In the following paragraphs, we outline methods for dealing with the common difficul­ties of premature ejaculation and erectile disorder. We also discuss a way to treat the less common condition of orgasmic disorder.

Lasting Longer

Some self-help and sex therapy approaches to learning ejaculatory control are easy to implement—in many cases, without professional guidance.

Strategies for Delaying Ejaculation In some cases, men can gain considerable control over ejaculation by practicing a few simple strategies. Men for whom premature ejacu­lation is not a problem and women readers may find the following discussion valuable simply because they would sometimes like sexual intercourse to last longer.

■ Ejaculate more frequently. Men with premature ejaculation problems sometimes find that they can delay ejaculation when they are having more frequent orgasms, by masturbation or partner sex.

■ Come again! A couple can experiment with continuing sexual interaction after the man’s first ejaculation, then resume intercourse when his erection returns. This

strategy is most useful for younger men, who experience erections again soon after ejaculation.

■ Change positions. If a man wants to delay ejaculation, he may gain some control by lying on his back and increasing physical relaxation. (See page 244 for variations of the woman-above position.) However, if a man attempts energetic pelvic move­ments in this position, it will be counterproductive because he will be increasing muscle tension by moving both his own weight and his partner’s.

■ Talk with each other. To delay climax, the man often finds it essential to slow down or completely cease movements. He needs to tell his partner when to reduce or stop stimulation.

■ Consider alternatives. To minimize performance anxiety about rapid ejaculation (and most of the other problems discussed here), it is often useful to think of intercourse as just one of several options for sexual sharing. •

The Stop-Start Technique James Semans, a urologist, developed the stop-start tech­nique, which enables the man to become acquainted with and ultimately control his ejaculatory reflex. The partner is instructed to stimulate the man’s penis, either manu­ally or orally, to the point of impending orgasm—at which time stimulation is stopped until the preejaculatory sensations subside (Semans, 1956). (A man can also practice this technique on himself during solo masturbation sessions [Zilbergeld, 1992].) These sessions generally last 15 to 30 minutes and occur as often as once a day for several days or weeks. During each session, the couple repeats the stimulation and the stop-start procedure several times and then allows ejaculation to occur on the last cycle. The cou­ple should reach an agreement about sexual stimulation and orgasm for the man’s part­ner. If the partner desires these, the couple can engage in nonintercourse sexual activity.

As the man’s ejaculatory control improves, the couple progresses to intercourse. For heterosexual couples, the best position is the woman above, sitting up. The first step is for the man to guide his penis in the woman’s vagina and lie quietly for several moments before beginning slow movements. When he begins to feel close to orgasm, they lie quietly again. This stop-start intercourse technique is continued as the man experiences progressively better ejaculatory control.

Medical Treatments A combination of sex therapy and medical treatments can be more helpful than either alone in helping men extend their arousal prior to ejaculation (Steg – gall et al., 2008). Small doses of selective serotonin reuptake inhibitors (SSRIs), medi­cation usually prescribed for depression, can help men to delay ejaculation. One of the side effects of these medications is suppressed orgasm in men and women, which is often helpful in treating rapid ejaculation. Other medications for treating premature ejaculation are under study, including dapoxetine, which has been developed specifically for such treatment and has shown positive results in research studies (Douglass & Lin, 2010; McMahon et al., 2011b; Serefoglu et al., 2011).

Reducing the sensitivity of the penis is another approach to reducing rapid ejacula­tion (Carson & Wyllie, 2010). In a placebo-controlled study, using an anesthetic spray five minutes before intercourse helped men extend the length of time of intercourse before they ejaculated from an average of 36 seconds to nearly 4 minutes. Their experi­ence of orgasm improved as well: About 62% said that their orgasm was good or very good, whereas only 20% had said so prior to treatment (Hellstrom, 2010).