Men with normal erotic preferences may experience difficulties during sexual intercourse. Some are impotent since they either cannot obtain an erection or are unable to maintain it once they do have it. This is one of the most common sexual dysfunctions seen clinically. Another problem is premature ejaculation in which the male climaxes too soon to allow his female partner to attain orgasm as well. The concept of premature ejaculation can be particularly difficult to define. Kilmann and Auerbach33 who reviewed the literature on this topic noted that time to orgasm was often important in defining the problem. Obler56 used "ejaculation in less than 2 minutes" as significant while Masters and Johnson50, noting the variability in each couple's performance, suggested that a male who could not delay ejaculation long enough on 50% of sexual occasions for the female to climax was impotent. The female's contribution is ignored for, as Kilmann and Auerbach noted, a male who could only delay ejaculation 30 minutes for his female partner who took 45 minutes would be considered a premature ejaculator. All men might be premature ejaculators in some instances with a partner or may not be dysfunctional for one partner but would be for another (cf. 77).
Mr. A was an exhibitionist who had intercourse with over 100 women. He was charming and when he first came to my office, several female staff commented on his good looks after he left. He illustrates how different women as partners can define the sexual dysfunction.