Delayed Ejaculation
How To Reach Orgasm & Ejaculate During Sex

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Sex therapy for delayed ejaculation (also known as retarded ejaculation)

If you're a therapist treating men with delayed ejaculation (retarded ejaculation), what might you expect to find most helpful? Conversely, if you are a man seeing a therapist for retarded ejaculation, what would you expect to happen? The following text outlines different treatment methods for retarded ejaculation.

Stimulation Techniques

Delayed ejaculation is involuntary and unconscious. No-one wants to miss the pleasure of ejaculation during sex - common sense tells us that men with an inability to ejaculate during sex must have either a highly elevated threshold for sexual arousal or require exceptional levels of stimulation during sex and masturbation to trigger the ejaculatory reflex. In any kind of therapy, the objective has to be the elimination of this inappropriate pattern of bodily response (delayed ejaculation in this case), so that a man can achieve normal ejaculation during sex.

As with other "sexual dysfunctions", the objective of therapy is to achieve normal sexual functioning. If a man is "over-controlled" during sex, then the techniques which are described here, which may be used in therapy by a sexual therapist, will help to provide increased stimulation, reduce the man's need for control, and desensitize any fears or anxieties which inhibit his sexual arousal. (For example, some men have an aversion to the vagina. This does not help increase their sexual arousal!)

These techniques are designed to distract the man from his need for control and allow him to receive more sexual stimulation. Essentially, the technique depends on two basic ideas: that desensitization can permit a man to feel less anxious in situation which he previously found threatening, and that sensory awareness can increase arousal and permit him to relax into his sensual nature - and of course these two techniques go hand in hand. Together the two components represent a cure for delayed ejaculation.

Before a program of desensitization can be applied in the treatment of retarded ejaculation, we obviously have to know what is causing the sexual dysfunction in the first place. This information is the starting point to design a series of behaviors, each of which is less anxiety provoking than the previous one because of the adaptation which has gone before it. So, for example, a series of sexual tasks might be arranged which go like this: masturbate to orgasm with one's partner downstairs; masturbate to orgasm with her in another bedroom; masturbate to orgasm with her just outside the room; masturbate to orgasm with her in the room but facing away from the man; masturbate to orgasm with her sitting on the edge of the bed; masturbate to orgasm with her lying bedside the man; masturbate to orgasm while she touches his body; have her start the process; have him reach orgasm with her hand over his; and so on. A couple can then move on to vaginal penetration, adopting a similar series of graded steps towards full penetration and intravaginal orgasm.

In this treatment method for delayed ejaculation, the steps gradually advance towards the final objective of ejaculation inside the vagina. It is essential that the man knows how aroused he is at each stage of this process as the objective in treating delayed ejaculation is to develop greater arousal more quickly - if he is not experiencing increasing arousal, then strategies to help intensify the process are used: these include increased use of fantasy and increased physical stimulation. When a man is receiving stimulation which is more effective in arousing him, his subjective level of arousal should increase. Perhaps easy to say, and harder to do, the man should also be encouraged to lessen his need for control so that he becomes more fully "into" his sexual experience. The final objective in this treatment approach to delayed ejaculation is of course the ability to penetrate his partner, thrust, reach orgasm and ejaculate in her vagina. There is a technique called the bridging maneuver which may be useful: a man is stimulated by hand or by mouth by his partner until he is close to orgasm - then his penis is promptly inserted into his partner's vagina (which requires his partner to be sitting astride him as he approaches orgasm), where he hopefully ejaculates. This is a classic desensitization technique designed to overcome inhibition about ejaculating inside the vagina and make the man more relaxed and less anxious as he enjoys his orgasm.

There is also an element of permission here: in the sense that the man must feel enabled to enjoy his sexual arousal and, indeed, the entire sexual experience. It's often helpful for him to imagine what his ideal sexual experience would be and for him then to seek it out and enjoy it, within the boundaries of the relationship: in other words, he should seek sexual pleasure for himself rather than his partner....this is especially important since many men with delayed ejaculation actually put their female partner's sexual pleasure in bed as more important than their own.

Obviously it is helpful if a man can observe what "turns him on" so he can later apply the same stimulation during sexual intercourse with his partner. It's also helpful, in fact essential, during treatment of retarded ejaculation, if sexual activity only takes place when a man is actually aroused (recall that the erection of many men with delayed ejaculation does not signify a high level of sexual arousal). And if any negative self-talk develops during intercourse or in any other form of sexual activity, a frank and open discussion of what is going on with his partner is often very helpful.

Therapy which involves a number of approaches is most helpful, so any underlying conflicts must be explored. Hostile or aggressive impulses, feelings of guilt, and rigid defense mechanisms must all be explored and dealt with. Reframing approaches, also called decontamination by TA therapists, are all about putting false beliefs to rights, which may amount to a long process of teasing out factually incorrect beliefs or simply providing new information to correct false beliefs. Most men with retarded ejaculation think they are  withholding something important from their partner and believe they should be more giving, so changing this attitude and emphasizing that it is in fact alright to be selfish during sex are a major part of the treatment program.

The therapist Bernhard Apfelbaum has suggested using the principles of orgasmic inhibition treatment in women to make a man aware of his unconscious refusal to enjoy sex without applying too much therapeutic pressure. Reinterpreting an unconsciously motivated inability to give during sex (inability to "give" his ejaculation and orgasm) into a more understandable inability to take sexual pleasure, and focusing on a man's strong conscientiousness about pleasing his lover, his desire to be in control and his perfectionism, are crucial parts of the treatment for delayed ejaculation. Men who cannot orgasm during sex are often unable to take, to be selfish, or to have orgasms "for themselves": satisfying their partner is all-important. Men coming from this place quickly get an erection, but usually do not receive additional stimulation; this means they try to enjoy sex with only  low to moderate levels of sexual arousal, which impedes any progress towards higher levels of arousal and ultimately their own orgasm and ejaculation in side their partners.

Men in this position need to understand that they are not trying to achieve an orgasm "for their partner" but for themselves - this insight can often provide new therapeutic opportunities. As many women partners are locked in this belief system too, they also need to be encouraged to accept that their partner's ejaculatory inhibition in general, and his delayed ejaculation in particular, are not any kind of rejection, but reflect the fact that he is trying "too hard" to have an orgasm for her.

Cognitive-Behavioral Interventions

Two factors that seem to maintain delayed ejaculation are high-frequency idiosyncratic masturbatory behavior and the discrepancy between a man's inner world of fantasy and the actual forms of his sexual expression with his partner. To overcome this, a couple need to integrate his masturbation fantasies into their sexual relationship, which will not only reduce feelings of guilt but also make it easier to overcome retarded ejaculation. And something as simple as encouraging the man to masturbate with his other hand - which may well fail to produce an orgasm - can be helpful in letting him understand how his retarded ejaculation and idiosyncratic masturbation have perhaps become an ingrained pattern of behavior.

From a cognitive - behavioral therapy viewpoint, the basic strategy is to identify inhibitions and anxieties so that the therapist and client can come up with new sexual scenarios and develop appropriate techniques to overcome them. The aim is always to increase erotic stimulation and identify the man's orgasm triggers, but, as we have observed already, interventions which seek to change  cognitions and produce changes in attitude are equally important. Here are some crucial aspects of this program:

Intimacy between the two partners is likely to reduce performance pressure on the man significantly; mutual pleasuring and giving will increase verbal and physical intimacy, and this will help to overcome inhibition and sexual isolation.

An "automatic" erection does not necessarily mean a man is ready to have sex. His subjective arousal may be too low. A major treatment strategy is to give a man permission to enjoy sexual pleasure and to encourage him to see his ejaculation as a natural culmination of his sexual arousal. As treatment for delayed ejaculation proceeds, a man learns to be more direct in his requests for stimulation and more straightforward in allowing himself to enjoy erotic feelings. By being more "selfish," he will experience more subjective sexual arousal and is more likely to enjoy an orgasm during sex.

A great help in the treatment of delayed ejaculation can be multiple forms of stimulation and knowing what will trigger his orgasm. Multiple stimulation might include fantasy, testicle stimulation or playing with his partner's breast or anal area during sexual intercourse. Orgasm triggers are very variable from person to person, but you can find out many of them by using fantasy during masturbation. Intravaginal ejaculation must be approached gradually, with a couple only starting intercourse when they are both highly aroused.

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[ Delayed ejaculation - retarded ejaculation - how to ejaculate during sex ]

[ Your boyfriend or husband can't come during sex or orgasm during intercourse ] [ What is delayed ejaculation? Why you can't ejaculate during sex ] [ Stopping delayed ejaculation ] [ Causes and effects of delayed ejaculation - retarded ejaculation ] [ My boyfriend or husband can't ejaculate during sex ] [ Medical view of delayed ejaculation / retarded ejaculation ] [ Treatment of delayed ejaculation ] [ Dealing with male anorgasmia ] [ Cure for delayed ejaculation (male orgasmic disorder) ] [ Treatment for retarded ejaculation - delayed ejaculation ] [ What causes delayed ejaculation? ] [ Case study of delayed ejaculation - a couple with retarded ejaculation ] [ Boyfriend unable to orgasm during sex, husband unable to ejaculate ] [ Case history of delayed ejaculation ] [ Sexual therapy for delayed ejaculation ] [ Delayed ejaculation treatment ] [ Retarded ejaculation treatment ] [ Retarded ejaculation treatment ] [ Unable to ejaculate ? ] [ How to stop delayed ejaculation or retarded ejaculation ] [ What to do if your boyfriend can't come during sex or your husband can't orgasm during intercourse ] [ Scientific research on DE ] [ Causes and treatment of DE ] [ Personal experiences of delayed ejaculation ]

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