It is not untypical for a middle aged couple beset by delayed ejaculation to split up, chiefly because one partner wishes to achieve greater sexual satisfaction and pleasure while the other is threatened by the disruption to the status quo that would ensue if the man obtained treatment for his ejaculatory issues.
When the woman provokes the breakup, it is not uncommon for the man to find that he is sexually more competent with a new partner, especially if she is less demanding and expectant than his previous partner. In such circumstances he is often able to learn to ejaculate intravaginally in more general ways compared to the rather limited or indeed very specific situations in which he was able to do this with his previous partner (if in fact he was able to ejaculate during sex at all).
Such situations exemplify the fact that a woman’s internal psychic conflicts are often evoked by any improvement in the ejaculatory capacity of her male partner. This may mean that the woman sees herself as having to “service” the man, a fact which can sometimes be traced back to traumatic sexual events in her history. A relationship like this is burdened by unresolved conflicts and deep psychological wounds in both partners. The treatment for delayed ejaculation therefore doesn’t just depend on the severity of the condition, or on whether it is primary DE or secondary DE, but also on the extent of the commitment to therapy on the part of both the man and his partner.
It’s important to remember that retarded ejaculation is involuntary and unconscious inhibition of sexual response. Naturally, the goal of any treatment is to extinguish this inhibitory process so that normal ejaculation can be enjoyed by both partners. One way delayed ejaculation is treated is to use guided stimulation techniques, the object of which is to distract the man from his desire to be in control — an excessive level of control — and to increase the stimulation that is available so that he can hope to achieve orgasm more easily during coitus.
There are two basic methodologies: the first is desensitization, and the second is a process of psychodynamically reframing the man’s perceptions and beliefs about sexual intercourse.
Desensitization consists of a series of steps which have been specifically worked out to suit the man concerned: each step gradually increases the level of sexual stimulation which he is receiving, so that he can become accustomed to the new situation and learn to ejaculate before he moves on to the next. Clearly, each time he progresses to the next level of stimulation, his inhibition is lowered. In a real-life situation, a couple would be instructed to perform a series of sexual tasks which addressed gradually greater levels of inhibition. So, for example, the initial request made of the man would be shaped according to his level of inhibition and his ultimate goal of intravaginal ejaculation. It follows that the patient’s cooperation is essential: he must be ready to monitor and report the level of arousal that he experiences in each of the steps along the treatment path.
Furthermore, both the man and his partner need to be guided so that they can achieve more effective physical stimulation, perhaps using erotic fantasies and other tools to greater arousal. If the man can cope with the anxiety induced by his increased arousal, and can dispel it using progressive relaxation techniques, and if he is not threatened by his partner or by the increasing levels of intimacy that he is likely to experience as treatment progresses, and also provided that there is no neurological barrier to his awareness of increasing levels of stimulation, nor his ability to respond to it, the man should be able to give up his need for control and respond naturally to this gradual progression of stimulation towards ejaculation. Read about progressive relaxation here.
Desensitization regimes need to be flexible, and the therapist needs to be somewhat creative. Thus, for example, if a man is initially only able to ejaculate in the absence of his partner, then the first step would be to set up a situation so he could masturbate to orgasm under those conditions. A potential next step would be to have his partner in the next room while he masturbated, then in the same room at some distance away…and so on.
However the sequence is enacted, the point is that every step in the process is planned and analyzed with the couple so that the purpose of the therapy is quite clear. Should the initial desensitization be successful, additional steps may be planned until the man is able to reach orgasm and ejaculate with his partner, hopefully during sexual intercourse. Helen Singer Kaplan described a so-called bridging maneuver to conclude this process, in which the female partner kneels over her partner while she masturbates him vigorously towards the point of ejaculation; just before he does so, she insert his erect penis into her vagina so that he ejaculates intravaginally. More sexual stimulation can be provided by stimulation of the penile shaft, testicles, or his anus — a discovery made some years later.
It appears that stimulating a man’s anus is a particularly good way of increasing his level of sexual arousal during the treatment of his delayed ejaculation. Indeed, several clients have reported to us that stimulating the man’s anus has been the final trigger that has allowed him to ejaculate more easily.
On a more general level, it’s absolutely essential that a man is given “permission” to actually enjoy sexual arousal with his partner, so he can relax into an understanding of the ideal conditions for sex. To achieve this, he is instructed to be selfish, and to “use” his partner for his own pleasure; most men with delayed ejaculation initially regard themselves as being dedicated to the provision of sexual satisfaction for their partner. The concept of being selfish during sex may trigger insights and observations which help a man to understand and release his inhibitions.
It’s also important that he understands he should only engage in sexual activity when he’s sufficiently aroused and excited to enjoy it; he must understand that no matter what his erection may look like, he needs to be sufficiently aroused. (As we know, the erection of a man who experiences delayed ejaculation is often hard and long lasting, even though he may not be particularly aroused).
It’s quite likely that during an exercise like this, a man with delayed ejaculation may start to engage in negative self talk, which can both serve as a distraction and a psychological defense: in such circumstances he should discuss with his partner what is happening, or use fantasies to increase his sexual arousal and avoid any return to a state of inhibition.
In psychodynamic therapy, it may even be helpful for the therapist to make some kind of paradoxical intervention such as “forbidding” a man to have an orgasm during intercourse; this added provocation may be effective in allowing him to break through his inhibitions around ejaculation.
All in all, sexual therapy involves a combination of psychotherapeutic methodologies which hopefully address both the man and his partner, and specifically structured exercises for retarded ejaculation treatment such as the ones on this website; these allow him to explore the unconscious hostile or aggressive defense mechanisms which delay or prevent his ejaculation. Any other defenses such as guilt, anxiety or shame must be subject to a similar analysis.
Reframing approaches which have been developed by Apfelbaum consist of treatment which is aimed at having a man acknowledge his lack of desire for sexual intercourse and his lack of arousal during sexual activity with his partner: this allows the therapist and the man to engage together in a process in which his distorted attitudes, beliefs and values can be reinterpreted in the light of factual information about healthy sexual activity. It’s important not to focus exclusively on the man’s inhibitions, but to supportively and sympathetically make a man with delayed ejaculation aware of his subconscious processes. If he is actually unable to “give” sexually to his partner — as in, unable to give of himself and more particularly to give his ejaculation — this can be reframed into an inability to take sexual pleasure from his partner, with the focus on eliminating his conscientious perfectionism, excessive control, and desire to please his partner.
It follows that this approach is best addressed to a man with delayed ejaculation who follows the classic model of being unable to take, unable to be selfish, and unable to have an orgasm during intercourse purely for his own pleasure. Changing a mindset which is about satisfying his partner, increasing his level of stimulation, and maintaining steady progress towards the point of ejaculatory inevitability, will overcome the inhibitions of erotic flow towards higher levels of arousal and orgasm.
The underlying assumption of this treatment methodology is that a man is desperately trying to achieve an orgasm for his partner rather than for himself. By constantly monitoring how aroused he may be, and by learning that his subjective level of arousal needs to increase progressively during sex, a man can increase the stimulation he receives, respond to it with greater arousal, and more coherently integrate it into his sexual experience, all the while gradually losing his inhibitions about ejaculation. It is also necessary to make sure that a man’s inhibitions about ejaculation are explained his partner so that she understands he is in effect “trying too hard” to have an orgasm on her behalf, a situation which undoubtedly increases relationship tension; when the woman understands that, she may find it easier to be more tolerant and less demanding of him.