Treatment For Delayed Ejaculation - A Case History |
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A case history of delayed ejaculation (aka male anorgasmia and retarded ejaculation)Continued from delayed ejaculation case history here Jim's delayed ejaculation was playing heavily in his mind when he came for therapy. To get details of the treatment for delayed ejaculation, follow this link. When gathering the details of Jim's delayed ejaculation, we established that he grew up with both parents, the older by two years of two siblings. Jim's father was the primary person he talked to about personal issues, at least until he reached puberty, and by his account they had a close relationship up to then. Certainly his sexual behavior and delayed ejaculation during masturbation were issues that he would never have dreamed of talking about. His relationship with his mother was less positive, though not damaging. Conflict and fights in the household were avoided, his father usually giving in to his mother to keep the peace. Jim recalled that his confidence had diminished markedly at puberty when his father became more distant towards him, possibly because his father was having an affair with an employee in the business. At 13 or so, Jim became depressed, and remained so for the best part of five years. He was humiliated when he attempted at the age of 15 to have sexual intercourse with a girl of 18, for he lost his erection after penetration and could not ejaculate during sex or masturbation, for which she derided him as "a little boy". Even then it appeared he was experiencing delayed ejaculation or some combination of symptoms which looked like the precursor to delayed ejaculation. He felt alienated from women, and could not confide in his mother about personal issues. He reported feeling desperate and unhappy. He found comfort in frequent masturbation, using an idiosyncratic technique which involved considerable force and left him unable to ejaculate except by, as he put it, "humping the mattress". Sex was a taboo subject in Jim's family. Jim used to look at girls with a mixture of fear and longing, his use of pornography to get aroused before masturbation tempered with a feeling of disgust at the appearance of the female genitals. The outcome of all this was that Jim felt he could not have normal sexual intercourse, and he had given up hope of ever having a relationship with a woman. Delayed ejaculation was ruling his sex life, and much of his emotional life as well. Two experiences with paid-for sex left him even more despondent, for in neither case could he ejaculate, experiencing delayed ejaculation so that even sexual intercourse for an hour or more did not produce ejaculation, even though as he put it "I thrusted like I was superman". When he arrived for therapy, hoping to find a treatment for his delayed ejaculation, he was in a delicate state of mind, with anxiety, self-doubt, and a feeling of despair and pointlessness around his sexual performance in general and his delayed ejaculation in particular. He had met Rose at a friend's party and they were instantly attracted to each other, though when the relationship moved from platonic to potentially sexual, he experienced considerable anxiety. Their first attempt at sexual intercourse, at Rose's encouragement, ended with Jim having a rigid erection which persisted for two hours but at no time, neither with manual or oral stimulation, nor during vaginal intercourse, was Jim able to ejaculate. This was the first time Rose had experienced delayed ejaculation, so she was patient and understanding, and non-judgmental about this, but she also expressed frustration in therapy that they were not able to share the pleasure of "normal intercourse". She said that one of the great pleasures of sex for her was seeing her partner ejaculate: her self-esteem was bolstered by the thought that he found her attractive enough to enjoy orgasm and ejaculate inside her. Rose came from a lower middle class family with social aspirations, all of which seemed to have been projected onto Rose, as the child who was most likely to go to university and achieve success is the world of academia and beyond. The family was dysfunctional in that her mother had clearly used Rose as an emotional prop during Rose's childhood, in the absence of any real emotional connection with Rose's father, who appeared to be a workaholic, spending little or not time with his family, even to the extent of not going on family vacations. Rose appeared to have tried hard to win her father's attention, but she was often met with impatience and abruptness. Although these did not discourage her, for even now she appeared to be confident she could win her father's approval before he died, there was no sign of sufficient emotional intelligence or literacy on her father's part to suggest that such a rapprochement would be made; her mother appeared to be alcoholic, severely dysfunctional, and increasingly neurotic as the years went by. Jim's delayed ejaculation seemed to mirror the emotional involvement of Rose's father, who, even in their intimate moments, somehow remained detached from her. Rose had survived by using a friend's home as an alternative base during her childhood and schooldays, and this family had given her enough encouragement and support to bring out her academic abilities. She had also enjoyed a sexual relationship with the elder boy in the family, unbeknownst to everyone else, which had continued for several years after they left school. This relationship had overtones of mild coercion by the boy, in that he had initially persuaded Rose to have sex with him in return for help with her schoolwork, and though both were over the age of consent when the relationship started, its emotional flavor was one of dominance and submission. This boy had, by all accounts been "good at sex", which appeared to mean that he had been able to control his ejaculation and ejaculate when he wished during sex: certainly he had not been experiencing premature or delayed ejaculation, and it was this relationship which had given Rose her expectations of sexual intercourse in general and ejaculatory latency in particular. She occasionally compared Jim's delayed ejaculation with her teenage lover's capacity to ejaculate when he wished during sex. Rose masturbated frequently, and reached orgasm on about half of these occasions, though she felt inhibited about doing so in front of a partner. She described sex as "pleasant enough" and "sometimes good", especially when she could give her partner the pleasure of orgasm - sex in fact seemed to be a vehicle for her to express her love to her partner and offer him what she regarded as a man's greatest pleasure. In return, she regarded a man's ejaculation as an expression of his love and attachment. Delayed ejaculation therefore seemed to serve as a signal that Jim did not love her as much as she loved him. How treatment for delayed ejaculation progressedThe first stage of the treatment program for delayed ejaculation involved classic sensate focus exercises to enhance intimacy, re-establish connection, and regenerate trust between the partners. This worked well in soothing the anxiety of the two partners towards sex with each other, in particular allowing them to establish a higher level of comfort with each other's bodies. Indeed, Jim's feelings of disgust around the appearance of the female genitals significantly reduced, and Rose's inhibitions about allowing Jim to see her naked dissipated somewhat, to the extent that they reported spending considerable time embracing naked in bed each evening. This was an indication that treatment for delayed ejaculation was likely to be successful. To remedy an intermittent erection problem which Jim reported, he was given a prescription for Viagra. This enabled him to overcome the erection problem, which appeared to be the result of his anxiety about his delayed ejaculation and not being able to satisfy Rose during sex, and further enhanced the intimacy between the couple in that they engaged in a dialogue about what was going on between them. In particular, they asked for sexual psychotherapy to work out the role of Jim's desire to explore his fantasies of domination and submission in his sexual life with Rose. Both partners became aware of their complementary scripts around sexual behavior, and Jim's reliance on this element of sex play for his arousal reduced significantly; his fear of failure and performance anxiety, especially around his ability to satisfy his partner (a recurrent theme, which he defined as "my ability to give her an orgasm") was also reduced by therapy. The consequence of this was that Rose perceived Jim as being committed to her: but she reported that though he "worked hard" at giving her an orgasm and attempting to enable her to reach orgasm during intercourse, she did not feel that he was psychologically present, or at least as not as present as she would like their lovemaking. The next stage of therapy was to tackle Jim's idiosyncratic masturbatory patterns: desensitizing his penis to hard and traumatic masturbatory practices took time, but he persevered and was eventually successful (the therapy which he used is described in detail on the page about treatment of delayed ejaculation). As the couple's enjoyment of sensate focus exercises increased, along with their level of intimacy and sense of connection, they expressed a wish to move on to erotic interaction in general and intercourse in particular. Although the physical act of penetration was not difficult, Jim still experienced delayed ejaculation and there was evidence of increased aversive sexual behavior on the part of both Jim and Rose: Jim reported feeling disgust with the female genitals, and expressed a wish to tie up his partner before sex (although he studiously avoided mentioning Rose in this context, it seemed clear that being able to act out this fantasy would have facilitated his sexual arousal). Jim appeared to be using his fantasy to boost his arousal sufficiently to overcome his fear and aversion to the female genitals. Rose, by contrast, found it challenging to be passive during sex; she wanted to be active, to please her partner and give him an orgasm while he was enjoying intercourse. The presence of delayed ejaculation was of major significance for Rose, and she imagined it to be a sign that Jim was not really interested in her. Since both the erection problems and the intimacy problems faced by the couple had been reduced somewhat, the final hurdle of the delayed ejaculation was now tackled, with a treatment program of gradual desensitization. [
Treatment of delayed ejaculation; the way to cure retarded ejaculation
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