially the marital unit and their physician had fallen into the socio-cultural trap of accepting the concept of sexual inadequacy as an aging phenomenon, the more Mr. and Mrs. A considered their dysfunction the less willing they were to accept the blanket concept that lack of erective security was purely the result of the aging process.

They reasoned that they were in good health, had no basic concerns as a marital unit, and took good care of themselves physically. Therefore, why was this dysfunction to be expected simply because some of their friends reportedly had accepted the loss of male erective prowess as a natural occurrence?

Each partner underwent a thorough medical checkup and sought several authoritative opinions, refusing to accept the concept of the irreversibility of their sexual distress. Finally, approximately five years after the onset of a full degree of secondary impotence, they were referred for treatment.

Sexual functioning was reconstituted for this marital unit within the first week after they arrived at the Foundation and as soon as they could absorb and accept the basic material directed toward the variation in the physiological functioning of the aging male.

No longer were they concerned with the delay in erective attainment; there were no more attempts to will, force, or strain to accomplish erection under assumed pressures of performance.

In short:

They needed only the security of the knowledge that the response pattern which initially had raised the basic fear of dysfunction was a perfectly natural result of the involutional process.

When they could accept the fact that it naturally took longer for an older man to achieve an erection, particularly if he were tired or distracted, the basis for their own sexual inadequacy disappeared.

Some six years after termination of the acute phase of therapy, this couple, now in the early seventies and late sixties, continue coital connection once or twice a week.

The husband has learned to ejaculate on his own demand schedule, and neither partner attempts a rapid return to sexual function after a mutually satisfactory sexual episode.

Husband and wife B

The husband, age 62, and his wife, age 63, were referred to the Foundation. They had two children, both of whom were married and lived out of the home.

Their sexual dysfunction had begun when the husband was 57 years old. He had noted some delay in attaining erection and marked reduction in ejaculatory volume and was particularly concerned with the fact that the ejaculatory experience was one of mere dribbling of seminal fluid from the external urethral meatus, under obviously reduced pressure.

All these involutional signs and symptoms developed within approximately a year after he had noticed some delay in onset of erection attainment.

The more he worried about his symptoms the more frequent the occasions of impotence.

Mrs. B was completely convinced that this pattern of sexual involution was true to be expected as part of the aging process.

Rather than distress her husband, she suggested that they use separate bedrooms.

She changed from a pattern of free and easy exchange of sexual demand to one of availability for coital connection only at her husband’s expression of interest. To resolve her own sexual tensions, she masturbated about once every ten days to two weeks without her husband’s knowledge.

Finally, Mr. B developed severe prostatic spasm with ejaculation during approximately half the increasingly rare occasions when there was sufficient erective security to establish a coital connection. It was the persistence of this symptom of pain that first brought medical consultation and ultimately referral for treatment.

In the evaluation of this man during the physical examination, there was marked muscular weakness noted, a history of easy fatigability, and increasing lassitude in physical expression.

Mr. B also had been distressed in the last two to three years before referral to therapy with distinct memory loss for recent events. He described the loss of work effectiveness for approximately the same length of time.

With these overt symptoms suggestive of steroid starvation, testosterone replacement was initiated empirically. Within those days there was the partial return of ejaculatory pressure and a moderate shortening of the time span for the delayed erective reaction. The prostatic pain did not recur.

Husband and wife B Steroid Replacement

Once Mrs. B could accept the explanation for the onset of her husband’s sexual dysfunction, she was pleased to return to the role of an active sexual partner. The coital connection has continued regularly for the past three years with both members of the marital unit supported by steroid-replacement techniques.

In brief, for the sexually dysfunctional aging male, the primary concern is one of education so that both the man and his wife can understand the natural involutional changes that can develop within their established pattern of sexual performance.

Sex steroid replacement should be employed only if definite physical evidence of the male climacteric exists. As the newer techniques for establishing testosterone levels in blood serum become more widely disseminated, it will be infinitely easier to define and describe the male climacteric and therefore to offer testosterone replacement to those who need it, on a more definitive basis than the empirical diagnosis.

With effective dissemination of information by proper authority, the aging man can be expected to continue in a sexually effective manner into his ninth decade. Fears of performance are engendered by a lack of knowledge of the natural involutional changes in male sexual responsivity that accompany the aging process.

Really, the only factor that the aging male must understand is that loss of erective prowess is not a natural component of aging.

Statistical evaluation of the aging population and a consideration of treatment failure rates will constitute the following section. This material arbitrarily has been placed in the male rather than the female.

First, it was felt important to keep the statistical consideration of the aging marital units together, and second, because there were 56 males So years old or over in marital units accepted for treatment and only 37 wives 50 or older, it seemed appropriate to include the brief statistical discussion in the chapter reflecting the larger segment of the aging population.