Original subtitles

Dr. Derek Polonsky is a psychiatrist teaching at Harvard Medical School.

His private practice specializes in couples therapy.

Dr. Marion Dunn is director of the Center for Human Sexuality at Downstate

Medical Center in New York and is in private practice.

This video contains depictions of explicit sexual behavior.

The information is intended to offer a self-help approach to controlling

premature ejaculation.

Although this tape will help many men achieve better ejaculatory control, we

realize that some men will need professional assistance.

This tape includes information on how to secure the services of a qualified sex

therapist.

It is important to practice safer sex techniques.

Unprotected sex should be engaged in only by committed couples who know they

are risk-free.

The treatment shown in this tape usually takes approximately three months to

complete. The times noted throughout the tape are suggested as typical of the

process.

By choosing to watch this video, you've taken a major step toward understanding

the causes of premature ejaculation.

I'm Dr. Derek Polonsky, and along with Dr. Marion Dunn, we'll show you how one

of the most common of all male sexual concerns can be easily self-treated.

The American Psychiatric Association and the World Health Organization describe

premature or early ejaculation as ejaculation with minimal sexual

stimulation.

or before, upon, or shortly after penetration, and before the person

wishes it.

Fortunately, this condition can be easily treated.

What's more, it can be treated by the man and his partner using the same

techniques most often prescribed by therapists.

This video will demonstrate two techniques, the stop-start technique and

the squeeze technique.

and you'll learn the advantages of each.

You'll see why both self-treatment methods are described as over 90%

effective by sex therapists who treat premature ejaculation.

After seeing these techniques and hearing them discussed, you'll explore a

number of important questions about ways to ensure successful use of the self

-treatment program.

First we'll take a few moments to explore some basic facts that, in and of

themselves, can reduce the impact of early ejaculation.

When a man ejaculates before he wants to, he often feels embarrassed, and he

and his partner can be disappointed, defensive, or withdraw from each other.

Some men feel like inadequate lovers or unfit partners.

Others are tempted to blame their partners for the problem.

feelings like these can put a damper on sex, causing both partners to feel hurt,

bewildered, and resentful.

One key to better self-esteem is an accurate understanding of several key

points regarding female sexuality.

Most important, women can and do enjoy aspects of lovemaking that have little

to do with the timing of ejaculation.

What's more, many healthy, sexually active women do not reach orgasm through

intercourse.

Often, women can have a very pleasurable orgasm through oral, manual, or

mechanical stimulation.

And most consider foreplay as important as intercourse itself.

Being a good lover depends on the man's desire to please.

Good communication, practice, patience, and imagination, but not just

ejaculatory control.

In fact, some men have actually become better lovers precisely because their

lack of ejaculatory control has led them to learn other possibilities for

satisfying their partners.

The bottom line is men who care about their partners and are sensitive to

their feelings, can be excellent lovers despite imperfect ejaculatory control.

So, by concentrating on ways to give maximum physical and emotional pleasure

by means other than prolonged intercourse, men with control problems

can often satisfy their partners and eliminate much of the shame, guilt, and

anger that can upset both partners more than the basic control problem itself.

Understanding the process of ejaculation can place the concern in perspective and

reduce its potential for causing damaged self-esteem and damaged relationships.

Let's look more closely at the definition already considered.

The key phrases for us are shortly after and before the person wishes it.

For some men, this means uncontrolled ejaculation.

before or just a few seconds after the penis enters the vagina.

However, some men with far less dramatic or severe patterns also consider

themselves premature ejaculators.

What seems premature to one man or woman may seem perfectly adequate to another.

In fact, few men have complete control over when they ejaculate.

From time to time, almost any man can be taken by surprise and come without

intending to.

The point is this.

Men whose lack of ejaculatory control causes real problems for themselves or

their partners may want to improve that control.

And like many other control problems, ejaculatory patterns can be improved

with a step-by-step method of learning control.

In fact, the odds for success are excellent for several reasons.

First, Virtually all men who feel that they have a control problem are

physically and emotionally normal.

Most also have very strong sex drives, and because their control problems are

not caused by physical or emotional factors, the treatment is relatively

straightforward, as you're about to see. The self-treatment program we will

demonstrate may be initiated with a sexual partner or alone.

However, it should be finished with a trusted supportive partner.

The entire process occurs in the privacy of the bedroom and usually takes a few

months or less.

It requires determination and a bit of discipline.

The decision to try it should be based on the extent of dissatisfaction caused

by the ejaculatory pattern.

If the dissatisfaction is slight, achieving improvement may not seem worth

the effort.

If the condition causes significant unhappiness, chances are that the effort

required will seem a small price for the change it brings.

The method you're about to learn is based on the fact that men can learn to

respond to bodily signals in such a way as to delay orgasm. Of course, learning

to respond to bodily signals is a basic part of everyone's development.

When we were infants, we had no ability to respond to signals that we were about

to urinate, so we had no means of controlling the process.

Gradually, with the help from adults, we learned to recognize that the bladder

had reached a certain degree of fullness.

This became our signal for responding to our condition.

And before long, we became able to respond by holding it in for an

appropriate length of time, long enough to urinate where and when we wanted to.

The same basic idea applies to ejaculatory control.

Ejaculation is more easily triggered in some men than others.

And successful techniques have been developed to help men exert more

voluntary control over this reflex.

The important thing to bear in mind is this. The ejaculatory function can be

controlled just as we control other bodily functions.

To gain this control, the man uses a series of exercises to become more aware

of the body signal that ejaculation is about to occur.

And he practices responding to that signal.

in ways that delay ejaculation for as long as desired.

This is an overview of the process we'll be exploring in detail.

During this phase of the treatment program, manual stimulation is used to

focus awareness on the feelings in the penis that accompany sexual excitation

and ejaculation, and to gain control of the ejaculation.

When step one is completed, the same focus and control techniques are used

during intercourse.

with the woman on top.

When step two is completed, these techniques are transferred to

intercourse and other positions.

When step three is completed, the couple use their favorite intercourse position

and practice slowing down rather than stopping and starting.

This four-step program is designed to help men become aware of and learn to

control the following physiological process.

Sexual response is often described as having four stages.

During the first stage, excitement, a number of changes occur in the body.

The most obvious change is blood entering the penis in such quantity that

blood vessels within the penis become engorged, resulting in erection.

During the next stage of sexual response called plateau,

Semen is manufactured in the testicles and passes through this tube, the vas

deferens, into the seminal vesicles, a semen storage tank where it waits for

the next stage of sexual arousal.

During plateau, sexual excitement typically builds from mild to extremely

intense. Its highest point of intensity leads to orgasm, the third stage of the

cycle.

Orgasm itself has two parts, emission and ejaculation.

Often, these two parts are not experienced separately because

ejaculation happens so fast.

However, they are physiologically distinct.

Emission occurs when muscles contract, squeezing semen from glands called the

seminal vesicles to a small reservoir located within the prostate.

At this point, ejaculation is inevitable. It can no longer be

controlled. The second part of orgasm is ejaculation itself.

This occurs when muscles throughout the region contract, often suddenly and

powerfully, propelling semen through the penis and causing sensations that range

from mild release to overwhelming pleasure.

The final stage is called resolution when the body returns to its pre

-stimulated condition.

Normally, men regulate their behavior in response to the pleasure experienced

during the plateau phase.

As the intensity rises, to the point where emission is about to occur, they

are able to slow down or adjust their thrusting action to postpone emission

and so delay ejaculation.

This treatment program improves control by helping you study your own sensations

during the plateau phase and practice ways to take control before you reach

the point of emission.

For the next few minutes, we'll look at each of these steps in detail and you'll

see every part of the process demonstrated.

The self-treatment program can be implemented with either of two effective

techniques, the stop-start and the squeeze.

You'll see both demonstrated because each has its own advantages.

Before beginning the program, we'll get an idea of how each of these two

techniques work.

The stop-start technique is simply the process of interrupting sexual motion or

activity by stopping it and then continuing after a brief halt.

Many couples find this technique most comfortable and effective.

Others prefer the squeeze technique.

This method includes squeezing the penis firmly but gently to reduce excitement,

allowing a brief cooling-off period that delays ejaculation.

As you'll see, the squeeze technique has two variations.

During the manual stimulation step, this variation should be used.

The thumb is placed on the frenulum.

The second and third fingers are placed just above and below the coronal ridge

on the opposite side of the penis.

A firm, steady pressure is applied for about four seconds and then abruptly

released. The pressure is always applied front to back, never from side to side.

The second squeeze technique should be used during the three intercourse steps

of the program.

The thumb is placed at the base of the penis and the first two fingers here.

Again, pressure is always applied by the thumb and forefinger, from front to

back, and never the pads of the fingers and thumb.

It's a good idea for the man to guide her early squeezes to show her just how

much pressure is needed.

Most women master this technique relatively quickly.

However, each couple is different, and some will find the squeeze technique

more satisfactory than others do.

Now, let's go through the ejaculatory control program step by step.

The first step is using manual stimulation as a method of gaining

control before emission occurs.

This step can be completed by the man himself or by the couple working

together. Before deciding whether to complete this step as an individual or

as a couple, it's wise to consider the advantages and disadvantages of each

alternative.

For example, it's important for the couple to avoid intercourse until this

step is completed, whether the step is completed by the man alone or by the

couple working as a team.

This does not prevent the man from helping his partner achieve orgasm

through manual or oral stimulation or any technique other than intercourse.

Still, the absence of intercourse, however brief, may be upsetting for

either or both partners.

A team approach to step one can help make this easier by giving both partners

a more complete sense of mutual involvement.

Equally important, the woman's early participation can provide strong

encouragement as she supports the program.

On the other hand, the partner's role during the manual stimulation step

demands patience, dedication, and real emotional commitment.

That's because the man must concentrate on the sensations in his penis and learn

to ignore the woman's feelings, which can only distract him.

Ordinarily, this approach to sex would be described as selfish.

But for this exercise to work, the man needs time to focus all his attention

inward to the signals his body is giving him. For the woman, this will mean

postponing her own pleasure now.

for greater pleasure later.

If this step makes the woman feel resentful or the man feel guilty, these

feelings will interfere with the treatment program.

Some men prefer to master the early exercises alone and then share them with

the partner.

Other couples may prefer to learn these steps together.

From that point on, intercourse is central to the treatment program and the

partner's role is therefore more natural and enjoyable.

although intercourse remains focused on the control exercises.

In all cases, it's important to think seriously about whether to complete the

manual stimulation step individually or as a couple.

It's good for couples to watch this entire tape together before beginning

the program.

This will give them an accurate understanding of what's involved and

help the couple decide when it's right for the partner to participate.

Once the program is underway,

a couple will be able to decide whether the stop-start or squeeze technique

works best for them.

If a couple chooses to work on the manual stimulation step together, easy

-to-recognize signals should be worked out in advance to avoid confusion.

Signals may be words, sounds, or gentle touches.

However, it's wise to remember that precise communication will not always be

easy. Mistakes will occur.

So don't get discouraged.

In other words, patience and a sense of humor are absolutely necessary in this

aspect of the couple's relationship.

The manual stimulation step includes five exercises, focusing on genital

sensations, stop-start or squeeze, wet stop-start or squeeze,

slow-fast stimulation, and learning to stay aroused.

The first exercise is simple.

Pick a quiet, relaxed time when you won't be interrupted.

Masturbate however you prefer or allow your partner to manually stimulate you.

When you begin to reach an intense level of excitement, slow down a bit or ask

your partner to slow down.

Now, consciously pay attention to the feelings in your penis and genital area.

In particular, give close attention to what you feel immediately before...

You reach the point of omission, the point at which it is no longer possible

to postpone ejaculation.

And then take pleasure in your climax.

Repeat the exercise on two or three separate occasions until you're sure you

can identify the sensations in your penis that precede the point of

ejaculation.

It's important not to move to the next step until this has been achieved.

Then skip one, two, or three days before moving on to the next exercise.

Once again, masturbate or ask your partner to stimulate you in a relaxed

environment, free of stress or time pressure.

Now, focus on your rising level of excitement.

When you feel yourself approaching the point of omission, it's time to stop.

Or stop and use the four-second squeeze technique.

Wait for just a few seconds. Do not wait long enough to lose your erection.

After your brief wait, continue manual stimulation again.

Interrupt this activity three times.

And then, after the third interruption and brief wait, continue stimulation to

ejaculation.

Throughout this exercise, focus on the physical pleasure you feel.

Rely only on the stop, start, or squeeze technique to keep yourself from coming.

Do not try to use non-sexual thoughts to hold yourself back.

During this program, never attempt to improve control by diminishing the

pleasure you feel.

Repeat the exercise every two or three days until, one, you become closely

aware of how you feel just before you reach the point of emission, and, two,

you gain some confidence in your ability to postpone ejaculation when you want

to.

The most important thing about this part of the program is not to get

discouraged, even if it takes a while to achieve this level of awareness and

control.

You may have to repeat this part of the program ten or more times, or you may

reach these goals after only two or three tries.

Remember, your chances of success are excellent, regardless of how quickly you

complete any exercise in the program.

Once you've achieved awareness and control through manual stimulation,

you're ready for exercise three, wet stimulation.

This exercise is very much like exercise two, but now you or your partner will

use a lubricant. Use any water-based lubricant you choose, for example,

Astroglide or KY Jelly.

The lubricant provides a sensation more like that of a woman's vagina, so it's

an important advance towards your ultimate goal of improved ejaculatory

control during intercourse.

Again, Use the stop-start or squeeze technique three times before allowing

yourself to come.

During the next session, try to pace yourself so that you can continue

stimulation for about three minutes before you have to interrupt

stimulation.

It's not important that your timing be exact, so don't let that distract you.

Whatever feels like three minutes is close enough.

When you can stop stimulation three times and last for about three minutes

during each period of stimulation, you're ready for the next exercise.

Exercise four is exactly like exercise three, with one difference.

Now, instead of stopping or squeezing to prevent ejaculation, try to gain control

simply by slowing down.

It doesn't matter whether you or your partner slows down slightly or almost to

a stop.

Your objective now is simply to maintain control without stopping or squeezing.

When you can be stimulated with lubrication, And without stopping or

squeezing and delay ejaculation for about three minutes, at least three

times, you've made very significant progress.

At this point, you are ready to complete the manual stimulation step of your

program with a final important exercise.

Once again, use your lubricant of choice.

Now you have two more objectives.

First, use what you've learned about your own arousal pattern to assign a

rising scale of numbers to the levels of excitement you feel.

Make zero equivalent to no arousal at all, and nine equivalent to ejaculation

itself.

Needless to say, this kind of scale can't be scientific or precise.

However, it can give you a practical way to identify the levels of excitement you

feel.

And because of this exercise, many men will misread their arousal level and

come before they want to.

This is to be expected.

So as you continue your manual stimulation exercise, concentrate on the

pleasure you feel and identify your levels of excitement on a scale of 0 to

9. As you do, adjust your masturbation technique or work with your partner to

keep yourself at a level of 5, 6, or 7.

High enough to be very pleasurable, but low enough to stay clear of ejaculation.

Once again, focus on the level of excitement you feel.

Adjust the speed and length of the strokes or the pressure applied to your

penis.

Maintain the level of excitement you want.

Keep it highly pleasurable, but well short of orgasm.

Continue this exercise until you can stay within the 5-6-7 range for at least

5 minutes, and preferably for 6 or 7 minutes.

Then you have successfully completed the manual stimulation step of this program.

You are now ready to begin your intercourse steps.

Step two of the program is completed with the woman on top.

The partner on top position is useful at this stage of the program because most

men find that it stimulates the penis less intensely than other positions.

Therefore it allows the best opportunity for the man to focus carefully on how

his penis feels and on the pleasure it provides.

The woman sits on top of the man and gently inserts his penis by lowering

herself onto it.

She begins this step by sitting quietly at first as the man focuses on the

pleasure he is experiencing while getting used to being inside her.

When he is ready, he places his hands on her hips and gently guides her

motion upward and downward until he feels that ejaculation is approaching.

He then signals her to stop moving.

until his level of excitement declines she stops or he or she apply the

squeeze technique they repeat the stop start or squeeze twice and the man

allows himself to come after the third period of thrusting

Generally, men are more aroused by intercourse than by manual stimulation.

So many attempts may be needed to apply the stop-start or squeeze technique

successfully. That's only natural because intercourse involves challenges

and distractions that don't occur during manual stimulation.

The man may have to focus renewed concentration on signals that emission

is approaching and readjust his timing to ensure that his partner's thrusting

stops before the point of omission.

At first, this step may include temporary setbacks. That's a normal,

predictable part of the treatment program, and it won't have any negative

effect as long as both partners maintain perspective, understand that the

likelihood of eventual success is not affected, and continue their exercises

undiscouraged.

When the man gains control in this position, it's time to change the

procedure slightly.

Now the man thrusts upward as the partner sits quietly.

Follow the same pattern as before, stopping or squeezing twice in periods

that last three minutes or more, and then ejaculating after the third period

of thrusting.

Remember, these exercises take time.

The next step involves two changes of position, but the same stop-start or

squeeze technique.

First, the exercise is usually done in a side-to-side position as shown.

Typically, this position provides more intense excitement than the partner on

top position, but less intense excitement than the man on top position.

So it's usually best to achieve satisfactory control in the side-by-side

position and then apply the stop-start or squeeze technique in the man-on-top

position.

Of course, not all the positions affect men the same way, so some couples may

select a different sequence of positions, always moving from the less

stimulating to the more stimulating for the man.

In each position, the stop-start or squeeze technique should be used to

reach the degree of control we've discussed so far.

comfortable, reliable ability to postpone ejaculation at least twice,

stopping after periods of several minutes and then completing a third

period of several minutes more, ending in free and pleasurable ejaculation.

By now, a very high degree of ejaculatory control has been reached.

The man is able to stay at a high level of excitement for many minutes without

ejaculating or losing his erection.

The final step, slowing down, represents a refinement of the process.

During the step, the couple select their own preferred position.

Again, they practice delaying emission.

But now, the man exercises control by slowing down rather than stopping and

starting or squeezing.

When you are able to maintain the desired level of control without

stopping and starting or using the squeeze technique, the treatment program

is completed.

Here are some of the questions most often asked about the methods you've

just seen demonstrated.

How do women feel about participating in this program?

Most women want their partner to be able to last longer for the pleasure and

sense of closeness it brings.

And men often underestimate how patient and understanding a woman is willing to

be. For this reason, mutual discussion and decision-making should precede

actual implementation of the program.

For the couple to cooperate successfully, the man must consistently

show appreciation for his partner's support and effectively communicate his

sexual desire for her.

Even during the manual stimulation step, the man should show tenderness,

affection, and desire when not actually engaged in the exercise.

Men with ejaculatory control problems often develop

the bad habit of thinking about work, food, sports, or other non-sexual

subjects in order to reduce their level of sexual excitement, thinking that they

will last longer.

As noted, this technique has no place in the treatment program you've just seen.

It can only interfere with success because this program builds control

through awareness and control of excitation, not suppression of pleasure.

How strictly does this method have to be followed?

The closer you stick to this treatment plan, the better.

For example, it does no good to rush the program by trying to cram too many

sessions into a single week or by skipping any steps or exercises within

steps, nor should you do the exercises less often than recommended.

Of course, there may be times when it's difficult to conduct the program exactly

as described.

However, it's always best to try to follow the program as closely as

possible.

Isn't this all too mechanical?

Yes, it is mechanical at first, but these mechanics are necessary to improve

control. After practice, men learn to pace themselves more effortlessly, and

lovemaking becomes natural and spontaneous.

What if I have a relapse?

Don't be overly concerned if after improving your ejaculatory control, you

have a relapse.

particularly if sex becomes infrequent or after a period of abstinence, you may

experience some loss of control.

This is to be expected. You can deal with this by completing a brief

refresher course of this program.

Can a man go through this program without a partner?

Yes, by mastering the five exercises in step one.

A man can gain confidence and greatly improve his ejaculatory control.

What if it doesn't work?

This can happen for several reasons.

For example, poor communication or emotional complications can make the

program difficult to complete.

However, even if this treatment program doesn't work as desired, other options

remain.

Chances are still excellent that a qualified sex therapist will make

success possible by acting as a trusted, experienced advisor.

Many men welcome the support and guidance of a trained professional

advisor, even if no significant problems arise in self-treatment.

In the last hour or so, you've learned a good bit about ejaculatory control

problems and what can be done to overcome them.

If you or someone close to you confronts this kind of challenge, the method

you've just seen may be the answer you're looking for.

Talk about it.

Think about it. The good news is this.

If you are committed to improving ejaculatory control, there's every

reason to believe that you can do it.