Treatment Of
Delayed Ejaculation
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Because delayed ejaculation is not subject to much investigation, there's little systematic research or data available regarding the outcome of any kind of therapy treatments. Nonetheless, accounts of sexual improvements from men who have had therapy suggests that psychotherapy can actually be very effective in dealing resolving delayed ejaculation, although a man must be willing to look at his deepest issues and possibly also the implications for his relationship with his partner. So what does psychotherapeutic treatment for delayed ejaculation actually entail?The usual treatment adopted for delayed ejaculation is around reducing and eliminating performance anxiety and establishing a high level of sexual self-confidence. The self-critical observer needs to be disempowered, and the man needs to be taught how to engage fully in sexual activity with his whole presence (emotional, physical and spiritual) so he is focused on the sensations that he's experiencing in the moment, and not on the achievement of orgasm - in either himself or his partner. Clearly the provision of adequate levels of physical stimulation so that the man is sufficiently sexually aroused to allow him to achieve orgasm and ejaculation is a vital part of delayed ejaculation treatment. The objective is to reduce anxiety about the goal on which the man is focused, which is usually around orgasm, either his own or his partner's and to enable him to enjoy sexual pleasure from caressing and stimulation. The only effective treatment methodology that I'm aware of which encompasses these objectives is the process of sensate focus to ensure that the man is actually more in connection with his own body, more aware of his own arousal, and more relaxed with his partner. Another aspect of treatment for delayed ejaculation that may be overlooked is simply to provide more physical stimulation to enable man to achieve orgasm more easily. This may include some method of increasing physical stimulation of the sexual and genital areas, including the scrotum, penis, perineum, and anus. One effective method of doing this is to use an anal stimulation probe which may provide extra simulation through application of a mild electric current or through vibratory stimulation. Another treatment method for delayed ejaculation has involved the patient learning to masturbate with a different focus. When a man is actually able to achieve orgasm during masturbation, this rather old-fashioned treatment for retarded ejaculation has involved his partner using manual stimulation on his penis, with a prohibition on intercourse. That's because intercourse is the very activity that causes the man to be more goal-focused than self-focused during sexual activity. The man needs to be in a mental space where he is simply enjoying the sensations of stimulation and arousal without any overt attempt to reach orgasm. The theory is that if the man approaches the point of no return, he or his partner is to discontinue stimulation and relax until his arousal has dropped. However, the problem with this approach is that most men with delayed ejaculation cannot reach orgasm through stimulation by their partner. While the theory is fine, the practice is rather lacking. The idea, however, is that the man will go through several cycles of stimulation and relaxation without any orgasm and ejaculation at the end of the session. This is supposed to behaviorally condition the man so that he is unable to prevent himself from having an orgasm during sexual stimulation at some point in the future. Its is in fact hard to see why the opposite would not occur - i.e. there's the possibility that the man could make it even harder for himself to ejaculate. When he does reach orgasm the therapy is adapted so that the man then only reaches orgasm when he feels it's going to happen despite the lack of intention on his part. It's fair to say that this is a poorly defined treatment strategy for retarded ejaculation - and it's also fair to say that it probably does not work. Those men who can masturbate orgasm on their own, but cannot with a partner, have often been given a modified treatment strategy for delayed ejaculation which is designed to overcome their inhibitions about displaying the loss of control associated with orgasm. For example, a man may be asked to role-play having an orgasm in a very dramatic fashion, acting as though he was out of control, or engaging a partner in the role-play as though she were out of control. When men fear loss of control it's possible that such exaggerated role-play can be effective in reducing embarrassment and shame and lowering man's inhibition about letting his partner see him having a real orgasm. However, it will not have escaped your notice that none of this addresses any emotional dynamic in the relationship such as hostility, shame or guilt between the partners. As the man is able to establish orgasm more reliably, the sexual repertoire that the couple engage in can be expanded to encompass oral sex, passive containment of the penis in the vagina, intercourse and thrusting by the man, and synchronous thrusting by both partners. As before, any attempt to reach orgasm is initially prohibited, being allowed only when the man finds that he is approaching orgasm spontaneously. The problem is that most of the men who seek help need considerable assistance with reducing performance anxiety and achieving greater arousal. This means that they need a more sophisticated methodology than the one described above. One method that has been used to achieve this is instruction in "orgasm triggers", which is a method used to help women who are anorgasmic achieve orgasm more easily. I quote: "Orgasm triggers are physiological events that tend to occur spontaneously and involuntarily when a person has orgasm. With experience, many people come to perform the orgasm triggers voluntarily when they are highly aroused, both to initiate their orgasm and to heighten its intensity. Orgasm triggers include arching the foot and pointing the toes, tensing the thigh muscles, contracting the pubococcygeal muscle and bearing down in the pelvis, caressing and squeezing the scrotum against the perineum, holding the breath in a Valsalva maneuver (i.e., attempting to exhale against a closed glottis), and throwing the head back to displace the glottis. However, telling a patient to perform all of these maneuvers at once to trigger an orgasm would certainly interfere with arousal and would lead to a performance-oriented spectator role! To avoid this negative effect, orgasm triggers are introduced sequentially over a few sessions, with each one described as a way to heighten pleasure and not initiate orgasm." A simple new treatment method for retarded ejaculationAnother powerful method of achieving greater physiological stimulation is to use anal stimulation. Many men have a problem with this because they naïvely believe that this is somehow associated with homosexual orientation. However stimulation of the anus can in fact trigger a reflex orgasmic response and thereby overcome delayed ejaculation. Anal stimulation can be achieved by a finger or an anal vibrator, and this actually is very effective (much more effective than applying a vibrator to the penis, a method which has limited effect). If the couple wish to include anal exploration and stimulation as part of sexual activity then they should start in the shower so that concerns about hygiene can be reduced. But finger play around the anus as the man approaches orgasm can trigger his ejaculation due to the intensely erotic nature of this pleasurable stimulus. Other factors in treating delayed ejaculation Clearly it is necessary to ensure that the man is on a medical regime which does not interfere with his ability to ejaculate. The most common medications which are implicated in this respect are SSRI antidepressants that do not also block the 5-hydroxytryptamine type 2 (HT2) receptor. One study has reported that there are five treatment strategies which can limit the side-effect of these antidepressants. The first is to wait for the accommodation to the side-effect to occur, although this is only likely to happen in fewer than one patient in ten. Clearly a better strategy is to switch to a different medication with fewer side-effects. A drug holiday is also possible, as is reducing the dosage. Another option is to apply a pharmacological antidote to the side-effect of the antidepressant although this clearly has implications for further side-effects. Yohimbine has been suggested as one candidate for this role, although a number of other compounds have been suggested including amantadine (Ashton et al. 1997; Balogh et al. 1992; Shrivastava et al. 1995), cyproheptadine (Ashton et al. 1997; Feder 1991; McCormick et al. 1990; Segraves 1993), stimulants (Bartlik et al. 1995), bupropion (Ashton and Rosen 1998b; Labbate and Pollack 1994), buspirone (Landen et al. 1999; Norden 1994), and sildenafil (Ashton 1999; Ashton and Bennett 1999; Nurnberg et al. 1999). Another approach that may be overlooked is simply to provide more physical stimulation to enable man to achieve orgasm more easily. This may include some method of increasing physical stimulation of the sexual and genital areas, including the scrotum, penis, perineum, and anus. One effective method of doing this is to use an anal stimulation probe which may provide extra simulation through application of a mild electric current or through vibratory stimulation. 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Delayed ejaculation treatment ]
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