Treatment Of Delayed Ejaculation - A Case History |
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A case history of delayed ejaculationContinued from delayed ejaculation case history here The secret of successful treatment is to approach the problem gradually. A combination of classical sex therapy and treatment specifically designed for delayed ejaculation can work well: this means, effectively, treating the delayed ejaculation with gradual desensitization while also addressing the problems of relationship and psychosexual issues in sex therapy sessions alongside the physical and behavioral treatment. This will mean dealing with all aspects of the case where either member of the couple is dissatisfied with their sexual performance. To go to the treatment method for delayed ejaculation, follow this link. Initially Jim was encouraged to masturbate to orgasm while Rose was in the next room, but not so near that Jim's anxiety rose to high levels. After he had become comfortable with masturbating to orgasm like this, a gradual desensitization program, in which Rose came closer and closer to him while he masturbated, was set up. Eventually (after about six weeks of consistent application), Jim was comfortable masturbating to orgasm while Rose was near him in the bedroom. Like many men who have developed idiosyncratic masturbatory patterns, Jim had been subject to great embarrassment as a teenager when he developed sexual urges and humiliated over the appearance of semen on the bed sheets. As a result he had developed a pattern of masturbation which excluded touching his penis (instead "humping the bed", as he put it). This technique placed great force on his penis, and seems to have been one primary cause of his delayed ejaculation, in that the level of pressure required to make him ejaculate was far higher than the level of pressure which developed in Rose's vagina during intercourse. The object of desensitization, of course, was to reduce the level of arousal at which ejaculation could occur so that normal intercourse was possible. This would constitute an effective treatment for delayed ejaculation. Needless to say, Jim experienced great anxiety and shame, which gradually lessened as treatment went on, due in large part to the support of Rose, who was consistently supportive and helpful during this part of the treatment for his delayed ejaculation. The issue for any man with delayed ejaculation is that the build up of sexual arousal which leads to orgasm is inhibited by the emotional issues around sex or masturbation, and inhibited further by the fact that the physical arousal necessary for ejaculation is simply so high that it is unachievable during intercourse. A gradual desensitization approach to masturbation may well reduce the shame and embarrassment around masturbation, sex and ejaculation to a level where the couple can then actively co-operate on treating delayed ejaculation. Jim achieved orgasm most of the time during his masturbation sessions and he reported that he was more successful at this when he felt more liberated, indicating that the internal critic which inhibited his sexual responses was a variable component of his sexual arousal: the more active it was, the harder he found it to achieve orgasm and ejaculate. Making the switch to sexual intercourse proved somewhat challenging, as Jim was wrapped up in his fear of failure around intercourse. This did not make dealing with his delayed ejaculation any easier. When he thought of his difficulty ejaculating during sex, he tended to develop physical tension and emotional feelings of shame and anxiety, both of which obviously hindered his sexual arousal. During the course of our treatment of Jim's delayed ejaculation, it became clear that both partners had deeper sexual issues which focused, among other things, on their appearance at orgasm. Both of them thought that the contortions and noises of orgasm were deeply embarrassing and even humiliating: for Paul, his delayed ejaculation seemed to be in part a way of avoiding what he called the "silly" grunts and "childlike noises" he made at orgasm, while for Rose this seemed to be more about fearing a loss of self-control in the moment of orgasm. So in both partners it was clear that loss of control - or perceived loss of control - was extremely anxiety-making. Delayed ejaculation clearly represented one way of dealing with this fear! This meant that for a while therapy had to focus on the bigger issues of sexual shame and freedom of self-expression. There was considerable anger in both partners towards the other, which resulted from some kind of transferential process originating in childhood relationships with their parents. A considerable amount of time was devoted to teasing out these factors as they related to Jim's delayed ejaculation. We developed a variety of therapeutic interventions including some behavioral techniques such as watching each other during orgasm and providing feedback to each other during sex. This reduced their level of anxiety around sex and enabled them to take a different view of what the gestures, sounds and movements of intercourse and orgasm represented - i.e. sexual pleasure rather something shaming. Jim was highly motivated to solve his delayed ejaculation problem and overcome his inability to ejaculate during sex; he wished to achieve normal sexual relationships; while Rose was highly motivated to enjoy normal sexual relationships and give Jim as much pleasure as she could during sex. With a highly motivated couple like this, treatment of delayed ejaculation was facilitated and rather easier than in some resistant cases where underlying sexual or emotional tension prevents forward progress in the desensitization of the sexual and emotional responses behind delayed ejaculation. At this point Jim had an affair with a woman he met at work, and reported that with her more relaxed attitude to sex and encouragement to him (which consisted of emphasizing his sexual skills rather than critiquing them, as Rose had been wont to do), plus her liberated enjoyment of sex and her "enthusiastic" approach to sexual pleasure, as he put it, he was able to ejaculate without too much difficulty during oral and manual stimulation. With the addition of a little alcohol, he reported that they had also been able to engage in intercourse, during which he had ejaculated in his partner's vagina. This was the first time he had ejaculated during intercourse. The key factor in avoiding delayed ejaculation appeared to be the lack of pressure and expectation from his partner - Jim reported that he felt he did not need to make her happy, as she was not a dependent woman and had no obvious sexual issues; he felt confident she could reach orgasm during sex with or without his help, so that he felt no pressure, no anxiety about satisfying her, and no embarrassment about seeing her during her orgasm, or being seen by her during orgasm. This experience of intercourse without delayed ejaculation changed Jim's attitude to sex considerably. He came to understand the co-dependent symbiosis in which he and Rose had been locked, and, having been able to let go of some of the shame around sex by elevating the experience of intercourse to, in his words, "a higher plane", he returned to Rose with new sexual confidence. He found that he could ejaculate during sex about fifty percent of the time with Rose: significantly, the occasions when she could not seemed to be those when he felt more angry towards her, anger which was usually caused by her anxiety about his progress in dealing with his delayed ejaculation. Rose was gently encouraged during this time to take responsibility for her own sexual pleasure and her orgasms, for she had developed a degree of dissociation which allowed her to regard her orgasm as Jim's responsibility, thereby avoiding the shame and anxiety she felt around orgasm and ejaculation. After several months of therapy, the psychodynamic and transferential features of the partners' sexual relationship were quite clear to all of us, and the future looked much more optimistic for both partners. They accepted that there might be problems with sex unless they worked through these issues, but had reached a level of sexual pleasure which pleased them both and they were genuinely fond of each other. This was, in their eyes, a firm enough basis to stay together, and work on the relationship further. Jim and Rose were typical of many cases of delayed ejaculation in a partnership. There were several factors underlying the case, and treatment focused on more than one approach. Jim developed the ability to ejaculate with his partner, both intravaginally and during manual or oral stimulation, and many of the psychic issues were resolved and explored so that both partners gained greater understanding of each other and themselves. The experience of Jim and Rose also emphasizes that delayed ejaculation can act as a safeguard against the emotional neurosis which holds partners back from full self-disclosure and intimacy, particularly in areas as sensitive as sex. When the delayed ejaculation, whose function is a safeguard against anxiety, is treated, and the symptoms begin to lessen, then intrapsychic sexual conflicts may be evoked. In particular, if the woman has sexual inhibitions, this is the point in therapy where they begin to show up. Jim and Rose's experience indicates that the outcome for the treatment of delayed ejaculation is likely to depend on both its severity and on the existence of deeper sexual issues. Since delayed ejaculation is commonly an outcome of traumatic masturbatory syndrome, and this in turn is frequently the outcome of repressive experiences during childhood and adolescence, the need for a complete and holistic treatment program for delayed ejaculation is clear. [
Delayed
ejaculation - retarded ejaculation - how to ejaculate during sex ]
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