Premature Ejaculation Treatment
This page outlines more of the guidelines used by therapists for teaching men ejaculatory control nowadays.
Learning the art of longer lovemaking includes learning ejaculatory control techniques like these:
1 PC muscle control
When a man consciously relaxes his pelvic muscles, or more accurately his pubococcygeus muscle, also known as the “PC muscle”, he’ll be able to more easily check how relaxed the muscles of his body are.
In addition he will have a technique that can improve ejaculatory control.
As you may have guessed, PC muscle training is a variation on the well-known technique of Kegel exercises for women, but instead of contracting the relevant muscles, a man learns how to relax his PC muscle (in this context, specifically the bulbocavernosus and the ischiocavernosus muscles) when he is feeling sexual arousal.
The most effective application of these techniques is in ensuring that a man is fully relaxed in the pelvic area generally and his PC muscles specifically before penetration.
However, a man will also use other techniques to control his thinking and behavior during intercourse (cognitive and behavioral “pacing techniques”).
The essence of this particular aspect of ejaculatory control is the focus on relaxation of the muscles that are associated with ejaculation.
2 The Stop Start Technique
The stop-start technique was invented by Dr James Semans around 1956.
Effectively, stop-start methods are a behavioral pacing technique, in other words a technique that allows a man to alter his actions during sexual intercourse in a way that will help him to last longer and greater ejaculatory control.
The essence of stop-start is a series of “progressive” exercises.
A man begins with progressive masturbation training, the purpose of which is to ensure that he is intimately familiar with the sensations in his body as he becomes more aroused.
By using this awareness, he develops the ability to control his arousal.
This method is then taken into sexual situations with the partner, where initially the partner masturbates him, but later they use the technique together during intercourse.
Stop-start training helps develop ejaculatory control because it allows the man to regulate the intensity of stimulation that he is receiving during sexual activity.
Of course, if he can regulate this downwards then he may well be able to last longer, as you may have guessed.
To explain this in more detail:
- a man begins to learn how to apply the stop-start technique when he’s on his own
- he uses a series of self-pleasuring exercises (i.e. masturbation)
- later the technique is extended to sexual interaction with his partner.
To apply the technique, a man stimulates himself until his arousal is just below the point of ejaculatory inevitability (also called the point of no return).
He then stops stimulating himself, so that his arousal will drop.
Through a series of progressive exercises that enable him to pay attention to his physical sensations whilst still in control of his ejaculatory reflex, he can both learn to recognize the sensations that occur immediately before orgasm and simultaneously learn to control his ejaculatory response and so last longer before ejaculation.
(One view of this is described here.)
When a man’s established a degree of control on his own, his partner can join in the fun and they can practice the same technique together.
Initially his partner will pleasure him, but after a series of successful sessions in which he has controlled his ejaculation by indicating to his partner when stimulation should stop, the couple will move on to full intercourse.
“Start-stop” intercourse begins, unsurprisingly, with the man’s penis inserted into his partner’s vagina.
This part of the exercise takes place whilst the woman is in the woman on top position, and the man is lying on his back.
This posture enables him to more adroitly relax his pubococcygeal muscles, while at the same time being able to guide his partner’s body by means of his hands on her hips.
In this way he controls the up and down movement of her body on the shaft of his erect penis.
At the point where the man feels that ejaculation is about to occur, he can immediately indicate that his partner should stop moving, whilst maintaining attention on the sensation that is experiencing in his groin area and in particular his penis.
As he does this, he consciously relaxes his pubococcygeal muscles until the need to ejaculate subsides.
By repeating this process a number of times before ejaculation is allowed to happen, greater duration of control can be achieved at this particular level of stimulation.
Thus, the next stage of the exercise involves repeating this process while accompanied by gentle thrusting from the woman, and the final stage involves thrusting by the man.
By using a stop-start sequence as described above once a week, a couple will quickly develop the ability to use incorporate these processes into sex as a natural part of intercourse, thereby giving the man the opportunity to exercise greater control of ejaculation under all conditions.
3 Becoming Aware Of The Cognitive Arousal Continuum
Michael Metz has come up with the term “cognitive arousal continuum”, which he describes a way to enable a man to “pace” his cognitive processes (i.e. his thinking during intercourse) in a way that enables him to regulate arousal by varying the level of stimulation he is getting, and also inhibit ejaculation by moving his attention onto sexually arousing thoughts and themes at various intensities.
Now, while this may sound complicated (it does!), what it means in practice is that the man is given a protocol for observing all of the elements that contribute to his arousal patterns.
These include the things he sees, what he does, how he feels, what’s happening, and the sequence of events that take place during his arousal. All of this will determine how long he lasts in bed.
With attention to these things, a man can become aware of which are more arousing and which are less arousing.
He can then rank them in the order of how powerful and potent they are in increasing his arousal.
Knowing that, he can focus on things that will either increase or moderate his level of sexual arousal during intercourse, and that in turn gives him some control over his sexual arousal and how quickly it increases.
This discipline requires full concentration, carefully applied during intercourse, but can be effectively used to regulate the man’s level of stimulation and help him last for a longer time.
4 Sensate Focus & Entrancement Arousal
Sensate focus exercises are a technique traditionally used by couples’ therapists for dealing with some kind of sexual dysfunction.
In the modern form of sex therapy described here, they can actually be used as a way of reinforcing the “entrancement arousal focus” (read on for an explanation of what this means) which has been established when the man is learning ejaculatory control on his own.
Because men with premature ejaculation often seem to focus on “partner involvement arousal” when a lover is present, a great deal of concentration may be required from the man in order to stay focused on his own entrancement and arousal.
Sensate focus is one way of practicing this.
Sensate focus is done at home with a couple relaxing and pleasuring each other until the man relaxes physiologically.
At this point he can lie on his back while the woman takes his penis and stimulates it while he focuses exclusively on the physical sensations that he is experiencing.
This is the meaning of entrancement.
Gaining an erection and gentle stimulation methods are used with the objective of achieving sexual arousal and physical relaxation simultaneously.
The exercise then moves onto mutual exploration of, firstly, the partner’s body, and secondly the partner’s genitals.
The objective here is to enable each partner to become proficient at sexual leadership with their own body, also to become a great deal more comfortable and relaxed when looking at teacher’s genitals, and finally to have their genitals both observed and touched and stimulated in a relaxing but not necessarily arousing way.
You can see that overall, the key factor here is about enabling a man to engage in a sexual situation where his arousal does not simply depend on the fact that he’s in that sexual situation.
Instead, his arousal is regulated much more by his conscious choice about what he does and how he becomes aroused — not to mention that he can hopefully also exercise control over the rate at which he will become aroused.
The final stage of the exercise, perhaps unsurprisingly, is acclimatization to intercourse.
The first step is to become acclimatized to vaginal penetration, so that the man enters his partner and then rests inside without moving (vaginal containment) whilst he focuses on relaxation of the PC muscle.
At some point during the “waiting period” the man will experience a transition to a state where he is calm, yet remains excited and and stimulated by the sexual enveloping of his penis by the vagina, the so-called “saturation point” which is described by Metz as a sensual dullness in his penis.
This is the point at which his penis has become accustomed to both the warmth, and sensuous wetness of his partner’s vagina, and his arousal does not increase any further. (The partner may use her mouth instead in oral sex exercises.)
Most men experience this “acclimated sensation” after around 10 minutes of penetration and resting inside the vagina, although Metz reports a range from as much as 27 minutes down to 7 minutes.
During this period the man moves only as little as may be needed to maintain an erection, because the more he moves, the longer the period of acclimatization will be – perhaps even lasting 30 minutes if he moves too much.
The point of this acclimatization is that once the man has become accustomed to the sensations of the vagina, his penis – and he – can begin not only to tolerate, but also to fully enjoy without anxiety or danger of ejaculation, the more intense pleasure of intercourse while still retaining a high level of ejaculatory control.
This enables him to increase both the length of time for which intercourse lasts, and the quality of the pleasure that he experiences, simply because he’s in control of his arousal patterns.