Psychological Treatment Of Delayed Ejaculation

Establishing The Facts

The first step in treatment if you see a sex therapist is likely to involve some kind of assessment of when you can actually achieve orgasm in sex. And here a number of typical questions that you might like to think aboutÖ questions that are relevant for the therapist and client alike!

  • Does the man experience performance pressure right from the start of intercourse or does it begin later on?
  • To what degree does the man feel himself to be "spectatoring", that is to say detached from the sexual process in which he is engaged with his partner, and to what degree does he feel himself fully involved from moment to moment?
  • Does the man have sexual fantasies, and does he accept them without guilt or shame?
  • Does the man focus on satisfying his sexual partner, or is he also aware of his own needs and does he set out to have them fulfilled?
  • Does the man believed that his partner is interested in sex with him, or that she is just tolerating it?
  • Does the man feel any anxiety or apprehension around the prospect of orgasm and ejaculation (especially intravaginally), or alternatively with the loss of control that he may feel if he ejaculates?
  • And finally - how does the man with PE masturbate? Does he use internal erotic imagery or sexual fantasies and accept these easily or try to repress them?

Now, these questions are designed to address the issues that a man seeking a cure for delayed ejaculation may face during sex. There are, of course, deeper issues which can be examined Ė such as feelings of anger or hostility towards the manís partner - but such psychodynamically complex issues generally emerge as therapy continues.

Short Term Treatment Measures

In the short term, there is considerable benefit to be achieved from the man reducing his masturbation frequency, and if heís using hard or idiosyncratic techniques to masturbate, switching to high quality lubricants such as massage oil and gentle movements of his hand are also helpful.

Becoming aware of his own arousal on a scale from 1 to 10 is also a critical factor in recovering the ability to connect with the internal erotic world.

However, what achieves great success are sensate focus-type exercises that are designed to bring the couple into closer connection with their own sexuality, the intimacy that it can bring to each other, and to develop what one could broadly described as "a relaxed" attitude to sex.

For those men who have difficulty revealing their feelings, some coaching may be needed in opening up and allowing his feelings to be seen by his partner.

Itís critical to obtain some motivating factor Ė for example, if a man is not experiencing good erections then offering Viagra to overcome this difficulty may provide new hope around both the prospect of satisfying intercourse and the prospect of enjoying ejaculation during intercourse.

Desensitization As A Way To Reach Orgasm

In essence, for men who have a degree of sexual inhibition or disconnection, desensitization is essential - this is a gradual approach which allows increasing experience of sexuality, intimacy, mutual touching, and non-anxious sexual behavior in the presence of the partner.

This may involve a graded series of exercises, starting (for example) with man masturbating to the point of orgasm with his partner in the next room with the door closed; progressing gradually to masturbation while his partner is in the next room with the door open; and finally masturbating while his partnerís present in the same room.

For anybody who has had difficulty with privacy or intimacy, or who has experienced invasion of their boundaries as a child, such gradual processes can overcome both emotional inhibition like guilt and shame as well as physical inhibitions such as those caused by traumatic masturbatory conditioning. Clearly the caring assistance of a dedicated partner is going to be helpful in such circumstances.

Itís hard to generalize about therapeutic approaches for delayed ejaculation because each case has its own unique features. Nonetheless sex therapy for delayed ejaculation is a well-established treatment protocol.

 


There have traditionally been two models for treating PE: The Inadequate Stimulation Model and The Desire-Deficit Model.

In the inadequate stimulation model, there are two different approaches for therapy.

First of all, thereís a treatment for delayed ejaculation based on behavior therapy. This assumes that the reason the man is not ejaculating is because he is not receiving enough stimulation to take him over the point of arousal at which his reflex ejaculation reaction would be triggered.

The treatment for this has often often been harsh and vigorous stimulation of the penis to the point of ejaculation.

And secondly, thereís an approach which is basically psychodynamically orientated and suggests that the symptoms of delayed ejaculation are the result of unconscious inhibition of orgasm because of unconscious conflicts or issues around sex. And does that mean you have to dive deep into your subconscious? No. Not really.

The desire deficit model was developed by Bernard Apfelbaum, who believes that the loss or absence of ejaculation is actually the product of low sexual desire or arousal.

From this viewpoint, any strategy which seeks to overcome the inhibition of ejaculation by providing harsh and vigorous stimulation to the penis is counter-productive because it increases the manís performance anxiety and makes the situation worse.

Bernard Apfelbaum suggested that in fact the right approach was to uncover and deal with any psychological issues that were causing the man to be inhibited sexually or making him fail to enjoy or enter into sexual relationships. Apfelbaum also suggested that the sustained hard erections that occur in (some) men with delayed ejaculation are not necessarily a sign of his high level of sexual arousal.

Apfelbaumís approach emphasizes the importance of the man taking responsibility for his sexual functioning, the starting point of which will generally be that the man should accept that he and his partner have an equal right to sexual pleasure, and that itís not his responsibility to please his partner Ė but it is his responsibility to ensure that he himself is satisfied sexually.

Apfelbaumís approach has been criticized on the grounds that not all men with delayed ejaculation show what Apfelbaum described as the key diagnostic feature of retarded ejaculation Ė that only the manís own touch is erotically arousing, and that his sexual orientation is autosexual (i.e. he gets pleasure from masturbation).

The fact is, many men are autosexual because this is actually the only way in which they can reach orgasm. And, as I have seen in my practice, many of them actually wish to have enjoyable sex with their partner, and feel a great deal of anxiety and pressure because of this internal desire rather than from their partnerís demands around sex.

Nonetheless, we always make the main goal of sex therapy in either approach our aim to encourage any man who is experiencing this level of sexual dysfunction to be able to openly express his feelings, to become more sexually aroused, and to bypass what he experiences as demands for a particular kind of "sexual performance" (as in, perhaps, making the woman orgasm during sex).

However, deep-rooted psychodynamic conflicts may take some time to resolve, so that in clinical practice, several sessions of therapy may be essential to establish a new viewpoint which allows a man to see how he has been inhibited from sexual expression by his previous experience.

In treating delayed ejaculation, no single approach will help all men.

This means that a great deal of flexibility is required in approaching the cure. However, there are certain essential elements that you could expect to be part of any treatment.

These include improving sexual techniques, that is to say becoming competent in sexual experience and lovemaking, and becoming more confident and self-accepting.

That means changing your self-image around sex ("I am a good lover and I can satisfy my partner!"). And thirdly, it also means using strategies which will promote a better relationship with your partner, both sexual and non-sexual. Such techniques also improve intimacy and allow mutual expression of love and affection within the relationship. Sex education, and instruction on how to make love in a way that satisfies both partners is usually helpful.


Back to delayed ejaculation

Using these approaches, delayed ejaculation can be successfully cured in only a few months, particularly if the problem results from the fact that either partner is lacking specific information about sex. The same is true if the problem comes from anxiety, or perhaps not having a sufficiently clear focus on oneís own pleasure during lovemaking.

Another critical aspect of treating delayed ejaculation is something about behavioral accommodation: that is to say, long-term issues that cause sexual difficulties are discovered, explored, and resolved as far as possible.

Sometimes the result of this is that delayed ejaculation diminishes in intensity but continues to be an issue from time to time, leaving a man able to ejaculate during lovemaking on the majority of occasions that a couple are intimate.

A suitable case for treatment

Certainly in every case, there has to be exploration of the possible biological, psychological, and genetic reasons why a man might be experiencing difficulty in reaching climax in a more timely way during intercourse.

As weíve already suggested on another page, if part of the problem is that a man is in getting too little stimulation during lovemaking, then itís possible to use additional "artificial" stimulation of his sensory and erogenous zones to increase his arousal.

This might include nipple stimulation, anal stimulation, or the use of a vibrator, which might be applied on the perineum, the base of the penile shaft, or other sensitive areas. Some men have found these approaches to be very helpful in speeding up arrival at orgasm.

You can see a couple of well-known sex pundits talking about vibrators for men in the video below. These tools may make a manís climax slightly faster but it may still have a tendency to dawdle slowly and linger along the way!



Other problems with retarded ejaculation

Furthermore, as weíve already suggested, any medication which might be interfering with the manís sexual responses should be stopped, or an alternative prescription found. Many prescriptions medications can delay ejaculation.

One of the interesting aspects about treating this condition is that obviously by the time a man and his partner come for treatment, he may be extremely frustrated with his own progress, and this impatience can sometimes act against the successful outcome of delayed ejaculation treatment.

If this applies to you, itís important to realize that the benefits you might get in the longer term will far outweigh the inconvenience now (in the sense that you think youíre "doing nothing" during treatment that goes slowly or takes a long time).

And because we know that anxiety and obsessive-compulsive characteristics are major aspects of delayed ejaculation, either in the sense that they can create the problem, or they can compound it, then clearly using any kind of technique that reduces anxiety will be a significant part of therapy for the retardation of ejaculation.

Now in essence these are cognitive-behavioral techniques, and Iíve written about them on another page, but Iíd like to go over them again here.

Behavior Therapy For Delayed Ejaculation

Therapists often start with mindfulness and breathing techniques which will increase a sense of self-awareness and induce progressive relaxation.

Naturally, one of the reasons that a man doesnít reach the point of ejaculation is that his sexual arousal isnít high enough to trigger his ejaculation. He hasnít (or doesnít) reached the point of no return, so using techniques that increase sensory receptiveness and awareness are also a helpful part of any solution.

For example, men with delayed ejaculation may find that they have a kind of "sensory defensiveness".

What this means in practice is that particular sensory input either doesnít register in the normal way, because itís repressed, or it produces a high level of anxiety, sometimes, in fact, overwhelming anxiety.

Now I know from working with men that such anxiety can be produced by many different aspects of intimate relationships: for example, open-mouthed kissing, or the sensation or smell of the vagina may produce a great deal of uncomfortable feelings or anxiety.

And sometimes these can even produce aversion, which will actually inhibit the development of normal sexual arousal.

One way of dealing with this within a behavioral treatment approach will be to use some kind of non-demand approach: this means exploring the problematic stimulus in a way that increases the manís tolerance of this particular type of sensory stimulation.

Just to give one example of this, if a manís inhibited and slow sexual responses have something to do with the sensation of vaginal wetness, then using lubrication on the body, rubbing sexual organs, and exploring stimulation in the shower together may be helpful.

Video: Sensate focus - HOW TO REDUCE ANXIETY AND INCREASE DESIRE!

Idiosyncratic masturbation & therapeutic resistance

As for idiosyncratic masturbation, sexual therapy would generally encourage a man with delayed ejaculation to use different positions and intensities of self stimulation, or to use different fantasies or visualizations whilst masturbating.

The aim here is to break the set established patterns that have played out over such a long time. And increased flexibility of approach to masturbation will help a man to develop further patterns of stimulation and responsivity during sex with a partner.

Should resistance come up during therapy, it needs to be explored.

Clearly resistance to therapy for ejaculatory delay, particularly in situations where a man claims that he wants to "cure" the problem, is indicative of a difficulty, either psychological or behavioral, that could get in the way of effective treatment.

As has been observed several times, men who experience resistance may well become aware that they do not, in fact, like their sexual partner.

Delayed Ejaculation and Subconscious Resistance

Delayed ejaculation can be a method of expressing that fact. Itís a way that the manís penis can express what heís really feeling, without him having to be consciously aware of what heís feeling.

And yes, you are correct if youíre wondering there might be a danger here that the relationship will end when this fact becomes conscious.

But another possibility is that exploring this resistance consciously can offer men and their partners and insight into why sex between them is an arousing or unappealing.

It may be, for example, that a man who is slow to ejaculate has a belief system that he is sexually inadequate, and his performance in bed is inadequate satisfy his partner.

It may be that he is being over-attentive to his partnerís needs, and paying no attention to his own sexual needs: perhaps the man believes that sex and aggression donít mix, or that he needs to pay great attention to his partner.

Itís also possible that a man can simply be "trying too hard", and not feeling any pleasure, because he feels a very high level of demand on him during lovemaking. That can be why his ejaculation is delayed.

Generally, with effective therapy, a man can come to see that these messages are simply picked up from other people within the family, or from some other aspect of the individual psychological history.

Masturbation as therapy for retarded climax in males

And what if the man doesnít currently have a sexual partner? How then can therapy proceed?

The answer seems to be that a therapist could recommend that a man uses masturbation with a vibrator, seeks out further sexual information and understanding, and explores his history in a way that might shed light on why he is having difficulty reaching orgasm.

Since a few men do have difficulty reaching orgasm during masturbation, this particular form of delayed ejaculation can be approached without a partner, by exploring flexibility in masturbation techniques.

Furthermore, focusing on increasing oneís sexual arousal without looking to the goal of reaching orgasm can allow a man to experience a different approach to climax. This puts the emphasis on pleasure rather than sexual performance. This can often help with delayed ejaculation, and it certainly avoid "spectatoring".

Sexual Pleasure vs Sexual Performance - watch the video!


Things that need to be approached during behavioral treatment of delayed ejaculation include

  • a tendency to retreat to masturbation rather than being involved with a partner
  • information and assistance around anxiety that may come up during sexual activity
  • some coaching in relationship issues such as non-demand pleasurable touch, increased intimacy, and encouraging focus on the relationship that goes beyond a sexual aspects of the coupleís interaction.
  • if there is any aspect of flashback or other sexual triggers during intimacy, then individual therapy should be applied so as to eliminate any trauma from the past.


 

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More Information On The Treatment Of DE

[ Treatment - The Psychological Approach ] How To End Ejaculation Delays ] Cognitive Behavioral Treatment ]


Videos You Might Find Helpful - Causes Of DE

 


 

Key Points

Delayed ejaculation can be solved at home in privacy, using a self-help treatment program.

You can deal with relationship issues, communication problems, low sex drive, low arousal, and long lasting sex.

Your objective is always about getting back to "normal" ejaculation speed.

 

Your investment of time in getting over delayed ejaculation will be about 30 minutes, 3 times a week.

You'll need a sexual partner for the final series of exercises, but the initial work you can do on your own.

 

Enjoying better sex can be a great journey of discover, self-exploration, coming into deeper contact with your masculinity and your own male power.

Whatever happens, you will be more of a man.

 

 

Updated August 12, 2016