How to Overcome Premature Ejaculation
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How to Overcome Premature Ejaculation

Helen Singer Kaplan

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  2. English
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eBook - ePub

How to Overcome Premature Ejaculation

Helen Singer Kaplan

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How to Overcome Premature Ejaculation discusses male sexual response and the cause of its disorders, and provides advice on leading a more normal sex life.

Based on the same therapeutic methods that have proven clinically effective for 90% of men suffering from premature ejaculation (PE), this straightforward volume describes a rapid, practical self-help program that can be used by single men or couples in the privacy of their home. Dr Kaplan first explains the nature of PE and its causes and then describes her effective treatment techniques. She also discusses the errors and resistances that can arise and provides suggestions on how to overcome them.

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Premature Ejaculation (PE) Can Be Cured
Before the advent of modern sex therapy, the great majority of men who suffered from premature ejaculation were stuck with their problem for life. In those days, the chances of finding a cure were exceedingly slim because the cause of premature ejaculation was not understood and no one knew how to treat this disorder correctly. Until recently, doctors were still recommending anesthetic ointments, which don’t work, or psychoanalysis, which, although requiring a great deal of time and money (usually three to five office visits a week for a matter of years), is also an ineffective therapy for this disorder.
Fortunately, sexual medicine has come a long way in the past few years. We now understand this potentially devastating dysfunction much better, and the new brief sex therapy methods have dramatically improved the outlook for men who climax too fast, so that today over 90 percent of premature ejaculators can be cured within an average of 14 weeks of treatment. In fact, the results of treatment for PE* are now so good that when I evaluate a troubled single man or couple for a sexual complaint, and the problem turns out to be inadequate ejaculatory control, I feel a little jolt of pleasure in the knowledge that, with rare exceptions, these unhappy people will be enjoying a much more gratifying sex life in just a few months.
In this book I explain what premature ejaculation is and describe the effective new treatment methods. I have also drawn on my experience of treating and curing many hundreds of premature ejaculators over the past 20 years to prepare some guidelines on how couples or single men can use these new sex therapy techniques to overcome this problem by themselves in the privacy of their bedrooms.
There are very good scientific reasons to expect that many PE sufferers will be able to improve their ejaculatory control by following these guidelines. But one word of caution is in order. If you conscientiously follow the rules suggested in this book and you do NOT succeed in improving your ejaculatory control, DO NOT DESPAIR. This does NOT mean you are incurable. What it does mean is that in some cases a therapist might be needed to help correct a simple mistake you could have been making in following the directions, or to deal with a deeper emotional problem or some troubles in your relationship which may pose a temporary obstacle to your cure.
So by all means first try your very best to help yourself. You have nothing to lose but your sexual problem. But if this doesn’t happen to work for you, please don’t give up on yourself. Remember, PE is now among the most treatable medical conditions and the chances are excellent that a reputable sex therapist will still be able to help you.
Go for it.
Good luck.
*  The initials PE are often used in medical writings instead of spelling out “premature ejaculation.”
What Is PE?
The sexually normal male has voluntary control over his ejaculatory reflex. Normal voluntary control does not mean being able to bang away at full speed for hours until his partner comes. No man can do that unless he suffers from the opposite problem, retarded ejaculation.* Adequate ejaculatory control refers to a reasonable degree of voluntary control which allows a man to continue to thrust while he is at a high level of pleasure and arousal, until he chooses to “let go” and come. Sometimes he may want an exciting “quickie” and will enjoy reaching his climax in a minute or two. Other times he may decide to make the pleasure last for five, 10, even 15 minutes. Sometimes men may wish to wait until their partners reach orgasm, and other times they may feel like following their own rhythm, perhaps stimulating their lovers to climax before or after intercourse.
How Fast Is Fast?
In the past, doctors attempted to define premature ejaculation in terms of how quickly the patient ejaculates. Some treatment centers believed that if a man lasted less than one minute after vaginal entry he was premature. Other groups used one and a half minutes or two minutes as their criterion. However, no one can put an exact time period on what constitutes normal or abnormal ejaculatory control. Some men with severe PE may ejaculate as soon as their penis touches the warm, moist vaginal entrance, even before entry, or after just one or two strokes. Others with less severe forms of premature ejaculation come* after 10 thrusts or so, while those with still milder control difficulties are able to hold out for as long as one or two minutes. Finally there are some men who suffer from inadequate ejaculatory control even though they may manage to last for four minutes or so, or even longer. Instead of the natural, easy control which men with normal functioning enjoy, men with this type of PE have to struggle to hold back, and can only do so with tremendous effort and with a great deal of tension, which takes all the pleasure out of the act for themselves and also spoils it for their partners.
Masters and Johnson, who were the first sex therapists to emphasize the importance of the couple’s relationship in understanding and treating sexual problems, proposed that a man should be diagnosed as having premature ejaculation if he comes before his sexual partner does more than 50 percent of the time.
The trouble with this definition is that 75 percent of perfectly normal women are not capable of climaxing on vaginal penetration NO MATTER HOW LONG IT LASTS. These sexually healthy women can climax only if they receive direct clitoral stimulation before or after or during intercourse. Since only 25 percent of normal women achieve orgasm with penile thrusting alone, the 50 percent definition does not make any more sense than a specific time period does.
Several years ago, I proposed a new definition of premature ejaculation which has been adopted by the American Psychiatric Association and by the World Health Organization. According to the new diagnostic guidelines, THE ESSENTIAL FEATURE OF PE IS THAT THE MAN LACKS ADEQUATE VOLUNTARY EJACULATORY CONTROL WITH THE RESULT THAT HE CLIMAXES INVOLUNTARILY BEFORE HE WISHES TO.
The key to this new definition is “climaxes involuntarily before he wishes to.” The diagnosis of PE should not depend only on how fast a man ejaculates, nor on how his partner responds, but on the QUALITY of his ejaculatory control which should be NATURAL, EASY, and VOLUNTARY.
Under ordinary circumstances, the physical and mental stimulation of making love to his partner causes a man’s excitement to rise progressively to the “plateau” stage of sexual arousal (see Figure 1). they can continue to enjoy rhythmic penile stimulation while staying at the plateau stage, near where orgasm will occur. They can savor their intense sexual pleasure, allowing it to mount slowly or rapidly until they feel rhythmic penile stimulation while staying at the plateau stage, near where orgasm will occur. They can savor their intense sexual pleasure, allowing it to mount slowly or rapidly until they feel like climaxing, without any special strain. By contrast, premature ejaculators become excited very quickly. They are unable to remain at the “plateau” stage of excitement, but come involuntarily as soon as they reach this level.
Figure 1. Comparison of the sexual excitement, plateau, and orgasm stages of the sexual response cycle of normal men and men with inadequate ejaculatory control.
In other words, a normal man can choose either to stay aroused for a while or to climax rapidly. But the premature ejaculator has no such choice. He peaks quickly and moves right through the “plateau” stage on to orgasm, which puts an end to the sexual experience before he wishes this.
The Destructive Effects of Premature Ejaculation
Ejaculating rapidly is not a problem for all men nor for all partners. Some men don’t mind coming quickly once they have entered the vagina and some women are not bothered by their partner’s lack of staying power. A number of men simply accept their lack of control. They do not let this spoil their sexual pleasure and, as a matter of fact, many such PErs have active sex lives. Likewise, some women accept their partner’s rapid ejaculations, and they take pleasure from other aspects of lovemaking.
Such flexible couples adapt to the premature sexual pattern in several ways, which might be instructive for those of you who are deeply troubled by your problem.
Some women I have seen can follow their partner’s rhythm by learning to climax rapidly themselves.
Some men with PE are sensuous, skillful lovers who know how to stimulate their partner to orgasm manually or orally, prior to intercourse or after they ejaculate, or before and after, so that their rapid ejaculations do not interfere with their partner’s sexual pleasure.
But far more often than not, PE is a source of distress to the man and to his partner as well. And, unless both partners are very understanding and mature, this condition can have a destructive impact on a couple’s sex life and may eventually threaten their entire relationship.
In our society, men often measure their self-worth by the hardness of their erection and by their “staying power.” Men who have poor control, especially if they are unsure of themselves in other ways, may end up with a general sense of inadequacy and failure, and may develop additional sexual difficulties.
Secondary Impotence
Not surprisingly, many men with ejaculatory problems lack sexual confidence, and they tend to be anxious about their ability to perform. This is unfortunate because performance anxiety is very disruptive to sexual functioning and often leads to chronic psychological impotence.
PErs who are very distressed by their symptom feel terrible each and every time they come fast. Each negative experience convinces them that they are “losers” and increases their performance anxiety. Then the next time they go to make love, they are even more apprehensive about failing again. But if a man tries to function while he is anxious, he is apt to have problems with impotence because it is physically impossible for a man to maintain an erection while he is under stress.
Erection is produced by a high blood pressure system in the penis. When a man becomes sexually aroused, his penile arteries enlarge, increasing the flow of blood into the penis, while at the same time the outflow channels close down. This traps blood within the penis at a pressure high enough to enlarge it and make it hard or erect. But if a man should become anxious while he is making love, adrenalin and noradrenalin, the body’s “emergency” hormones, are released. These reach the penile circulation in less than one second and instantly reverse the erectile process—the penile blood vessels constrict so that less blood gets in, and the venous outflow channels snap open, which causes the extra blood to drain out of the penis rapidly—leaving it flaccid.
Performance-oriented men with poor ejaculatory control find themselves in a real dilemma. They can decide either to give up their struggle to hold back and simply come fast, which makes them feel awful, or they can make a terrific effort to delay their ejaculation until their partner comes, thereby risking getting so anxious that they flood themselves with adrenalin and lose their erection, which is even worse. I have seen this pattern of performance anxiety lead to a downwardly spiraling cycle of fear of failure and failure and more intense performance anxiety and permanent erectile failure.
Relationship Problems
It goes without saying that PE is not good for your romantic relationships. That is why many of you are now doing something about it.
But you should realize that the sexual insecurity, performance anxiety and defensiveness which this problem can cause in men whose self-esteem was not all that solid to begin with can do more damage to your relationships with women than the symptom itself.
The following case is typical.
Al, a 32-year-old accountant, and his new wife, Alice, a pretty, 28-year-old secretary, came to my office because she had lost her desire to have sex with her husband, and was thinking of asking him for a divorce. Al, who loved his wife deeply, was heartbroken and blamed his lifelong problem of PE for their problem.
It turned out that he was indeed a premature ejaculator. The longest he could hold out after vaginal entry was about a minute. Alice had never been particularly troubled by Al’s PE. She usually reached her climax on oral stimulation, and although she had reassured Al repeatedly that she was satisfied with this, he became upset and morose each time they made love. All her efforts to comfort him were to no avail, and, not surprisingly, after a while sh...