The New Male Sexuality (58 page)

Among the drugs used are Prozac, Zoloft, Paxil, Luvox, and Anafranil. So far there haven’t been enough good studies done to know which drug is best for which person. It’s mainly a process of trial and error.

As you might expect, there are some problems associated with taking these drugs. Although the doses used to treat rapid ejaculation are usually lower than those used to treat depression, there still can be side effects, and these side effects tend to increase in number and severity as the dose gets higher. Among the possible side effects are anxiety, dizziness, dry mouth, headache, insomnia, and, in some cases of high doses, a significant decrease in sexual desire and even erection problems. Another downside to using the drugs exclusively to deal with rapid ejaculation is that there is no lasting effect; that is, you don’t learn anything about lasting longer and you have to keep taking the drugs to last longer. When men stop taking the pills, the vast majority return to rapid ejaculation.

Which drug you should try and in what dose are things you need to work out with your physician. Individual response to these drugs varies considerably. For some men they work wonderfully well, for others the effect is more modest, and for some men they don’t help at all. Some men
need to take a pill every day, whether they’re going to have sex or not. Other men do fine just taking a pill only on the days they have sex.

If you’re willing to take these pills for the rest of your life, you need only discuss the subject with your physician. If you would rather develop your own skills at ejaculatory control, you should explore the program in the rest of this chapter. For many men, a combination of the pills and the exercises works best. Taking a drug can be helpful in demonstrating that it’s actually possible to last longer. This makes you and your partner feel good. Being able to have longer-lasting sex at least sometimes (by taking a pill) gives a break from the regular menu of quick orgasms. And for some men, the increased time to orgasm also makes the ejaculatory control exercises work more effectively. In the situations where you’re using a drug and the exercises, as you develop ejaculatory control by doing the exercises you can phase out the pills.

Bo had been a severe rapid ejaculator his whole life but hadn’t been willing to seek treatment until his wife, Sara, threatened divorce. By the time they came to see me, Sara’s anger had been stewing for years. I started Bo on some of the exercises later in the chapter, but they didn’t work because Sara got so angry while doing them. Because of this, I suggested they give Anafranil a chance. Only a few days after taking the first pill, Bo and Sara had their longest-lasting intercourse ever. A day later they repeated their success. Sara was so pleasantly surprised she forgot to be angry the next time they did an ejaculatory control exercise. By alternating long-lasting intercourse (their “pill days”) with the exercises, this couple was able to complete the program in three and a half months, toward the end of which Bo gradually stopped using the Anafranil. Given the intensity of Sara’s anger, none of us thought we would have achieved this success without the drug. This is a good example of how a medicine that makes a man last longer can help in a situation in which the drug is not wanted as the long-term solution.

If you and your partner agree you should try one of the drugs either alone or in combination with sex therapy exercises, all you need to do is talk to your doctor.

Don’t be too disappointed if you try one or more of the drugs and they don’t work for you. They work for many men, but not all. And for some, the drugs make for greater ejaculatory latency but the side effects are intolerable. If the drugs don’t do what you need them to, you can still benefit from the program that follows.

A SEX THERAPY PROGRAM FOR DEVELOPING EJACULATORY CONTROL

My approach for developing ejaculatory control stems from the work of Dr. James Semans in the 1950s. Semans’s stop-start technique is the foundation of all the successful procedures used by sex therapists today. Many of them have added variations of their own. I’ve experimented with most of them and also with some I’ve developed myself. What follows is the best program of suggestions and exercises for improving ejaculatory control I’ve come up with in twenty-seven years of dealing with the problem.

Developing better ejaculatory control involves learning two skills. One is the ability to attend more fully to your own sensations of arousal and tension. The other is the ability to make changes in your behavior that will prevent or delay ejaculation.

Let’s go back to
Figures 8
and
9
to understand in more detail what ejaculatory control means. The shaded area represents the time from the beginning of penile stimulation to just before the point where ejaculation becomes inevitable. I call this area the control zone, because this is where the man can make changes in his behavior to influence when he ejaculates.

The man whose experience is represented in
Figure 8
—we’ll call him Fred—wants to enjoy a long session with his partner. He wants to get to and savor high levels of arousal without coming right away. As he nears the middle and upper ranges of his control zone, he may change his thrusting from faster to slower, and maybe he’ll even stop moving altogether for a few seconds or longer. Or perhaps he’ll move his hips slightly to change the angle of the thrusts, or maybe he’ll do some circular movements for a few minutes. He may monitor his breathing and take some slow, deep breaths. If he knows that holding her hips or looking at her face is orgasm-producing, he won’t do that until he wants to come. By making these adjustments and avoiding orgasm-producing activities until he’s ready, he’s able to stay in the shaded area, having a good time and enjoying the sensations. When he wants to come, he’ll act differently.

Although
Figure 9
represents the experience of a man without much ejaculatory control, it could also be Fred’s experience under certain circumstances. Let’s say that just as he begins intercourse he recalls that he and his partner have only a few minutes before they have to dress and leave the house. So he wants to come as quickly as possible. His past experiences will guide his behavior to do just that. He will do the kind of thrusting that’s most arousing to him, and he may do other things as well: kiss his partner in his favorite way, touch her breasts or hips, look at her
face, and perhaps call up his most arousing fantasy. Although Fred’s experience in this situation seems similar to that of a man without control, there is a critical difference. Fred is choosing to have a quick orgasm. The other man has no choice. He goes pretty much directly from nothing to orgasm without leveling out. He may be aware of when he’s going to come, but he’s not aware of the shaded area and what he could do there. Since he’s not in the shaded area very long, it’s hard to be aware of it. Nonetheless, it exists and can be used. The more it’s used, the larger it grows, until this man’s experience is similar to that of Fred.

Fred’s behavior, whether in trying to lengthen or shorten his sexual encounter, comprises a number of habits carried out automatically and largely outside of conscious awareness. He probably can’t tell you what he does to control ejaculation, and he might not believe that what I’ve written has anything to do with him. I once interviewed a number of men with good ejaculatory control and asked how they did it. They not only didn’t know, but at first denied that they did anything. Only after they carried out my suggestion to observe themselves during sex did they agree that they were actually doing things to influence when they came. This shouldn’t be surprising. Although I’ve been an avid bicycle rider for many years, I can’t begin to describe how I manage to keep my balance on the fool thing. Yet I must be doing something (actually a number of things), because a bike won’t stand up alone and neither will one with an inexperienced rider on it.

At the extreme upper end of the control zone is what Masters and Johnson called the point of ejaculatory inevitability. This is the point at which the man feels he’s starting to come. And that’s exactly what’s happening. The sensations he feels are the contractions of the prostate gland and seminal vesicles; once they contract, the ejaculation is on its way and nothing can stop it. No control can be exercised once the point of inevitability is reached.

The control zone represents either sexual arousal or tension (anxiety). For most men without good control, it’s usually a combination of both. Many men have trouble distinguishing between arousal and tension, but it really doesn’t make much difference for those who want to develop better control. Both can make you come quickly. When you’re having sex, something in you is increasing or rising, whether you call it passion, tension, or something else. That is what you need to be aware of. The best way to increase awareness is to focus on the part or parts of your body where you most strongly feel the rise in arousal/tension. For most men, this is either the penis or the scrotum. You need to know at what level this anxiety/arousal
becomes the point of inevitability. It’s before this point is reached that you need to do something to control ejaculation.

Men who have good control have learned that control, usually without knowing they learned anything. And all of us, whether we have ejaculatory control or not, have learned to control other reflexes. Urination is perhaps the closest parallel. At some point when you were very young, your parents let you know that it was no longer acceptable to urinate in your pants. You gradually learned to recognize the sensations in your body signaling that you were about to urinate, and you could tell someone that you had to get to a toilet. You could tell something was about to happen, but you couldn’t delay its occurrence.

As time went on, you completed your training. You not only knew when urination was imminent, but you could also exert some control to delay it. If you were in the middle of a game or watching a TV program and had to urinate, you could squeeze some muscles, wiggle around, or literally grab your crotch to hold it back, at least for a while.

All this is many years behind you, of course, and you probably have no memory of it. The processes of control have been under automatic pilot for so long that you may not be aware that you are actually doing anything to control urination, just as many men with ejaculatory control don’t realize that they are doing anything to delay ejaculation. If you have any doubts about what I’m saying, just focus your attention on your pelvis the next time you have to urinate but are in a situation that requires you to wait. If you want to see the control mechanisms in vivid detail, watch what you do when you’re caught in a long and unexpected traffic jam after leaving work without urinating.

Before getting to the exercises, I need to give some definitions and principles. All of the physical exercises have a similar structure:
While your penis is being stimulated by you or your partner, you will do two things—attend to your arousal/tension level and either stop or do something else to maintain ejaculatory control
. By doing this repeatedly, you will learn more about your control area and expand it. In doing so, you will achieve control over your ejaculations. And you’ll be able to act exactly like Fred.

How Often to Do the Exercises

Therapists differ on how often they ask clients to do the following exercises, from daily to two or three times a week. My experience is that three
or even more times a week is best, provided this is comfortable for you and your partner and you don’t have difficulty getting erections. It is crucial that you not try to force erections during the program; if your penis doesn’t easily get hard, just stop and do whatever you and your partner want. Return to the exercise another day. If three or more times a week is too much, or if you sometimes have trouble getting erections, twice a week will be fine. Two or three times, however, is an average. If you do an exercise only once during a week, you might want to see if you can do it three or four times the next week. If you can’t, you’ll probably still be okay if you get back on track in the following weeks. Less than twice a week does not work. You will never develop better control on such a schedule.

Which Exercises You Should Do

Every reader who wants to improve ejaculatory control should do the mind-power exercises and the two masturbation exercises later in this chapter. If you think you don’t need to do the masturbation exercises, it’s a good idea to do each of them once just to make sure you can easily and comfortably handle them. If you don’t want to masturbate, you can skip those exercises and start with the first partner exercise. After the description of the mind-power and masturbation exercises, I discuss exercises you can do with a partner and what to do if you don’t have a regular sex partner.

What You Should Focus On

As your penis is being stroked, you need to be aware of your arousal/tension level. For most men, this means focusing attention in their penis or scrotum, the places where they can feel increases in fullness, tingling, or other sensations that mean arousal/tension to them. I guarantee you will get distracted by all sorts of things: fear of coming fast, concern about disappointing your partner, concern about reaching your goals, wondering if your partner really wants to be doing the exercise, and so on. You can’t stop yourself from being distracted, but what you can and must do is bring your mind back to where it belongs as soon as you’re aware it’s elsewhere—what I call refocusing. Just imagine your attention is like a searchlight on a swivel. When it’s not where you want it, imagine gently pushing the swivel and the light back where it should be, on your arousal/tension level. Refocusing gets easier and more effective with practice, and
you’ll be getting a lot of practice with it. Don’t get discouraged that your attention wanders: That’s natural and expected. Just keep bringing it back, over and over.

When You Should Stop During an Exercise

Many questions come up regarding exactly when during an exercise you should stop stimulation. Anytime you’re in the control zone is fine—that is, anytime after stimulation has begun and you’re feeling aroused. But you don’t want to play brinkmanship, trying to stop just before the point of inevitability is reached. If you do this consistently, you’ll find that you often ejaculate before you want. So stop sooner.