A guy 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.