Treatment Methods For Delayed
Ejaculation:
|
||
To go directly to the treatment method for delayed ejaculation, follow this link.Sexual therapy for delayed ejaculationHeiman and Meston (1997) reviewed treatment methods for delayed ejaculation and came to the conclusion that there were so few controlled studies of treating delayed ejaculation that it was impossible to work out if any were really effective! However, the fact is that anyone who works with men who have delayed ejaculation knows that treatment is not only possible but can be very effective. While this kind of circumstantial evidence does not hold the weight of controlled scientific studies, it is enough to reassure men who have delayed ejaculation and the therapists who work with them that a cure is not only possible but can be achieved by working at home on your own, or with your partner. There are two basic models of cause and treatment for retarded ejaculation, male anorgasmia and delayed ejaculation (all terms which mean the same thing). These are the inhibition model and a desire deficit model. Treatment of delayed ejaculationThe so-called inhibition cause of delayed ejaculation and the approach to treatment which comes from it was promoted by Masters and Johnson (1970) and Kaplan (1974). But even within this treatment approach, there are different rationales for the causes of delayed ejaculation. First of all, the behavioral approach assumes that a man is not receiving enough sexual stimulation - in either quality or quantity - to reach his orgasmic threshold, so he is not able to ejaculate. Obviously, the implication here is that if the level of stimulation can be increased above his ejaculatory threshold, then he will be able to ejaculate - though the problem is that his ejaculatory threshold may be so high as to make this impossible. Is this a case of inadequate stimulation or a high stimulation threshold? These are actually quite different things when you consider them: for example, the high stimulation threshold concept behind delayed ejaculation implies that a man's delayed ejaculation comes from inhibition of his orgasmic capacity because he is consciously or unconsciously expressing deep rooted hostility and anger towards women. Inadequate stimulation might also result from a man having learnt to masturbate with an idiosyncratic technique such as thrusting his penis against the mattress without using his hand. Obviously the conclusion behind this line of reasoning is that treatment methods for delayed ejaculation might either have the aim of increasing sexual arousal through intense stimulation or they might aim to interpret and resolve conscious and unconscious impulses and neurotic defense mechanisms; or they might, of course, aim at both these objectives. If a man has a lot of anxiety around sex and especially around his performance as a lover, then any treatment approach which aims to increase stimulation thresholds - for example by rough and powerful manual stimulation of the penis - as a treatment for delayed ejaculation may actually have the side-effect of increasing a man's anxiety even further (after all, the delayed ejaculation is the result of performance anxiety in the first place). This any kind of aggressive approach to curing the desire disorder, or overcoming a high ejaculatory threshold, is likely to be counter-productive. It certainly sounds counter- intuitive to suggest a scheme like this for a man whose symptoms are probably rooted in anxiety anyway. In sex therapist Bernard Apfelbaum's view, delayed ejaculation speaks of arousal and desire deficits which need to be understood, therapeutically approached, and clarified so that a man can take responsibility for dealing with the unconscious conflicts which have caused his delayed ejaculation in the first place. Apfelbaum described this as "counter bypassing", and suggested that treatment should explore with a man his lack of desire for sexual intercourse and his lack of arousal which leads to his inability to ejaculate during sex. It is a fact that most men with delayed ejaculation are firmly convinced they are withholding something from their partner and that they should be more giving; this implies that changing a man's attitude and separating his distorted beliefs around sex in general and delayed ejaculation in particular are a main component of this treatment approach. 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 actually want to have sex, they do not desire their partner, but they feel at the same time compelled to have intercourse to please their partner. This kind of delayed ejaculation is very often partner-specific, and the fact that a different partner, as in our case history, results in a lessening of the symptoms is indicative that we need to expand the range of therapies beyond aggressive stimulation of the penis to overcome the desire deficit. Having said that, there are problems with Apfelbaum's approach. Other therapists have observed that many men with delayed ejaculation show features of affective disorders, obsessive-compulsive disorders, paraphilias, anxiety disorders, and even various personality disorders. In such cases, delayed ejaculation is very likely to be a sign of inhibited arousal and desire in a partner-specific context, but backed up by a profound intrapsychic or interpersonal psychopathology that needs effective treatment. Apfelbaum also suggested that in cases of delayed ejaculation, only the man's own touch is erotically arousing, which makes him autosexual (i.e. masturbatory) rather than heterosexual or homosexual. However, it's possible to see idiosyncratic masturbation as the simple expression of the fact that a man can only reach orgasm through masturbation rather than a sign that he only finds his own touch arousing - though of course that might be true. In other words, delayed ejaculation is not necessarily a sign of auto sexuality, or autoeroticism, and this will be especially true when a man is clear that he wishes he could ejaculate during sex, and when he is clear that this wish comes from his own desires rather than his desire to please his partner or from an externally imposed standard which dictates that ejaculation during orgasm is the goal of sexual intercourse. However, there is no clear division between different approaches in the treatment of delayed ejaculation, and it is obvious that any treatment which is effective in opening up the subconscious drives and inhibitions which affect a man's sexual relationship with his partner is a worthwhile endeavor. 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, whether within or without the framework of treating delayed ejaculation. In therapy, this process is facilitated by offering or stimulating different interpretations of beliefs held by the man and his partner around sex in general or delayed ejaculation in particular. This is of course a kind of reframing approach which allows men and their partners to "see things in a different light", a kind of decontamination of the beliefs which the man holds. There may be some powerful insights which have an impact on the cognitive level almost immediately - others, more deeply rooted in the unconscious, may take longer to change. Surrogate therapy with specially trained partners has also been helpful in the treatment of delayed ejaculation. What all this tells us is that the overall approach to the treatment of delayed ejaculation need not be limited to one modality. All treatment approaches reflect some reality for one man or another with delayed ejaculation. 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. [
Treatment of delayed ejaculation; the way to cure retarded ejaculation
]
|
|
|
