Different Approaches To Treatment
Two factors that seem to maintain delayed ejaculation are high-frequency idiosyncratic masturbatory* behavior and the discrepancy between a man’s inner world of fantasy and the actual forms of his sexual expression with his partner.
To overcome this, a couple may find it helpful to bring the man’s masturbation fantasies into their sexual relationship.
This will not only reduce his feelings of guilt but also make it easier for him to overcome his difficulty ejaculating.
You see, something as simple as encouraging the man to masturbate with his other hand can be helpful in letting him understand how his idiosyncratic masturbation habits have perhaps become an ingrained pattern of behavior that’s led to delayed ejaculation (DE for short). (When a man who has used an idiosyncratic method of self-pleasuring tries masturbating with the other hand he often finds he cannot reach orgasm.)
From a cognitive – behavioral therapy viewpoint, the basic strategy is to identify inhibitions and anxieties so that the therapist and client can come up with new sexual scenarios and develop appropriate techniques to overcome them.
Sidebar: Quote from mytango.com
Or, he’s an “idiosyncratic masturbator,” which sounds like what they call Lady Gaga when she rubs one out. It means he can’t come while f*cking. He’s literally choking his figurative chicken when he masturbates. He’s applying so much lube, torque and pressure that a factory-standard, street-legal vagina can’t possibly compete.
The aim is always to increase erotic stimulation and identify the man’s orgasm triggers. For example, anal or nipple stimulation can be very helpful here.
All of these changes in behavior and strategies try to change thoughts, feelings and emotions around sexual activity. They are equally important. Here are some crucial aspects of our treatment program:
- Intimacy between the two partners is likely to reduce performance pressure on the man significantly; mutual pleasuring and giving will increase verbal and physical intimacy, and this will help to overcome inhibition and sexual isolation.
- An “automatic” erection does not necessarily mean a man is ready to have sex. His subjective arousal may be too low.
- A major treatment strategy is to give a man permission to enjoy sexual pleasure and to encourage him to see his ejaculation as a natural culmination of his sexual arousal.
- As treatment for delayed ejaculation proceeds, a man learns to be more direct in his requests for stimulation and more straightforward in allowing himself to enjoy erotic feelings. By being more “selfish,” he will experience more subjective sexual arousal and is more likely to enjoy an orgasm during sex.
- A great help in the treatment of delayed ejaculation can be multiple forms of stimulation and knowing what will trigger his orgasm. Multiple stimulation might include fantasy, testicle stimulation or playing with his partner’s breast or anal area during sexual intercourse.
- Orgasm triggers are very variable from person to person, but you can find out many of them by using fantasy during masturbation.
- Normal intercourse must be approached gradually, with a couple only trying intercourse when they are both highly aroused.
Treatment Protocols Outlined
Two factors more than any others have a role in causing and maintaining delayed ejaculation:
- vigorous and idiosyncratic masturbation patterns, and
- a big gap between a man’s inner world of erotic imagery and the actual reality of his sexual life with his partner.
If a man can talk to his partner about his masturbatory fantasies, he may find this relieves any sexual guilt and aids honest communication between him and his partner.
And if they can incorporate these fantasies into their sex life, this is also going to be helpful in increasing the man’s arousal and helping him to ejaculate.
There are other simple techniques which can help a man in this situation – even something as simple as switching hands during masturbation, for example, will increase his awareness of the way in which he masturbates and show him how he may be making difficulties for himself as he tries to attain orgasm and ejaculation. To put it simply: if his other hand can’t bring him to climax, no wonder his partner couldn’t do it either!
The Wonderful World Of Sex Therapy
There are many therapies which help overcome delayed ejaculation. One starting point is to examine the inhibitions and fears which may lie behind the problem and to develop sexual situations and techniques to overcome them.
Another good strategy is for the man to ask his partner for increased intimacy and eroticism.
These are what we could call “cognitive-behavioral strategies”. They involve a three-part combination:
- forming a connected and close intimate sexual team,
- enjoying comfort with sexual pleasuring, and
- increasing the level of erotic stimulation.
1. If a man and his partner form an intimate team, the degree of performance pressure which the man feels will be a lot lower. Suddenly it isn’t all about him pleasing his partner.
And helping each other to enjoy pleasure is important in generating greater intimacy, because that can overcome inhibition and a sense of separateness. This is a crucial first step in overcoming problems with ejaculation.
2. An erection does not mean a man is ready for intercourse. A man may need to be more aroused. you see, you can enjoy sexual pleasure as a precursor to gradually increasing arousal. If your arousal is high enough, you will ejaculate.
The more direct you can be about requesting stimulation, and the more you can enjoy erotic feelings, the more confident you will be of your ability to be sexual. And that means you will be more likely to enjoy high levels of arousal and reach orgasm naturally.
You see, when you can be “selfish”, and focus on your own pleasure, you are much more likely to be able to enjoy your ability to reach orgasm and end delayed ejaculation.
3. There are many ways for you to get greater stimulation and greater arousal: enjoying sexual fantasies during partner sex, enjoying stimulation of the testicles, perineum, anus and nipples are just a few of these. You and your partner can have fun discovering your individual orgasm triggers.
And it’s important you don’t initiate sexual intercourse until you’re very aroused. (Remember your sexual fantasies can be an effective way of heightening your arousal.)
What’s Your Delayed Ejaculation Hiding?
What’s at risk if you change the way you respond during sex? There will certainly be some consequences if the symptoms of your DE disappear, though what they might be will be different from couple to couple.
For example, one woman might wonder if her man will search out new sexual experiences with other women; another might wonder if her man will find her as desirable as he does now; and so on.
These points, and others like them, can be very enlightening for you and your partner to discuss as you work through these issues. You need to look at your erotic life together.
One of the biggest questions is what happens to the foundations of your relationship when you start to work on your sexual issues.
If you have a boring sexual life, and an inhibited attitude to sexual experimentation, bringing some of your hidden and dark sexual shadows into the light may make your sex lives more vibrant, flowing and exciting.
As you may know, men with slow ejaculation often show exaggerated concern for their partner as a way of hiding the things they fear. So start looking at what you fear during sex or intimacy – what is the big issue for you?
It’s exciting to discover new erotic worlds, but it can also be scary and lead to defensiveness, fear and guilt. As you overcome your delayed ejaculation, you should be aware of which of your own sexual fears have been hidden by your sexual “problem”.
A very effective way of getting to the bottom of your unmet or unexpressed wishes or desires is to imagine being completely self-centered in sex, with no need to think of your partner. What then would be an ideal sexual scenario for you?
Lifelong or chronic delayed ejaculation is more common than you might think. And the causes can be different for each man who has it, just as a different approach to treatment will cure it.
There are two basic models of treatment for male anorgasmia. These are called the “inhibition model” and the “desire deficit model.” Don’t worry about these terms, they are just scientific language for some simple ideas…..
Treatment Based on The “Inhibition Model”
The “inhibition model” and the approach to ending delayed ejaculation which comes from it was promoted by the famous sex therapists Masters and Johnson, and Helen Singer Kaplan.
This approach to the problem assumes that a man is not receiving enough sexual stimulation – in either quality or quantity – to reach his orgasmic threshold, his point of no return (also known as the point of ejaculatory inevitability), so he is not able to ejaculate.
Interestingly, this implies that if the level of sexual stimulation a man receives can be increased above his ejaculatory threshold, then he will be able to ejaculate. Also, the higher his ejaculatory threshold, the harder it will be for him to achieve orgasm.
This could involve two different issues: a stimulation threshold which is too high or inadequate levels or intensity of stimulation.
These are two different things.
For example, a high stimulation threshold might mean a man is consciously or unconsciously holding fear, anger, or some other inhibiting emotion around, intimacy, sex or women.
Also a high threshold for ejaculation might be the result of a man having an insensitive penis, perhaps because he learned to masturbate as an adolescent with an idiosyncratic technique such as thrusting his penis against the mattress without using his hand. Another common factor is hard and fast masturbation with a tight grip, either as a teenager or as an adult.
With this in mind, treatment methods for ejaculation problems might take two different approaches.
First, increasing sexual arousal through intense stimulation; second, resolving conscious and unconscious issues around sex such as guilt, shame or inhibition.
Sidebar: if you have a lot of anxiety around sex and especially around your sexual performance as a lover, then any treatment approach which aims to increase stimulation levels with rough and powerful manual stimulation of the penis should be avoided. This might your anxiety even worse – especially if your trouble ejaculating is the result of performance anxiety in the first place!
Treatment With The Desire Deficit Model
In sex therapist Bernard Apfelbaum’s view, delayed ejaculation speaks of low levels of arousal and desire which need to be addressed. That way a man can take responsibility for dealing with the unconscious conflicts which have caused his difficulties in the first place.
This involves exploring your low levels of desire for sexual intercourse and your lack of arousal as causes of your inability to reach orgasm during intercourse.
Most men with this problem really want to give pleasure to their partner. So if you can change your attitude and beliefs around sex in general and what your role during lovemaking is in particular, you will make great strides with this treatment approach. (This is all simply described in the treatment program.)
When a man has delayed ejaculation, he may often have a long-lasting erection, which he can maintain for hours – but this is not a sign of his arousal.
Indeed, many men in this situation have very low desire: they do not really want to have sex, because they do not feel sexual desire, but at the same time they feel compelled to have intercourse to please their partner.
This problem may be often partner-specific. In other words, a man may be able to ejaculate with a different partner.
But there are problems with Apfelbaum’s approach. For one thing, it doesn’t explain or examine other emotional issues which often go along with DE such as obsessive-compulsive disorders, paraphilia, anxiety disorders, and even various personality disorders.
All of these suggest DE itself could be caused by inhibited arousal and desire towards the partner, with other intrapsychic or interpersonal issues which deserve attention.
Apfelbaum suggested that in many cases of slow or non-existent ejaculation, only the man’s own touch is erotically arousing, which makes him autosexual (i.e. masturbatory) rather than heterosexual or homosexual.
However, this could just be the simple expression of the fact that a man can only reach orgasm through masturbation!
In other words, DE is not necessarily a sign of auto sexuality, or autoeroticism. Often a man really wants to ejaculate during sex, and he’s clear that this is about his own wishes needs and wants rather than just a desire to please his partner.
Commonality In Approaches to Treatment
Open expression of feelings, awareness of lack of arousal, and the ability to indulge one’s own desires rather than focus on the needs of one’s partner, are all clearly highly desirable objectives for any couple, regardless of whether the man has delayed ejaculation or not.
So if you can come to see sex in a different way (e.g. as a matter of equality of pleasure and responsibility between man and woman) then the hold of delayed ejaculation will lessen immediately.
What this tells us is that various approaches to treatment may be needed.
Apfelbaum and Kaplan look at different sides of the same coin: on the one side, the unconscious aggression and hostility that makes a man experience low arousal with his partner; on the other, feelings of guilt, shame, a tendency to excessive giving during sex, and so on. Both of these approaches can be useful with different patients.