Category: Premature Ejaculation

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Premature Ejaculation

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Premature Ejaculation

Premature Ejaculation History

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Sexual histories recorded from prematurely ejaculating males have a consistently familiar pattern. Variations on the basic theme arc are reflected by the man’s age and, in some instances, the circumstance in which his initial sexual adventures were experienced. For the premature ejaculator now in the over 40 age group, the history of first coital experience is usually that of prostitute exposure.

In the days of the prostitution houses, prior to the advent of the call-girl era, the accepted pattern of prostitute function involved satisfying the male sexual tensions as rapidly as possible. Indeed the more rapid the customer turnover, the higher the financial return.

25 to 45 Years Ago

When the neophyte first gathered his courage to follow socio-cultural demand that he “prove his manhood,” he was subjected, often unexpectedly, to the frequent prostitute insistence that he complete the act as soon as possible. The sooner the male would mount and the faster he could ejaculate, the more pleased the prostitute.

It took only two or three such house visits (frequently just the initial visit was sufficient) to establish the young man’s commitment to self-centered expression of sexual-need with its resultant physical pattern of rapid intromission and quick ejaculation.

As the inexperienced male became conditioned to this pattern of sexual functioning, a life-time of rapid ejaculatory response might be established.

As the years passed and with them the “houses,” the young male’s first sexual opportunities with girls in his peer group frequently took place in the back seats of cars, lovers’-lane parking spots, drive-in movies, or brief visits to the by-the-hour motels.

Intercourse was established in these semi-private situations under the pressures inherent in dual concern for surprise or observation resulted in both coital and ejaculatory processes encouraged toward rapid completion. In these situations there usually is as little male concern for the female partner’s sexual release as there was for that of her professional counterpart in previous years.

Thus a pattern of rapid completion of the male sexual cycle is established by socio cultural demand, and again it only takes two or three such pressured exposures for potential conditioning of the young male to a pattern of premature ejaculation.

Teenage Sex

Yet another technique of teenage sex play encountered in the background of the premature ejaculator is frequently recorded in the histories of young men during their early years of sexual encounter.

In this situation teenagers pet extensively and then the male mounts in a male superior position, clothes relatively in place, and pantomimes intercourse without any attempt at vaginal penetration until he is stimulated to ejaculation by the friction engendered by this pseudocoital process.

This sex-play technique does preserve virginity and above all else does protect against unwanted pregnancy. Yet, young men repeatedly enjoying this form of premarital sex play are exposed to premature ejaculatory patterning, because value is given pre-eminently to accomplishing male sex-tension release as rapidly as possible with the full cooperation of the female partner.

Of course, thought seldom is given to the sex tensions that develop in these young women serving as ejaculatory release mechanisms.

Another procedure that is popular with both married and unmarried groups is the withdrawal technique during coital connection. With this approach sex play terminates in active coital connection, but the man withdraws as he reaches the stage of ejaculatory inevitability and ejaculates outside the vagina.

With this release pattern there is no necessity for the man to learn ejaculatory control.

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Premature Ejaculation

Premature Ejaculation Help

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When the male is approached pelvically, stimulative techniques are best conducted with the wife’s back placed against the headboard of her bed (possibly supported with pillows), her legs spread, and with the husband resting on his back, his head directed toward the foot of the bed, with his pelvis placed between her legs, his legs over hers, so that she may have free access to his genital organs.

In this particular position the wife, responding to therapeutic direction with the full understanding of the male performance fears involved, should approach her husband directly to encourage penile erection. As soon as full erection is achieved, the “squeeze technique” is employed.

The concept of a direct approach to the premature ejaculator’s pelvic organs in an attempt to teach control was first introduced by James Semans.

The “squeeze technique” develops when the female partner’s thumb is placed on the frenulum, located on the inferior (ventral) surface of the circumcised penis, and the first and second fingers are placed on the

superior (dorsal) surface of the penis in a position immediately adjacent to one another on either side of the coronal ridge.

Pressure is applied by squeezing the thumb and first two fingers together for an elapsed time of 3 to 4 seconds. If the man is uncircumcised, the coronal ridge still can be palpated and the first and second fingers correctly positioned. An approximation of frenulum positioning must be estimated for thumb placement.

In either event, using an artificial model, cotherapists should make sure that the anatomical orientation so necessary to effective use of this technique is absolutely clear to both husband and wife. If there is any residual confusion on the wife’s part as to the anatomical specifics of the squeeze technique and ejaculatory control does not develop, professional explanation and direction is presumed at fault.

Rather strong pressure is indicated in order to achieve the required results with the squeeze technique. As the man responds to sufficient pressure applied in the manner described, he will immediately lose his urge to ejaculate.

He may also lose 10 to 30 percent of his full erection. The wife should allow an interval of 15 to 30 seconds after releasing the applied pressure to the coronal ridge area of the penis and then return to active penile stimulation.

Again when full erection is achieved the squeeze technique is reinstituted. Alternating between periods of specifically applied pressure and reconstitution of sexually stimulative techniques, a period of 15 to 20 minutes of sex play may be experienced without a male ejaculatory episode, something unknown to the couple in prior sexual performance.

Ejaculatory Urge

There may be some wifely apprehension as to the amount of pressure that may safely be applied to the penis without eliciting physical distress from her husband. The amount of pressure necessary to depress a man’s ejaculatory urge would be somewhat painful if the penis were in a flaccid state, but causes no similar level of discomfort when the penis is erect.

If the wife still expresses concern over application of pressure, the husband should place his fingers over hers and apply sufficient pressure through her fingers to guide her to the required result.

Showing his wife the degree of pressure that can be applied without resultant physical distress relieves her concern for his welfare and in turn improves the unit’s level of non verbal communication. As stated, pressure should be applied with the squeeze technique for a period of no more than 3 to 4 seconds.

If a positive clinical result is to be returned, it will be apparent in the loss of the husband’s ejaculatory urge within this brief period of time.

Sexual Excitement

Experience suggests that the male be brought to a low level of sexual excitement and depressed from his incipient ejaculatory urge with the squeeze technique four or five times during the first training session. Aside from obvious control improvement, the greatest return from use of the squeeze technique is improved communication both at verbal and nonverbal levels for the couple.

At first the wife applies pressure at her husband’s direction, but soon his levels of sexual excitation become obvious to her, and she learns to apply the squeeze technique by observing his reactions to sexual stimuli.

Obviously the basic therapeutic concept involved in the squeeze technique is to enable the premature ejaculator to establish objectively a state of sexual excitation that he not only can identify but also can maintain indefinitely without ejaculation. He must be able to delay voluntarily that level of sexual excitation from which he cannot withdraw, the stage of ejaculatory inevitability.

For Most Premature Ejaculators

Prior to experiencing physical response to the squeeze technique, any significant level of sexual stimulation usually has resulted in a quick leap toward ejaculatory inevitability. Once in the first stage of orgasmic experience, a man cannot be diverted or stopped from a total ejaculatory response.

As the result of the first day’s exposure to the squeeze technique, the husband’s fears for ejaculatory control and the wife’s for her husband’s inadequate sexual performance will be somewhat abated.

Following the typical “healthy skepticism” concepts of the therapy program, husband and wife, while employing the squeeze technique, demonstrate for each other that complete cooperation, under proper therapeutic direction, can establish ejaculatory control.

This self-demonstration of ejaculatory control markedly improves unit confidence and certainly is a major step toward re-establishing communication and terminating the cold war between the marital antagonists.

Establishing security of response relative to the squeeze technique is but the first step in a therapeutic progression that moves from onset of successful ejaculatory control under manipulative influence to a controlled coital process. Usually two or three days of husband and wife cooperation are necessary to establish full ejaculatory control with the squeeze technique under manipulative conditions. The next step in progression of ejaculatory control involves non demanding intromission.

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Premature Ejaculation

Premature Ejaculation Frustration

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The uninformed wife’s reaction to a husband with an established problem of premature ejaculation also is relatively type-cast. During the first months or years of the marriage the usual response is one of tolerance, understanding, or sympathy, with soft-voiced expressions of confidence that the problem will be overcome with patience, love, and mutual cooperation.

With due passage of time and with her husband’s rapid ejaculatory tendency not only continuing, but frequently becoming worse, the wife’s sexual frustrations rise to the surface. She verbalizes her distress by accusing her husband of just using her as an object for sexual release; in short, of being selfish, irresponsible, or simply of having no interest in or feeling for her as an individual.

These wifely complaints are legion, couched in individually self-expressive terms but reflecting in general rebellion at being used sexually rather than loved sexually. The “just being used” is the part most difficult for wives to accept.

Although they complaint of premature ejaculation have been referred to the clinic after as brief an interval as one year of marriage, generally this particular syndrome is not presented for therapeutic reversal until after five to twenty years of marriage. Usually the problem is ignored or tolerated by the wife until children are born.

With distractions provided by the demands of the new family, the prematurely ejaculating husband is accepted. But once a family of desirable size has been achieved, and the youngest has reached some level of independence, the wife’s sexual frustrations, enhanced by her increasing psychosocial freedom as the children mature, reach the breaking-point.

She spotlights the problem by insisting on professional guidance for herself, demanding that her husband seek professional help, enjoying sexual release provided by another partner, male or female, or any combination of these three potentials.

In General

Psychotherapeutic support for the wife of a premature ejaculator is palliative at best. There is no way to alleviate the main source of irritation when dealing professionally with her sexual problems in a one-to-one method of psychotherapy. Nor has psychotherapy directed specifically toward the problem of premature ejaculation been particularly successful, because there has not been widespread professional knowledge of clinical techniques available to teach ejaculatory control.

At Best

The wife, by seeking other coital partners, can only double her levels of frustration, if she realizes comparatively through successful sexual experience with other men the inadequacies of her own husband’s sexual performance. Conversely, she may find herself unresponsive in extramarital coition, possibly from feelings of guilt or from conditioned repression of her own sexual responses through years of contending with her husband’s rapid ejaculatory pattern. Many women have sought psychosexual release in homosexual experience under these circumstances.

Before acknowledging loss of all hope of successful sexual functioning, the members, of the couple individually or together try any number of physical dodges to avoid the usual rapid ejaculatory termination of their sexual exposures. The most consistently employed homemade remedy is the “don’t touch” treatment. The husband requests that his wife not approach his genital area during their precoital play.

Instead, both partners concentrate their attention on stimulating the female partner almost to the point of orgasm.

Of course, there is concomitant male stimulation coming from observation of his wife’s obvious “pleasure response” to his sexually stimulative approaches. Finally, if and when the wife attains a high level of sexual stimulation, there is an episode of hurried penile penetration with the husband vainly trying to distract himself from the sexually stimulating experience of intromission.

Sexual Distress
Various procedures for distraction are employed by the anxious husband. He fantasies such non sexual material as work at the office, an unbalanced family budget, an argument with a neighbour, a fishing trip, counting backward from one hundred, etc.

When the fantasy material has been proved ineffectual, the next step is to initiate some form of physical distress. The husband may bite his lip, contract the rectal sphincter, pinch himself, pull his hair, or use any other means of physical distraction.

All techniques, subjective or objective, are designed, of course, to enhance ejaculatory control by reducing the level of the sensate input during the coital process.

The wife meanwhile is thrusting frantically in a vain attempt to achieve orgasmic release before her partner ejaculates. The rapid transition from the mutually agreed upon “don’t touch” approach in precoital play to a rushed mounting episode and immediate contention with a demanding, thrusting, highly excited woman usually provides sufficiently forceful stimuli to initiate ejaculation before the wife possibly can obtain sexual release.

Premature Ejaculator Frustration
When all distraction techniques fail, the warmth of the couple’s interpersonal relationship slowly ebbs away. As the wife’s level of cold personal disinterest reflecting her sexual frustration increases, and denunciations (verbal or silent) of her husband’s sexual dysfunction continue, the next step taken by the now anxious, self-effacing husband, “the man who just can’t get the job done,” is one of slow but definite withdrawal from the unit’s established frequency of sexual contact.

Usually this action is temporarily acceptable to his frustrated wife. His withdrawal from sexual exposure continues despite the fact that the one thing the premature ejaculator cannot tolerate and still maintain any semblance of control is increasing periods of sexual continence.

He frequently sleeps on the sofa or in another room; she visits her family and stays longer than planned, or simply refuses sexual contact for increasing periods of time.

The longer the periods of continence, regardless of source, the more rapid and severe the husband’s ejaculatory response on those rare occasions when sexual contact is permitted.

Granted that the premature ejaculator may exhibit little significant control at the usual once or twice-a-week rate of exposure, yet he certainly will have no control at all when the coital exposures are reduced to once, twice, or thrice a month.

Sexual Confidence
Over a period of years with no obvious improvement in her husband’s sexual performance, the wife loses confidence in her partner’s consideration for or appreciation of her as an individual, and concomitantly some degree of confidence in herself as a woman.

Sexual Demands
For effective sexual performance are continuously verbalized or acted out by the female partner over an extended period, the complication of erective inadequacy may appear. The husband, questioning his own sexual prowess time and again, abetted in this frightful concern by his wife’s specific verbal derogation of his masculinity, frequently is enveloped by anticipatory fears of performance whenever sexual expression is imminent.

Fears of performance
Combined with techniques for avoiding direct penile stimulation during precoital play and his wife’s obvious disinterest in active sexual functioning, not only make the man increasingly conscious of his inadequacies of sexual performance but also raise psychologically crippling questions as to his very maleness.

In short, all these factors plus his fantasy patterns of trying to distract himself from subjective pleasure during active sexual functioning finally place the man in the spectator role in his own marital bed. There is a slow transition from the role of physical self-distraction during coition to that of a fear-ridden spectator at his own sexual performance.

Thus, the husband assumes the psychological stature of a secondarily impotent male with all of the well-established concerns for sexual performance and the constant retreat to a spectator role. Time and time again premature ejaculators of many years standing not only lose confidence in their own sexual performance but also, unable to respond positively while questioning their own masculinity, terminate their sexual functioning with secondary impotence.

This stage of functional involution is, of course, the crowning blow to husband and wife as individuals and usually to the marital relationship.

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Premature Ejaculation

Premature Ejaculation & Sex

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The male is encouraged to lie flat on his back and the female to mount in a superior position, her knees placed approximately at his nipple line and parallel to his trunk.

The nearer the two individuals are to the same height, the nearer the woman’s knees should be placed to the nipple line. If the wife has the shorter trunk, she should place herself somewhat below the nipple line. If the wife has the longer trunk, her knees should be just above the nipple line.

Female Superior Position

Leaning over her mate at a 45-degree angle, she is comfortably able to insert the penis and then to move back on, rather than sit down on the penile shaft.

After bringing:
The penis to full erection and employing the squeeze technique two or three times for his control orientation

The wife then should mount in this specifically described superior position. Once mounted, she should concentrate on retaining the penis intravaginally in a motionless manner, providing no further stimulation for her husband by thrusting pelvically.

Her physical restraint enables the husband to become acquainted with the sensation of intravaginal containment in a non demanding, therefore non threatening, and environment. No longer does he respond to the subconscious concept that his wife is ready to force his ejaculatory process to an unhappily rapid conclusion by overt physical expression of her own sexual desire.

For the established premature ejaculator the ultimate of sexual stimulation occurs with the mounting opportunity and during the first few seconds of intravaginal containment. If the man with inadequate control has not ejaculated prior to intravaginal penetration he will do so in short order, once penile containment has been accomplished, when there is any suggestion of active pelvic thrusting on his wife’s part.

When his wife cooperates fully in the superior coital position and in the sexually non demanding fashion of penile containment described above, she enables her husband to concentrate on the concepts of ejaculatory control elicited by the squeeze technique and additionally to become accustomed to the stimulative effect of intravaginal containment.

During the husband’s level of sexual excitation threatens to escape his still shaky control, he should immediately communicate this increased sexual tension to his wife. She then can elevate from the penile shaft, apply the squeeze technique in the previously practiced manner for 3 or 4 seconds, and reinsert the penis, again providing full vaginal containment without the added stimulus of pelvic thrusting.

The specifically described female-superior coital position makes pelvic elevation from the penile shaft physically easy for her so that the squeeze technique can be applied rapidly to the proper area of the penis, if threatened loss of ejaculatory control develops.

In subsequent days, with some degree of performance reliability established for penile containment in the female-superior position, the husband is encouraged to provide just sufficient pelvic thrusting to maintain his erection. Again the wife is requested to maintain the specifically fixed superior position without active pelvic thrusting.

If man and woman lie together with the penis in intravaginal containment without either partner providing some degree of pelvic thrusting, the man will tend to lose his erection after a short period of time, just as the woman will note marked reduction in the rate of lubrication production.

This physiological evidence of reduction in sexual tension is:

Due to the fact that both marital partners become distracted by any long continued state of sexual inactivity, losing focus on the sensate pleasure inherent in the principle of quiet vaginal containment.

It should be emphasized to the couple that success in ejaculatory control in the female superior position is but another psycho physiological step toward effective coital functioning in any desired coital positioning. It is an important psychological step in providing further relief for both husband’s and wife’s fears of performance.

With a “healthy skepticism” attitude encouraged by authority, both members of the couple develop insight into the fact that they are accomplishing their own “cure.” Through their physical cooperation and increasingly effective verbal and nonverbal communication, ejaculatory control is developing.

Proof positive of improved control develops by the second or third day’s exposure to the female-superior coital position in that 15 to 20 minutes of intravaginal containment without untoward ejaculatory demand is a relatively routine accomplishment.

Yet another important factor coming into focus at this stage in the development of the husband’s voluntary ejaculatory control is the cooperative wife’s level of sexual responsivity. Indeed many women married to premature ejaculators have never been orgasmic in the marriage, and most of those women that have been orgasmic in the marriage have obtained this release through manipulative or oral-genital techniques rather than coital opportunity.

Intercourse in married couples attention obviously has been focused upon the male partner for the first few days of the therapeutic program, yet the wife may have experienced an elevation of sexual tension far superior to levels she might have anticipated. There are many reasons for this sex tension increment, the most prominent of which should be considered in some detail.

First
During the sensate-focus phase of the therapy, there is mutual “pleasuring”. Usually her levels of sexual responsivity elevate rapidly under these most advantageous conditions. There is physical closeness and holding, development or redevelopment of communication, and markedly increased warmth of understanding between husband and wife.

Many of the misconceptions, fallacies, or even the taboos relating to the couple’s prior sexual interaction have been faced, examined, explained in depth, and, to a major degree, reversed or mutually accepted during daily interviews with the cotherapists. There is no environment more conducive to marked elevation in the levels of female sexual response than that occasioned by the concept that something is happening of a positive nature to reduce or eliminate the couple’s sexual dysfunction.

As both husband and wife cooperate in the pleasuring opportunity, the increasing warmth of their interpersonal relationship is a hopeful support for the emotionally insecure woman that .the wife of a premature ejaculator usually becomes after years of sexual frustration.

Second
During manipulative phase of the squeeze technique there concomitantly is further increase in the level of female sexual tension. When the wife provides controlled play for her husband and observes both the physical pleasure she provides and his obvious delight in progress toward ejaculatory control, these reactions are reflected as positive and highly stimulative biophysical and psychosocial influences. In short order the wife finds herself highly excited sexually and strongly motivated toward orgasmic release.

Third
Although the wife is instructed to avoid pelvic thrusting, the initial period of intravaginal penile containment provides her with the simultaneous opportunity to feel and think sexually, not infrequently for the first time in her marriage. The sensate pleasures of non demanding penile containment have not been available to her in view of the couple’s basic sexual dysfunction.

When there has been sufficient ejaculatory control to accomplish penetration, the actual act of physical connection usually has been followed immediately by the wife’s straining demand for tension release. Alternatively, if past sexual patterning has forced her to lie quietly after penetration in the vain hope of avoiding forcing her husband to ejaculation, the entire psycho sexual experience of coital connection has been focused on his battle for ejaculatory control rather than on providing her with any expression of freedom to enjoy personal sexual responsivity.

Contending with a husband fighting a constant battle for ejaculatory control not only engenders severe sexual frustration for the wife but also over the years produces in her a distinctively negative attitude toward sexual expression.

Fourth
When in the female-superior coital position with intravaginal containment of the penis and even with controlled restriction of pelvic movement, the wife has been directed simply to feel and think sexually and to enjoy the sensation of vaginal distention. Following these suggestions, the proprioceptive pressures created by intravaginal containment of the erect penis are subjectively anticipated and appreciated. The wife gains almost as much from this stage in the exercise of ejaculatory control as does her husband.

Thus, the combination of subjective relief of fear for her husband’s inadequacy of sexual performance plus the opportunity to feel, think, and relate sexually are enormously stimulating to the female partner. As her partner’s control increases, female pelvic thrusting can be encouraged, initially in a slow, non demanding manner, but soon with full freedom of expression. Once sexual tensions, built from both freedom for biophysical-system response and growing confidence in the psychosocial elements of the unit’s interpersonal relationships, are released to be enjoyed at will, orgasmic expression becomes a natural potential.

Final Phase
In the voluntary development of ejaculatory control is entered as the couple is encouraged to convert the female-superior position to that of the lateral coital position. In the lateral coital position there is a maximum opportunity for male ejaculatory control. As the husband’s sexual tensions elevate, he can withhold active pelvic thrusting yet provide a full controlled erection with which his wife can continue to express her own sexual demands and against which she can relieve her sexual tensions.

In the lateral coital position the woman uniquely has complete freedom of pelvic movement in any direction. There is no pelvic or chest pinning, or cramping of leg or arm muscles. She can respond to her own tension demands as she sees fit, confident that this coital position provides her husband not only with high levels of subjective sexual pleasure but also with the best possible physical opportunity for ejaculatory control.

After becoming secure in the multiple protection the position affords and in the anatomies of leg and arm arrangement, most couples employ lateral coital positioning by choice in at least 75 percent of their coital opportunities.

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Premature Ejaculation

Premature Ejaculation

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From a clinical point of view it is extremely difficult to define the syndrome of premature ejaculation. Most definitions refer specifically to the duration of intravaginal containment of the penis. For teaching purposes a genitourinary service in a medical centre has described a premature ejaculator as a man who cannot control his ejaculatory process for at least the first 30 seconds after penetration. In similar vein a hospital psychiatric service has described the premature ejaculator as a man who cannot repress his ejaculatory demand for one full minute of intravaginal containment.

More realistically, a definition of premature ejaculation should reflect socio cultural orientation together with consideration of the prevailing requirements of sexual partners rather than an arbitrarily specific period of time.

30 to 60 seconds of intravaginal containment is quite sufficient to satisfy a woman.

If she has been highly excited during precoital sex play and is fully ready for orgasmic release with the initial thrusts of the penis. However, during most coital opportunity, the same woman may require variably longer periods of penile containment before attaining full release of sexual tension.

While readily admitting the inadequacies of the definition, the clinic considers a man a premature ejaculator if he cannot control his ejaculatory process for a sufficient length of time during intravaginal containment to satisfy his partner in at least 50 percent of their coital connections. If the female partner is persistently non orgasmie for reasons other than rapidity of the male’s ejaculatory process, there is no validity to the definition. At least this definition does move away from the “stopwatch” concept.

The male’s level of concern for an uncontrolled ejaculatory pattern and the concomitant depth of his female partner’s sexual frustrations tend to increase in direct parallel to the degree of their formal education.

For instance:
grade-school or early high school dropouts rarely request relief from premature ejaculation. In this socio cultural setting the man generally dominates the pattern of sexual function within the couple, and his sexual satisfaction is the major concern.

Rapidity of ejaculation is not considered a sexual hazard, and in fact may provide welcome relief for the woman accepting and fulfilling a role as a sexual object without exposure to or personal belief in the concept of parity between the sexes in the privileges and the pleasures of sexual functioning.

Rapid release from sexual service frequently is accepted as a blessing by women living in the restrictive levels of this subculture’s inherent double standard. Of course these women are free to enjoy orgasmic expression if it develops, but neither partner usually considers it the man’s responsibility to aid or abet woman’s sexual responsivity. (It should be noted that clinic and clinical studies have been extremely limited in material of cross-cultural or racial significance.)

The complainee in the couple contending with an established pattern of premature ejaculation usually is the female partner. If the male ejaculates regularly during premounting sex play or during attempts at mounting, or even with the first few penile thrusts after intravaginal containment, there rarely is opportunity for effective female sexual expression.

Time and again women’s sexual tensions are elevated by precoital sex play, further edged by the additional stimulation of the penetration process, only to be confronted with almost instantaneous ejaculation and subsequent loss of penile erection. There is a high level of female frustration, particularly when this male response pattern is repeated routinely lime after time.

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Premature Ejaculation

Penis Withdrawal Technique

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With coital partners using the withdrawal technique as a means of contraception, the usual sexual sequence prescribes participation in sex play to a plateau level of male excitation, a rapid mounting process with a few frantic pelvic thrusts, and then abrupt withdrawal, which satisfies the male with an ejaculat0ry episode and protects the female from pregnancy. Usually, both partners fall into the psychosexual trap of ignoring at onset any concept of male responsibility for aiding female tension release.

This withdrawal practice serves to encourage and ultimately to condition a rapid ejaculatory response upon the sexually inexperienced young man and to physiologically and psychologically condition both partners to the concept that the vagina is only to be used fleetingly as a stimulant for male ejaculatory pleasure. The anxious female partner, worried that the male may not withdraw in time, rarely has the opportunity to think and feel sexually, so any experience of orgasmic tension release would be coincidental.

In every situation, ranging from the impatience of the prostitute to the contraception-oriented withdrawal techniques, total emphasis is placed on the presumed male prerogative of freedom of sexual expression without responsibility for his partner’s sexual response. The old double standard of male sexual dominance is perpetuated by the concept of rapid and effective release of male sexual tensions provided by a female companion who services a man without expecting or receiving comparable sexual prerogatives from her sexual partner.

Masturbation

Despite strong cultural beliefs to the contrary, masturbatory practices, regardless of frequency or technique employed, have not been identified historically as an etiological factor in the syndrome of premature ejaculation.

After all, in the usual male masturbatory sequence there is no female companion negating her own birthright of functional sexual demand in order to provide her male partner with tension releases.

When the established premature ejaculator contemplates marriage, there may be an “engagement period” expression of concern by the wife-to-be for his sexual patterning.

However, there usually is the expression of faith by both partners that the lack of ejaculatory control will be resolved with the new wife’s understanding and cooperation and the continuity of the sexual exposure inevitably engendered by the privilege of marriage.

There is no way of knowing how many men who ejaculate prematurely in the first few months or even first year or two of marriage develop in due course reasonably adequate ejaculatory control, because these temporarily beleaguered couples do not seek consultation. However, probably hundreds of thousands of men never gain sufficient ejaculatory control to satisfy their wives sexually regardless of the duration of marriage or the frequency of mutual sexual exposure.

Unfortunately, all too few of these couples ever seek professional direction.

Men and women have relatively stereotyped reactions when they are husband and wife in a unit contending with the syndrome of premature ejaculation. Some men simply cannot be touched genitally without ejaculating within a matter of seconds. Others will ejaculate immediately subsequent to observation of an unclothed female body or while reading or looking at pornographic material.

Many others ejaculate during varying stages of precoital play. However, most men who ejaculate prematurely do so during an attempt at intromission or during the first few full strokes of the penis subsequent to intravaginal containment.

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Premature Ejaculation

Male Superior Position

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Yet another reason for emphasizing the female-superior and the more effective lateral coital positioning is that the most popular position in our culture, the male-superior positioning, presents the greatest difficulties with ejaculatory control.

If the coital connection is to be brief with both partners obviously wishing rapid pelvic thrusting to release of their high levels of sexual tension, coital positioning does not matter. But if there is desire to prolong the connection either for mutual pleasure or because the female partner needs more opportunity to feel and think sexually, the male superior position, which places the greatest strain on ejaculatory control, should be avoided when possible.

On every occasion, before female-superior coital position is established and then possibly converted to a lateral mounting arrangement, a comfortable period of precoital sex play is encouraged. The wife should employ the squeeze technique at least two or three times before penetration is attempted.

It takes a significant period of time to alter an early imprinting of the pattern of rapid ejaculation.

However, in the two-week treatment program, sufficient competence in ejaculatory control can be developed to alleviate mutual fears of performance, obviate the spectator role, and provide all the opportunity necessary for continued improvement in control subsequent to release from the acute stage of therapy.

Before the couple leaves the clinic, the cotherapists emphasize the fact that problems of ejaculatory control continue to a minor degree for at least the subsequent year. Several techniques to encourage continuing success in ejaculatory control are described for marital-partner benefit. The unit is reminded that after returning to the demands of their everyday world, regularity of sexual exposure is of primary concern.

For the first six months the squeeze technique should be employed on at least a once-a-week basis prior to coital opportunity; the remainder of the unit’s sexual opportunities during the week are encouraged to develop in a natural, unconstrained fashion. This approach provides the man with the necessary means for transition from a controlled sexual experience to a completely extemporaneous opportunity.

It is also suggested that the couple take advantage of the wife’s menstrual period each month to provide at least one session of 15 to 20 minutes devoted specifically to male sexual stimulation with manual manipulation and repetitive application of the squeeze technique for control of the ejaculatory process.

Ejaculatory Control Techniques

Usually are indicated for a minimum of six to twelve months after termination of the acute phase of therapy. During the routine follow up discussions after termination of the unit’s acute phase of treatment decision to terminate use of the squeeze technique is made by professional evaluation of the degree of control during the unit’s spontaneous matings.

It also is important to emphasize that if circumstances lead to separation of marital members for a matter of several weeks, coital exposure after the couple is physically reunited may find the male returning to his role as a premature ejaculator. Obviously, the procedure in this situation is to reemploy the squeeze technique for several consecutive coital exposures.

If constituted with warmth and understanding ejaculatory control will return rapidly.

With adequate warning of the possibility of these complications, a more relaxed concept of freedom of sexual approach is possible for couples contending with severe premature ejaculation.

Numerable approaches to the treatment of premature ejaculation have been described, discarded, or conducted with varying levels of professional acceptance. Hypnotic suggestion, both in natural and drug-induced states of receptivity, has been a popular approach to the problem.

Penis Cream

There has been widespread acceptance of anesthetic creams and jellies prescribed for application to the erect penis theoretically to reduce neurogenic end-organ sensitivity to the stimuli of manipulation or vaginal containment. Specific drug preparations, tranquilizers, barbituates, etc., have been prescribed in an effort to dull male sensitivity to stimuli in general and to stimuli of sexual content in particular.

Many men have tried with varying degrees of success to lower their natural sexual tension levels by ingestion of sizable quantities of alcohol before anticipated sexual encounter.

Frantic men consume a never ending list of potions, nostrums, and poisons, all designed to reduce rapidity of ejaculatory response, all curiously directed to a male’s sexual functioning alone without regard for his partner’s involvement. Any form of sexual inadequacy is a problem of mutual involvement for partners in a marriage.

With a wife’s full cooperation, her willingness to learn and to apply the basic principles of ejaculatory control, and the warmth of her personal involvement expressed openly to her mate, reversal of this crippling marital distress is essentially assured. As further support of this argument for the necessity of involvement of the wife in the resolution of a well established premature ejaculatory pattern, it should be pointed out that the squeeze technique is not effective if done by the male attempting to teach himself control.

If a man manipulates his penis to erection and then applies the squeeze technique to control an imminent ejaculatory response, he usually can halt the natural progression of sex tension increment and successfully depress his ejaculatory urge.

However, once this man returns to the stimulation of a heterosexual relationship, it is as if he had made no prior solitary attempts at control. What is obviated by solitary attempts to learn ejaculatory control is the fact that with a female partner the individual male cannot entirely set the pace of sexual functioning, nor can he entirely, deny the sexual stimuli absorbed from the obvious psycho sexual involvement of his marital partner.

In The 11 Years:

186 men have been treated for premature ejaculation. There have been 4 failures to learn adequate control during the acute phase of therapy. Adequate control is defined as sufficient to provide orgasmic opportunity for the sexual partner during approximately 50 percent of the coital opportunities. The failure rate is 2.2 percent.

Three of the failures were with couples; and one was with a man previously divorced because of his premature ejaculatory pattern, who brought a replacement partner to the treatment program.

In two of the four instances there was no real motivation on the part of the male partner to learn ejaculation control. These men had accompanied their non orgasmic wives as a cooperative venture, but when they learned that they were in fact contributing to their wives’ sexual dysfunction they refused further cooperation. They simply could not accept a reversal of their deeply ingrained double standard of sexual function.

There is no specific explanation for the two remaining failures to control the premature ejaculatory tendencies of the men involved. Both units were fully cooperative but the techniques simply did not work. One of these men, 64 years old, was the only failure among 19 men 50 years or older treated for premature ejaculation.

A brief note of clinical warning is in order. After learning to control a premature ejaculatory tendency, 23 of the couples treated by clinic personnel were confronted by a brief period of secondary impotence just before or shortly after termination of the acute phase of therapy.

Sexual Function Improvement

Most couples, delighted with the significant improvement in sexual functioning, enter a period of marked frequency of coital connection as compared with their sexual exposure rate just before visiting the clinic.

Sometimes the male partner simply cannot meet the suddenly elevated frequency demand and encounters an episode of erective failure. He only has to have one such experience before all his fears of performance flood his consciousness. What new form of dysfunction is this? Has the treatment caused it? His initial anxiety reaction is of serious proportion.

The thought that he was sexually satiated for the moment never occurs either to the concerned husband or his sexually enthusiastic wife. Care must be taken by authority to warn couples of the possibility of a transitory experience with impotence, as they are adjusting their overwhelming pleasure with their newfound sexual function to the practicality of the male’s level of sexual responsivity.

With prior warning the couples take an episode of impotence in stride, even laughing at the concrete evidence of their sexual greediness. Without adequate warning, a persistence of symptoms of secondary impotence is possible, for the fears of performance and spectator roles return to their dominant position before adequate explanation of the distressful event is available,

In brief, the problem of premature ejaculation is uniquely one that can be resolved effectively and permanently. For successful resolution of the problem, a man needs some understanding of the origin of distress, a knowledge of techniques to establish control, and, above all else, a cooperative, involved sexual partner.