Cognitive-Behavioral Treatment


One of the treatment possibilities for delayed ejaculation (DE) is cognitive behavioral therapy.

This therapy can be successful because it’s a direct approach to changing the level of inhibition around sexual activity, as well as giving many new perspective on sexual issues so as to facilitate the full expression of his sexuality.

Two of the main authors in this field are McCarthy and Perelman, who have spoken of how frequently harsh idiosyncratic masturbatory patterns play a role in the etiology (i.e. causation) of delayed ejaculation.

They also observed that how a man perceives sex in his mind may be radically different to the way in which he sees the reality of his relationship with his partner.

Cognitive behavioral therapy can be highly effective with delayed ejaculation!

So, for example, cognitive behavior therapy might help him take the fantasies he uses during solo-masturbation to orgasm, and introduce them into sexual activity with his partner.

This has two effects: it helps him to reduce the level of guilt that he experiences around sex, and it facilitates an increase in the level of arousal that he experiences, possibly enabling him to reach orgasm.

Additionally, Perelman suggested idiosyncratic masturbation might be addressed by something as straightforward as telling the man to masturbate using his other hand. 

man in bed with hand suggesting masturbation
It’s a great picture, isn’t it? It sums up traumatic masturbatory syndrome perfectly.

Though at first this may sound ridiculous, switching hands in this way causes a man to understand that his orgasm and ejaculation are entirely dependent upon the precise method of stimulation which he receives.

In general, men looking for a cure for delayed ejaculation who try this exercise will find that they cannot reach orgasm by using their other hand, a fact which brings home to them the delicate balance they have created between receiving stimulation and achieving orgasm.

It can often be a moment when a man sees very clearly the true extent of his difficulty.

But of course while simple exercises like this may give an insight into the condition, they do not cure it.

For an effective delayed ejaculation treatment, a combination of several therapeutic techniques is usually required.

Video On Cognitive Behavioral Therapy

This might include cognitive behavioral therapy, where a strategy to identify the man’s fears and inhibitions around sexuality will tease out the primary factors behind his difficulty in ejaculating.

By bringing such techniques into the relationship between the man and his partner, it’s entirely possible for a man to find that his negative emotions around sex dissipate to a level where his natural sexual arousal can take prominence.

The object of the exercise is not to completely remove his fear or anger around sex, or his sexual aversion if it exists, but simply to provide him with an opening, as it were, to a higher level of sexual expression.

This includes the period during sexual activity and also before and after it. Then he may be able to, for example, attend easily to simple matters such as asking his partner for what he wants.

When a couple work together on improving communication around sexual activities, the level of intimacy that can be achieved is remarkable.

Taking the established principle that intimate connection between the man and his partner are necessary as a precursor to sexual arousal, you begin to see how effective this treatment for retarded ejaculation – or difficulty in ejaculating – can be.

The other implication of the treatment technique is that, generally speaking, the involvement of the partner is necessary for a successful outcome.

Indeed, in my experience, I find a partner can be extremely helpful in helping a man to understand that even though he has an erection, he may not be aroused sufficiently to enjoy sex.

One of the key factors in delayed ejaculation is that men appear to be aroused, as indicated by the presence of a hard and prolonged erection, when in fact their true level of sexual arousal is rather low.

This seems to be some kind of autonomic response in the body to the expectation of sex, producing an erection and permitting a man to engage in long-lasting intercourse without ever coming anywhere near his threshold of ejaculation.

Sidebar: Why can a man get an erection even when he is not aroused?

couple making love
Experience and confidence in lovemaking contributes to normal ejaculation in men.

One could see this as a matter of reframing sex, or educating the man around the conditions necessary to enjoy successful intercourse.

That’s why cognitive behavioral techniques can be so successful here: for example, explaining to the man the basic sexual techniques that are necessary to arouse a woman, or showing him how to enjoy sex and how it’s possible for him to “let go” during the act of intercourse.

These things can all form part of a treatment strategy for retarded ejaculation that reduces the inhibitions the man feels around sexual arousal and allows him to ejaculate normally, or at least more easily.

To sum up another approach: a man generally has a number of particularly sensitive areas which can be used to provide an enhanced level of sexual stimulation, perhaps enough to bring him to orgasm.

This might, for example, involve bringing masturbatory erotic fantasy that arouses him into sexual activity with his partner.

It might include stimulation of different parts of the body, for example the anus, or nipples, to get more physical stimulation. The anus tends to be an area that few men have explored but which can provide high level of sexual stimulation and excitement.

Men Know What To Do!

In addition, many men are ready to deal with the issues that underlie delayed ejaculation. They are almost always have some sense of the factors that have led to their ejaculatory problems, even when they deny it.

It’s also important to understand that removing a sexual dysfunction may serve only to reveal an underlying causative factor which actually holds more “juice” for a man than the dysfunction itself.

In one case, a client reported that he felt deprived of sexual experience as an adolescent and young man, and that he had a strong need to explore sex with many different women.

This was incompatible with his marriage; knowing that he could not ejaculate with a woman appeared to serve as a defense against the temptation of extramarital affairs.

Couple lying naked in bed
What keeps a couple together in relationship? Good sex, for sure.

Clearly such issues can be very threatening for a couple, and extremely difficult to deal with. Complete trust and honesty are necessary for a successful resolution: a slightly ironic observation, in view of the fact that trust is one of the commodities most frequently lacking in couples where the man has a slow climax.

By that, I mean a deep level of trust sufficient for a couple to communicate openly and honestly about their deepest fears, as explored in Jungian Psychotherapy, their expectations and hopes to each other.

Fear of that level of communication is probably one of the reasons why it’s so common for couples to seek a simple solution, such as a pill which might treat delayed ejaculation. Needless to say, there is no such thing.

As a therapist one needs to be highly aware of couples who seek such a solution because it implies that they are striving to avoid opening up the dynamics of their relationship.

It isn’t possible to surgically remove one  sexual dysfunction and leave a healthy sexual relationship when the very purpose of that sexual dysfunction is to disguise some fundamental difficulties in the relationship.

This has led to the suggestion that a couple may be brave enough to explore their deepest and darkest sexual longings to help achieve a level of understanding and communication which allows an expression of normal sexuality.

The difficulty is, in my opinion, that couples where DE manifests are often sexually naïve and content to settle for the most conventional and reassuring form of sexual interaction.

There are techniques that can overcome this: it’s possible, for example, to ask each partner in a couple to write down the sexual scenario that frightens them the most, but which they would most like to enact.

In therapy each couple can then be given the choice of whether or not to examine these possibilities or to keep them secret, but the very act of writing them down and bringing them into consciousness may serve to illustrate the sexual dynamics that play out both within each individual and in the relationship between them.

Simple, powerful, effective solutions for men who have difficulty coming during intercourse