We speak of a patient presenting absence of ejaculation when he can maintain a normal sexual life, in which the erection and pleasure are perfectly preserved , but, on the contrary, he cannot ejaculate.
It is important to note the difference between ejaculation and orgasm , as both can occur independently of each other. In the first, which is of testicular origin, there is an expulsion of semen to the outside. In the second, a pleasant and liberating response originating in the central nervous system (CNS) is perceived. In reality, ejaculation usually occurs when the orgasm is already wearing off.
Lack of ejaculation has traditionally been considered impotence. However, it is currently more understood, associated with a case of reverse premature ejaculation.
In a great majority of cases, the lack of ejaculation appears in people with a personal history related to repression in the sexual plane . Kinsey Reports in a proportion of one thousand mentioned for this medical condition, maintaining the relativity of the data. Other reports report a somewhat lower percentage of occurrence.
Although there are cases of total absence of ejaculation, the greatest medical dilemma appears when ejaculation has taken place at some point in life, to disappear later.
It has been possible to document cases in which traumatic situations related to sexual life are evidenced and that have a well-defined origin, as well as educational situations that include the demonization of masturbation or the superstitious terror of women.
Other cases refer to defensive reactions to premature ejaculation or to the idea of not being able to satisfy the partner sexually.
Almost in all cases, the lack of ejaculation is linked to a personal, emotional and / or educational development in which sexuality has not been integrated in a healthy way in the totality of the individual. Ejaculation has been elevated, on these occasions, to the highest value quality of sexual capacity, as a test of virility.
The sexuality of these patients is very weakened, feeling increasing anxiety to show and prove, before a possible partner and before himself, his own sexual capacity.
This anxious situation can evolve into truly complex pathologies that are difficult for sexologists to address. These are patients who, the more they have tried to get out of their problem, the more they have delved into it, since many of them have rejected the idea of consulting a professional for a long time, either out of embarrassment or distrust.
There is an important factor that works against the solution of the problem, and it is the demand by the patient for a drug or medical-surgical solution, for a problem that he previously assumes as of organic origin, so the approach of a sexological approach and psychological may not be well received.
The therapeutic response begins with a cognitive, emotional and behavioral sexual restructuring, and then moves on to a sexual education more focused on the sensual and erotic aspects than on the physical responses of the genitalia.
Once the collaboration of the patient and their involvement in the process is achieved, the results of the intervention on the absence of ejaculation show really optimistic results, with a high percentage of total recovery .
In short, the absence of ejaculation is a problem of a personal nature but that encompasses an educational and social context, which can lead us to reflect on the terrible consequences that the stereotypical idea of masculinity has in our lives and that of our partners.
Kinsey, AC, Pomery, WB, & Martin, CE , 1948. Doi: 10.1002 / ajpa.1330060119
