Delayed Ejaculation (also known as retarded ejaculation)
One possibly useful treatment methodology is to employ a series of exercises which are effectively a kind of CBT or cognitive behavioral therapy. Classically, a man would be encouraged to masturbate to orgasm in a series of graded steps, on successive occasions, starting with his partner some distance away, and ending with her on top of him, before finalizing the sequence by masturbating to the point of orgasm and then inserting his penis into her vagina just before he climaxes. In this series of steps, the woman would be encouraged to lend a helping hand by masturbating her partner firmly with plenty of lubrication. We've observed that some men who've undergone this treatment are subsequently able to engage in sex and ejaculate much more easily. It's almost as though a single act of release within the partner is enough to break down the psychological barrier and establishing a new behavior pattern. Unfortunately the technique often involves vigorous – if not rough – stimulation of the penis, and it does not, of course, address any relationship issues which may be at play. Indeed, once intercourse is resumed, or more accurately once intercourse is again possible, the relationship issues that have been obscured by the delayed ejaculation often come bubbling to the surface very quickly. After all, not having sex will prevent many confliction issues from surfacing in a relationship. It's certainly true that a couple have to be highly motivated to solve this problem, and that good communication is absolutely essential, as is patience, mutual support, and a great deal of sensitivity. The sensate focus technique, whereby a man is re-sensitized to the sensual input of his body during intimate relations, can be very successful in treating delayed ejaculation, with or without deep psychotherapy. There's something about the relaxation and sensory input which allows a man who is ready for transformation to undergo some kind of internal change that allows him to "rewire" the neural patterns in his brain which appear to be responsible for the flawed sexual response that lies behind his retarded ejaculation, and allow him to ejaculate normally with appropriate treatment for delayed ejaculation and anorgasmia. Perhaps the key factor in the success of this treatment is that a man already has a subconscious understanding that he is not getting the pleasure from sex that is his birthright, and he's therefore ready to make the shift to a different way of approaching intimacy, physical stimulation and sex. Although it's occasionally of great benefit to a woman when her partner maintains an erection for a prolonged period of time without reaching climax, in the sense that she may be able to reach orgasm multiple times during intercourse, most of the time the situation just results in frustration, soreness, and irritability – not to mention self-doubt. The man will wonder what's wrong with him, when he can't achieve the most fundamental thing that men are expected to do with women, while the woman will wonder whether or not his failure to reach orgasm without receiving retarded ejaculation treatment - is due to the fact that he finds her unattractive. The most fundamental dynamic of any sexual relationship is that the man has a deep instinct to penetrate and "give" to the woman, while she has a deep instinct to be penetrated and "receive" from the man. Anything that interrupts this dynamic will of course unsettle both partners. Theory aside, what we've discovered in our practical sessions with men who seek out retarded ejaculation treatment is that about 80% of them will respond quickly to treatment, and in general another 16% will respond well to treatment over a prolonged period of time. And the form that this treatment takes? As we said before, it depends on the nature of the problem. The form of DE that is acquired later in life is in fact slightly more common than the lifelong form. I'd say that it was also slightly more common for delayed ejaculation to be partner specific than generalized to all partners, which is a good clue that there are deep relationship issues at work in many cases. If the man who has difficulty reaching his natural conclusion during intercourse has a very strict religious background, a degree of fear or anger against women, or a need to be in control in all situations, or if he has high levels of existential shame, then therapy needs to focus on both the sexual dysfunction and the deeper issues. And to turn sex back into a pleasure that produces joy rather than frustration, the co-operation of the partner is essential, as is an approach that takes into account all the other personality traits which may be at play. These include perfectionism, anxiety, disconnection from the body, disassociation during sex, and generalized self-esteem issues. It's often also helpful to provide factual information about the nature of intercourse for an average couple (if any such thing exists!), and to provide a series of sensate focus exercises during which sexual contact is banned, so that the psychological pressure on both partners is reduced. In essence, sensate focus is one of our principal retarded ejaculation treatments, and works extremely well when a man is unable to ejaculate – the method is described on this website. It's also helpful to have some simple changes in routine such as extending the interval between sex so that mutual desire is higher; equally, changing sexual behavior so that the couple can focus on intimacy rather than orgasm as the expected outcome can be helpful. Once again, this is about taking the pressure off the partners and removing the expectation that the man will have to reach orgasm. The very fact that it doesn't matter whether he does or he doesn't during a particular session of intimacy can in itself give both partners the permission to relax and enjoy the sensual aspects of their interaction. This in turn often promotes greater arousal and desire; in this context, it's a common experience for therapists who prescribe sensate focus to find that a couple will arrive for a session with big smiles on their faces - this is a pretty good indicator that the couple have reached a point where they naturally felt able to break through the "ban" on intercourse spontaneously. The other useful thing about sensate focus is that it's a progressive treatment which starts with a couple having completely nonsexual contact, and progresses through to full intercourse. Re-establishing connection with the sensual aspects of nakedness and mutual intimacy allows a couple to reduce their anxiety about sex and places their attention quite simply on what feels good. Since most sexual arousal actually originates in the body anyway, it's usually not long before a couple become aroused and wish to progress on to more overtly sexual contact. Finally, it's also important that a man who relies excessively on fantasy for his physical arousal is taught to respond to stimulation of his body instead. Moving from a place where a couple's expectations are focused on orgasm to a focus on sensuality and physical pleasure instead can be the single most helpful factor in treating delayed ejaculation. |