In psychotherapeutic practice, the most famous is the method of sex therapy, which, according to many sexologists, is better than other forms of therapy, gives a successful prognosis for the treatment of premature ejaculation.

The goal of sex therapy, which occurs in the form of sexual exercises, is to change the causes of the psycho-physiological symptoms of the disease in sexual partners.

Each such case requires the selection of a specific behavioral program, specific erotic “homework assignments” offered by the doctor for the treatment of various disorders. The main thing in the application of this technique is to form in the patient a clear awareness of the sensations that precede the onset of orgasm. The formation of this feedback sensory communication is carried out in a relaxed atmosphere, in the presence and with the participation of a permanent partner (best of all – the wife). Making the patient think or say something, and as a result, turning a thought or a word into a feeling is the essence of this therapy. To cause a certain feeling (cold, heat, for example), which is modified into a similar sensation, is rather difficult, but possible. Under the guidance of a psychotherapist, these sensations can replace each other, ensuring the proper effect. In our case – to extend the time before the onset of ejaculation.

The most popular methods of treating premature ejaculation are the “compression” technique proposed by W. Masters and B. Johnson, and the “stop-start” method developed by James Samans and adapted for practical use in the Cornell clinic. The basis of these techniques is the ability of the patient in the heterosexual situation to “sharpen” the awareness of their pre-tragic sensations. For example, in the last admission, the partner should stimulate the man’s penis, manually or orally, prior to the moment of orgasm. And at this very moment, she stops the stimulation until the sensations preceding ejaculation go out.

Clinical experience suggests that all cases of treatment of premature ejaculation have a favorable prognosis during the application of these techniques, except for those manifestations where ejaculatory “incontinence” serves a deep-rooted psychological need.

“Stop – start”

Urologist James Semans proposed a technique developed to extend the sensations that precede an orgasm, which gives a man the opportunity to become better acquainted with them and eventually gain control over the ejaculatory reflex. Similar techniques for the individual correction of sexual dysfunction have already been considered in the first chapter. Now the doctor deals with his problems with a man (and partner).

Initially, the patient achieves control through manual stimulation by his wife. Spouses are recommended to carry out foreplay until the moment when the husband develops a steady erection. Then he lies on his back, closes his eyes, and his wife stimulates the penis. The wife in this case performs manipulations that a man could do on his own, but moral or religious attitudes about masturbation prevent him from doing them.

As a typical example in medical practice, one can cite the case of male believers, Catholics and Jews, who are not recommended to prescribe exercises with masturbation, since there is a sin of Onan (marked “dropped the seed”) in marked religious denominations. Masturbation, therefore, can lead to excessive patient resistance during treatment. That is why in the treatment of premature ejaculation in observable Catholics and Jews, we apply the standard “stop-start” procedure as follows. The wife receives instructions to stimulate her husband’s penis in the usual intermittent manner, while her husband lies on his back, and she sits on him with his knees apart so that her genitals are located next to his penis. She is asked to insert his penis into the vagina in order to “catch” his seed as soon as he starts ejaculating after the third “pause”. This modification is in full compliance with the goal of treatment, which is to strengthen the patient’s lack of sensory self-regulation. This takes into account the peculiarities of the religious beliefs of the married couple.

A man focuses his attention on his own erotic sensations. Sensing the approach of an orgasm, he tells his wife to stop. After a few seconds, the urge to ejaculate will weaken, and the wife will continue the stimulation again. When pre-orgasmic sensations appear, he again asks for a pause. The procedure is repeated four times. For the fourth time, he ejaculates. A man is given a setting to focus on his feelings and not allow himself to be distracted. Unlike cases of impotence and delayed ejaculation, when distraction to fantasy is specifically encouraged, with premature ejaculation, the patient, on the contrary, should refrain from any kind of distracting moments. The essence of therapeutic treatment is that the patient learns to recognize the signs of the coming orgasm.

After two successful attempts, the spouses repeat the whole procedure, but this time, petroleum jelly is used to enhance the arousal. After three or four successful attempts using Vaseline, the spouses are ready for coitus, which is also carried out along the lines of “stop-start”. A woman takes a position on top. After the introitus, the man puts his hands on her hips and directs her movements up and down. Then he stops her. A few seconds later, after easing the urge to ejaculate, they continue again. Initially, he does not make any movements. In the fourth case of the approach of orgasm, he makes an introductory movement and reaches ejaculation. And this time it is extremely important that the man focuses his attention on the experienced feelings. After three or four exercises (the woman takes a position from above, and he actively performs coital movements) and as the self-control is successful, the couple can proceed to perform the same actions in a “lying on their side” pose. As noted earlier, the “classical” posture, or the “man on top” posture, is problematic for this type of procedure, and is recommended to be taken as the very last.

As a rule, a man achieves good control over ejaculation over a period of 2 to 10 weeks, although steady control is usually achieved after several months have passed since the termination of therapeutic procedures. During this time, spouses are advised to do one stop-start exercise per week.

The use of the “stop-start” technique requires a motivated, willing to participate in the treatment of a partner and a delicate, competent sexologist. As a rule, while the man achieves good control over ejaculation for the period from 2 to 10 weeks. If the initial effectiveness of this therapy is 60-95%, then after 3 years – 25%. Unambiguous increase the time of sexual intercourse by an order of magnitude or more, it does not.