Premature ejaculation is mostly due to a weakening of the inhibitory processes in the cerebral cortex. It is caused by hyperexcitability of the higher sexual centers, weakened inhibitory processes in the primary ejaculatory centers of the spinal cord, and hyperexcitability of the sacral medullary ejaculatory centers. Clinical experience shows that the influence of training factors on the duration of ejaculation is powerful. Premature ejaculation is fundamentally due to the low stimulation threshold required for ejaculation and poor psychological control, therefore, the treatment of premature ejaculation is nothing but to improve the stimulation threshold for ejaculation and psychological control.
One way to improve the stimulation threshold is to train the couple with the technique, and the other is modern sexual tool therapy. The so-called sexual tools are some apparatuses that can help men and women overcome their sexual difficulties and complete their sexual responses like normal people. In a sense, they are significantly stronger than a thousand so-called aphrodisiacs. But they are not a panacea, they can only help to cause or improve the excitement of the sexual organs. The use of sexual tools has a long history and is widely used in various cultures, such as the Golden Lotus in the introduction of a variety of sexual tools, in addition to the ancient Greek and Roman paintings also have such descriptions.
The main new sexual tools that have emerged in modern times are the following two.
Dummy vagina: it is useful for patients with impotence and premature ejaculation. Since the prosthetic vagina contains an oscillator device, it has a massaging and stimulating effect on the penis, which helps to restore its function. Modern fake vaginas are made of high-grade plastic, either hand-held or attached to the whole plastic female body. Foreign-made ones are expensive, but the current domestic ones are also well-made and functional and should be the object of choice.
Oscillator: Its power supply is battery or alternating current, mostly driven by a small motor a cam device, thus generating a frequency of 80 times / min oscillation or frequency can be adjusted oscillation. This high-frequency stimulation easily provokes the growing sexual excitement and allows patients who do not ejaculate to quickly break through the orgasmic threshold so that the ejaculation disorder is overcome. There are male and female oscillators, male ones are generally designed in the form of a sperm collector, female ones are designed in the form of an imitation penis, and there are universal types. But don’t forget that instruments are after all instruments and cannot replace human emotional input and tangible sensations, so you can’t rely entirely on tools, they can only play a supporting role.
Behavioral therapy is one of the first methods applied in the treatment of premature ejaculation, mainly including sensual concentration training, penile squeezing therapy and intermittent penile stimulation method, which is easy to use and patients need to carry out their own treatment of premature ejaculation under the guidance of a doctor
The aim of the treatment is to shift the goal of the sexual activity of the partners from completing the sexual response to giving and receiving sexual pleasure and pleasure from each other. The aim of the treatment is to shift the goal of the sexual activity of the spouse from completing the sexual response to giving and receiving sexual pleasure and pleasure from each other. Principles of Sexual Focus Training Method: Recognize that sexual dysfunction is a matter for both partners, not just for one of the spouses. Both parties should act with the conviction that they have a sincere willingness to face and solve the problem with each other. No sexual relations outside of marriage should take place during the treatment period.
To organize work and life, it is better to get rid of the worries of work and housework. Since patients with sexual dysfunction are prone to anxiety and ideological stress, or fear of sex due to failure of sexual intercourse, sexual intercourse should be abstained from during the course of behavioral therapy, so that the patient receives treatment in a relaxed and pleasant atmosphere. Let the cerebral cortex have a time to properly adjust and recuperate. The decision to resume sexual intercourse should be made according to the progress of training, and medication should be suspended or reduced as appropriate, and alcohol should be abstained from during treatment.
Training should be carried out at a time suitable for both partners and under good environmental conditions, avoiding interference from others, in a warm, comfortable room with soft, dim lighting, or accompanied by relaxing music. Both spouses should preferably be nude, if full nudity makes the patient feel uneasy, nervous or shaky, then start with less nudity or half nudity, and then full nudity after getting used to it. The body position is generally supine or prone for the passive party, with the active stroking party lying on its side or sitting, with both parties taking a face-to-face position. The training time is generally one hour per day, and both parties take turns to play the active or passive role. A total of 15 to 30 sessions are scheduled, depending on the progress of treatment.
As stroking often need to strengthen the sexy feelings of both spouses and reduce the discomfort and disgust brought about by dry stroking, massage milk or lubricant can be used, and inert lubricant can also gradually eliminate the patient’s disgust and unpleasant feeling of genital secretions, because the two are similar in physical properties, habitual contact with the similar nature of the lubricant, it may no longer feel disgusted with the secretions. The basic program of erotic focus training: non-genital erotic focus training; genital erotic focus training; vaginal accommodation; vaginal accommodation and activity. Sexual focus training should obtain a detailed treatment response. The doctor should get the couple’s response to the treatment at each stage of treatment, asking them how it went, what they felt and what problems they had, and how they responded to the treatment; without knowing this, it is difficult for the doctor to continue the treatment with the patient couple.
Patients who have failed in their sexual focus therapy should be examined for the cause of the failure. Identifying the cause of failure is often the key to successful treatment. It also serves to increase the couple’s interest and understanding of the treatment plan.
Doctors also revise the treatment plan in the course of sex-focused therapy in response to the treatment situation. In behavioral therapy, if the previous phase of treatment is unsuccessful, the next phase of treatment should not be entered into for the time being, and the previous phase of treatment should be extended or revised.
Establish a “retrospective phase” of treatment. From the beginning of treatment, a time should be designated as a “retrospective phase”. Usually after three sessions, it is important to review their progress and any problems that have arisen. This can help couples feel emotional and confident about their treatment. The physician can also use this time to pause for analysis and modify the treatment plan.
Follow medical ethics and maintain patient confidentiality. Most of the issues discussed during treatment are private and should be kept confidential by the physician in accordance with medical ethics.
The couple should also be consulted about the treatment schedule. For example, how long and how many times the treatment will take place, when to schedule the patient’s follow-up appointments, etc.
The patient’s spouse should be involved in the discussion of the treatment plan. The patient’s spouse must be involved in the discussion of the development of a new treatment plan is the key to success, in cooperation with the treatment, should not consider the previous failure, have confidence in themselves and the patient to cure, treat the treatment of sexual dysfunction as a major life event, and ensure that both spouses have plenty of time in the treatment process.
The difficulties in the treatment are faced squarely. Couples should anticipate the difficulties they may encounter during treatment and not view a failure or difficulty as a serious relapse, but rather as a good opportunity for the treating physician to help and understand their sexual difficulties.
Pre-treatment problems such as discord and resentment between spouses can often prevent and reduce the pleasurable sensation of physical contact between the couple. In such cases, what couples need is general marital therapy rather than sex therapy. However, some couples with minor relationship problems can mostly be resolved before a sex therapy program begins.
One spouse is sexually frigid and has a severe fear of physical contact between spouses, which is often one of the reasons for not being able to perform non-genital sexual concentration training. For such fearful couples, they can be instructed to perform relaxation training once or twice a week on a regular basis to relieve this fear. Spousal contact can begin with the hands and a clear prohibition of any more intimate or extensive physical contact. Gradually increase physical contact between spouses, even when both partners are finally able to perform sensual focus training, still wearing a small amount of underwear.
For occasional premature ejaculation, a complete sexual treatment plan is not necessary and a simple discussion can be taken to resolve the problem. Clinical experience suggests that most couples should be advised to spend at least 1 to 2 weeks in the early stages of a sexual treatment program on non-genital and genital sex-focused training before special techniques are needed to address their particular problem.
Sexual concentration training is a method that focuses on making both spouses express mutual affection through sight, touch, smell, and retreat in many ways rather than simply having sexual intercourse. They provide and accept each other’s flesh to give their own pleasant feelings. It should be clear that the purpose of sensual focus training is to provide and receive pleasurable feelings from each other in caresses. In the case of sexual arousal caused by erotic focus training, the solution can be relaxation and rest.
Stages of treatment
Phase I: Non-genital eroticism training
Specific methods and instructions
1.Obtain the consent of both spouses and warn them not to have sexual intercourse or fondle each other’s genitals and breasts during the implementation of this phase of the treatment plan until the completion of several stages of sensual interaction.
2. The caressing phase of the treatment should be carried out at the place and time desired by both spouses, and make sure that both spouses will not be disturbed by other parties and will not talk about anything unrelated to the treatment in order to concentrate on caressing and experiencing pleasant sensations.
4, the position of the caress can be more flexible, the basic requirement is that both parties can look at each other’s whole body.
5, non-genital sexy concentration training began, one of the spouses should try to touch each other’s whole body, in order to cause each other a sense of pleasure, but not to touch the genitals of both sides and female breasts.
6, the main purpose of the fondling treatment is to make both spouses begin to build confidence and establish a sense of intimacy, but, take care not to exceed the scope of behavior allowed by the fondling stage.
7.Decide how many times to caress, the progress of the treatment is largely based on the number of strokes that have been made, generally three times a week is good.
8, the skin can be stroked with a small amount of lubricant, such as baby lubricant that makes stroking comfortable, talcum powder and other topical auxiliary lubricants.
9, the various stages of family therapy can be artificially divided and arranged, the length of treatment can be determined by the progress, generally the total time of the first treatment is about 1 week.
10, both spouses in sexy concentration training and daily life should try to use the personal pronoun “I”, such as “I want to know, I do this how you feel”, rather than saying “you do not seem to like this “, pay attention to avoid vague communication.
11, after several sessions, one spouse feels and likes the sexy focus training, then should pay attention to seek the other party’s clear views, such as “I like to experiment with these caressing training, do you need?” rather than making vague, ambiguous comments. If one spouse has a positive or affirmative attitude toward fondling, the other spouse should accept the invitation. If one partner is negative about fondling, the other partner should encourage the other to try to explain the negative reasons.
After giving the first session of non-genital eroticism training and learning about the specifics of each spouse’s completion of the training, the next phase of treatment can be prepared based on the treatment. The couple is asked to review in detail what progress they made in the first session and what they feel is lacking or hindering the effectiveness of the treatment. This will make it easier for the doctor to ask questions in the next session, as otherwise the doctor may not be able to do so for fear of asking questions that may cause embarrassment to the patient. Also the treating physician makes personal predictions about the progress and effectiveness of the treatment based on the information obtained during the initial evaluative counseling and the couple’s response to the initial instructions.
After 3 to 4 sessions of non-genital erotic focus training, the couple should communicate their feelings to each other in a straightforward manner, and the doctor should begin counseling at this time. The consultation begins by asking each spouse what progress has been made since the previous session. Then, the treating physician should ask each partner for details about what happened and how they reacted to the treatment, including both positive and negative experiences. Care should be taken to avoid blunt statements such as “that’s good” or “that’s not good” when asking. It is important for the treating physician to have a detailed understanding of the situation at the time of treatment, not only to obtain a wealth of information, but also to encourage spousal communication about the sexual relationship through a detailed discussion of family therapy.
Response to therapy: Couples’ response to non-genital sexual focus training may be positive or negative, or more often both. For some couples, this training provides an impressive and positive experience, which can lead to changes in the behavior of both spouses. In therapy, such changes are common and obvious, such as couples appearing closer and more affectionate. However, the initial response may also be negative, or the couple’s behavior may not remain within the permissible range.
It is important that the treating physician help couples recognize their reactions and relate their sexual difficulties to the causative factors that can be identified in evaluative counseling, and if further treatment can be recommended, couples can turn to these recommendations for complete treatment. If the couple does not get a good experience and results from non-genital sexual focus training, subsequent treatment may be more difficult. In this case, the treating physician should advise the couple not to proceed to the next phase of the treatment plan, but to continue repeating the above treatment until there is a good response, with the physician’s explanatory guidance.
Phase 2: Genital Sexual Focus Training
Specific treatment methods and guidance: In this phase of the treatment plan, the spouses should continue to exchange ideas and requests with each other. Stroking should also continue initially at each session with one spouse active and the other passive, and rotate this role. Sexual intercourse should not occur during this phase.
During stroking, the man’s attention should shift from one part of the woman’s body to another, and the woman should let her spouse know how she feels. The couple should adopt the position they want to be in, and the “non-demanding position”, where the woman sits in the man’s arms, is recommended. Some impotent patients can often begin to feel an erection in this position.
It is also necessary for patients with premature ejaculation to learn this training method before using the C-stop technique or the squeeze technique. Couples who have already used lubricants during non-genital erotic focus training can continue to use them during touching.
When Genital Sexual Focusing Training is successfully conducted in family therapy, the couple should take turns taking the active and passive roles.
During this phase, some couples are able to appreciate the genital erotic focus experience immediately after the removal of doubts and rapidly aroused sexual desire. If sexual intercourse is performed at this time, it often has a negative effect on the subsequent treatment, therefore, sexual intercourse is also not advocated during this subphase.
Negative reactions are also common, even though couples may have had several successful non-genital sensual concentration pleasant feelings, but at this stage may still cause sexual anxiety, anxiety is generally caused by the success of sexual arousal but not sexual intercourse between spouses. Mild anxiety may disappear after a few strokes, in severe cases it may lead to avoidance or even stopping the treatment or cause one or both spouses to become increasingly bored in the treatment. Negative reactions are mainly manifested by
Sexual intercourse initiation, which may be a healthy response to sexual desire, but this may also be a negative response to stopping genital touch and proceeding directly to sexual intercourse due to inability to control sexual arousal and anxiety and boredom about sexual behavior.
Negative experiences, such as anxiety, irritability, lack of concentration or even pain during touching, will can lead the patient to avoid this phase of treatment.
If these reactions do not manifest immediately, avoidance can be used to reduce negative attitudes and concerns. Other factors that may cause negative reactions include general inhibition, guilt, anxiety about the appearance of the genitals or the smell and secretions of the sexual act, and fear that the partner is not in control. To prevent negative reactions and increase sexual arousal, sexual fantasies may be used. If sexual anxiety is caused by a part of the treatment program that does not seem to play a major role in resolving the couple’s sexual dysfunction, this part of the treatment should be abandoned.
Stage 3: Vaginal Accommodation
The next step in the treatment plan, after the successful establishment of a genital sexual concentration experience, is to gradually engage in sexual intercourse through the intermediate phase of vaginal accommodation. One of the goals of this phase of treatment is how to reduce the anxiety that some couples experience as a result of sexual intercourse.
Specific treatment methods and instructions: Once the couple has gained experience in genital erotic focus training, treatment for vaginal accommodation can begin. The sexual position for the vaginal accommodation phase should be selected experimentally, and a woman-on-man position, or a lateral position with the female partner guiding the sexual activity, is generally recommended. Of course, whatever position is chosen, the treating physician should describe it in detail. Vaginal accommodation can take place for 4 to 7 days, and both partners should focus on experiencing sexual pleasure and improving their ability to control orgasm.
Response to vaginal accommodation: During this phase, if the patient is accompanied by erectile dysfunction, the erectile dysfunction may recur because but penile insertion into the vagina and the patient feels the need to maintain an erection of the penis causing anxiety. These problems are usually temporary if the male partner is able to maintain a satisfactory erection during genital sex-focused training and is also able to train the penis to swell and subside. Patients with premature ejaculation often have anxiety and difficulty with penile insertion into the vagina because they often cannot control ejaculation themselves after insertion, resulting in premature end of sexual activity. This should be repeatedly trained until you can control yourself. Penis integration is of course an important stage in the treatment of women with vaginal spasms.
Stage 4: Vaginal accommodation and movement
In this stage, the couple can perform penile activity while the vagina is being accommodated, which is the final stage of the sexual behavior therapy program.
1. 7-day non-demanding sex-focused training therapy.
This therapy is a complement to the home sex-focused training therapy. Because of the longer time required for home sexual concentration training, it differs from home sexual concentration training in that the basic point is to achieve sexual euphoria without allowing the range to be exceeded. This therapy is also adapted to the treatment of impotence, non-ejaculation and sexual indifference in women.
On the first day, the non-genital sexual concentration training starts with the couple in “non-demanding position”, which can start with the husband touching the wife, and then after 10-20 minutes, exchange the position and the wife touching the husband, and then after 10-20 minutes, both parties can relax and fall asleep.
The next day, the couple spend 30 minutes talking about their past and current experiences in sex.
On the third day, the wife strokes first, and after 10 to 20 minutes, the husband strokes instead, for 10 to 20 minutes each time.
The fourth day, first by the husband stroking, at this time should pay attention to appreciate other parts of the body.
The fifth day, first by the wife to touch the husband, 10 minutes ~ 20 minutes after the couple changed positions, the husband touched the wife.
On the sixth day, the two sides do not touch, for a second exchange.
On the seventh day, they can touch each other in either way, but no sexual intercourse is allowed. If, through a week of training treatment, both partners do have euphoria, it means that the purpose of sexy concentration training has been achieved. If there is no progress, then the training needs to be repeated for a week.
2.Penis squeezing therapy
Since the main manifestation of premature ejaculation lies in the high sensitivity of the glans penis, Masters and Johnson proposed squeezing therapy in 1970. The penile squeezing method refers to squeezing the head of the penis or the root of the penis by manipulation to increase the stimulation threshold and relieve the ejaculatory urgency, so as to delay ejaculation and treat premature ejaculation. The specific operation method is as follows.
The husband lies naked on his back with his legs apart and the wife faces the husband sitting between his legs. Then, the wife with her hand on the penis to continuously apply stimulation, when the man appears to ejaculate urgency, the woman put her thumb on the foreskin of the penis tether area, index finger and middle finger on the penis glans dorsal side of the coronal edge below, tightly pinch a few seconds and then release, the penis will gradually weaken. After the penis weakens, sexual stimulation is performed again, and so on. The direction of the penis squeeze pressure is backward and forward, not left and right, the female use of the finger belly, rather than pinch with the nail to pinch, pinch squeeze should pay attention to master the strength to the male does not feel pain as appropriate; erection firm force can be slightly heavy, erection is not firm or flaccid, the force should be light.
This technique can improve the stimulation threshold of men’s ejaculation, thus relieving the urgency of ejaculation, insist on using 15 times to 30 times, can significantly strengthen the ability to inhibit ejaculation, prolong the ejaculation time, it is also important to note that the male partner’s attention should be focused on the sensations generated by the stimulation of the penis, and do not pay attention to when it will ejaculate. Moreover, there should be no uneasiness or guilt once ejaculation occurs. The operation must be performed by the female partner to achieve good results.
After a few days of squeezing training, the man’s confidence increases and his symptoms improve, then the method should be transferred to the woman-on-top sex, because for the man, the sensation of the penis rubbing or being placed in the vagina is very different from the sexual activity without intercourse, and before preparing to insert the penis into the vagina, tell the woman to use the squeezing technique 3 to 8 times in the woman-on-top position. Before insertion, the penis should be squeezed, and after entering the vagina, it should be held still while both partners focus on the physical sensations, telling the man to never initiate friction at this time.
After the penis is rested in the vagina for a short time, the woman should pull out the penis and squeeze it again, then insert it again and start to do slow friction at this time. If the male partner feels that he is about to ejaculate, give the female partner a hint and the female partner comes down and then pinches and squeezes. If the vaginal shelving lasts up to 4 to 5 minutes, the speed of friction can be accelerated and allowed to ejaculate. When ejaculation control is improved by this method, you can switch to squeezing at the root of the penis so that you don’t need to go up and down to interrupt intercourse in order to perform squeezing.
3.Intermittent penile stimulation method
The intermittent penile stimulation method was first proposed by Kaplan in the 1970s to reduce the sensitivity of the penis through constant stimulation to raise the ejaculation threshold. The method: The man lies on his back and focuses entirely on experiencing the sensations that arise from the stimulation of the penis by the woman. The woman sits next to the man or between his legs and slowly strokes the penis with her hand to make it erect, and when the man indicates that he is about to reach an ejaculatory climax, he stops stroking the penis and lets the arousal subside. After a few minutes, the woman then continues to stroke the penis to make the man excited again. This is repeated so that the patient can gradually tolerate a large amount of stimulation without ejaculation. The number of intervals gradually decreases, and eventually the patient is able to withstand long periods of continuous stimulation without premature ejaculation without the need for a break.
This kind of training can also be carried out by the patient himself masturbating to experience the strength and manner of stimulation, and can also carry out similar training during sexual intercourse, such as reducing the amplitude and speed of penis pumping or suspending pumping to reduce sexual excitement, and then pumping when the penis is about to weaken. So repeatedly, you can extend the intercourse time, when the female partner to reach orgasm and then ejaculate.