The Inhibition Model:
Curing Ejaculatory Dysfunction
This approach to dealing with delayed ejaculation was developed by the founders of modern sex therapy Masters and Johnson, and sex therapist Helen Singer Kaplan.
They suggested there are two different causes of delayed ejaculation (DE) – and two starting points for treatment.
The first was that a man is not receiving enough sexual stimulation to take him to his ejaculatory threshold, which is the level of arousal where ejaculation becomes inevitable (i.e. the so-called “point of no return” or PONR for short).
If correct, this means the sexual stimulation he is receiving must be increased in some way so that a man can reach his ejaculation threshold.
The second cause of delayed ejaculation in these guys’ thinking is that a man needs a higher than normal level of stimulation to reach his point of no return.
As you can imagine, this also means finding ways to get the man more aroused – or, perhaps, more responsive to sexual stimulation.
By the way, a psychodynamic approach to ejaculation difficulties takes a very different view, and assumes a man has emotional challenges around sex, and that he can’t ejaculate because of some internal emotional or psychic conflict.
Kaplan tried to combine both concepts: she said that while the apparent cause of problems reaching orgasm might be inadequate stimulation or lack of arousal, this might be caused by more profound subconscious conflicts. I’m sure she’s right, too.
That’s why my self-help treatment program can do both things – it increases your sexual arousal through new techniques of sexual stimulation, and it also helps you resolve any unconscious feelings which might be causing you to have a very long-delayed ejaculation during sex.
Getting To Your “Point Of No Return”
How can you do this? Masturbate harder and more fiercely, perhaps?
At first sight, treatment which involves a high level of vigorous stimulation to the man’s penis doesn’t look like a loving, sensual expression of the deepest emotions that a man or woman can feel towards each other.
But the thing is, some men really can be stimulated enough by vigorous masturbation and other sexual activities which they find exciting, so that they can eventually ejaculate inside their partner.
These techniques for increasing sexual arousal seem to produce a kind of “breaking of the barriers” for some men, so they can ejaculate inside their partner with much less difficulty thereafter.
Maybe this is an outward sign of a man overcoming deeper emotional issues in his feelings and attitudes towards women.
And, having come inside a woman once, a man’s neural pathways will be changed so that whatever was stopping him ejaculating no longer has any power over him.
This can be an effective way to treat delayed ejaculation if a man has conditioned himself during adolescence to reach orgasm from extremely hard and vigorous masturbation, maybe thrusting against a mattress, for example, or using hard and fast hand movements.
This is called “Traumatic Masturbatory Syndrome”.
But the question is, why do boys stimulate their penises in this way? Is it because they are already emotionally inhibited about sex and their own sexuality?
In the latter case, normal masturbation – which involves touching the penis, self-stimulation by the hand, and a fantasy life to accompany all this – might increase anxiety. That’s when we need to look at the deeper emotional issues.
So as you can see, this approach to overcoming problems with ejaculation during intercourse assumes that a man is not receiving enough sexual stimulation – in either quality or quantity – to reach his “point of no return”. That means he is not able to ejaculate.
The idea is that if the level of sexual stimulation can be increased enough, then he will be able to ejaculate. But what if his ejaculatory threshold is higher than normal?
Maybe so high as to make reaching climax very difficult? The answer is still the same: find ways to get him more excited. You could do this by using things the man fantasizes about, or by increasing bodily stimulation – for example the prostate, anus, nipples, scrotum and perineum are very sensitive to touch and this can be very arousing. My treatment program explains all
The Desire Deficit Model For Delayed Ejaculation
This is an alternative way of explaining delayed ejaculation. The desire-deficit model was explained by Bernard Apfelbaum in his article “Retarded Ejaculation: A Much Misunderstood Syndrome”, in the book Principles And Practice Of Sex Therapy, edited by Leiblum and Rosen, Third Edition, New York: Guilford Press, 2000.
Apfelbaum sees delayed ejaculation as an excitement and desire disorder disguised as a performance disorder.
In other words, he thinks a man is just not aroused enough to ejaculate. (Even if he has a hard erection.) And both he and his partner think there is something wrong with him, his sexuality, or his sexual performance…..
Apfelbaum strongly opposed the “almost aggressive attack” on the penis – i.e. the use of vigorous stimulation which we described above – to try and overcome the problem when a husband can’t ejaculate during intercourse.
And sure, any kind of intense stimulation aimed at enabling a woman’s boyfriend to come easily, to get him over the problem a couple experiences when a boyfriend can’t ejaculate during sex, may be seen by the man concerned as very harsh and uncomfortable. His anxiety around sex may increase, not decrease.
And I think that forcing a woman’s partner to ejaculate during intercourse inside a woman’s vagina at any price may simply avoid looking at the lack of arousal and desire he’s feeling, a lack of arousal which needs to be uncovered and examined.
That way, he can become truly aware of, and able to take responsibility for, the underlying factors that lie behind his delayed ejaculation.
Apfelbaum came up with the term “counter bypassing” for his treatment approach, in which treatment is aimed at helping a man understand and acknowledge his lack of desire and arousal during intercourse.
I think most men with slow or late ejaculation do have a sense there are deeper issues at work. For example, they often want to be more giving to their partner.
So for me, it is essential to help a man with delayed ejaculation reinterpret common myths and his own incorrect beliefs around sex, and his role in sex, and what he “should” be doing for women, so that he has a normal view of male-female relationships during sex and intercourse.
But are these two approaches to ejaculation problems as incompatible as they may first seem?
Apfelbaum says that the long-lasting erections of a man with delayed ejaculation do not indicate he’s aroused. In fact, they are more a sign of his lack of desire and excitement, particularly when he has partner-specific ejaculatory problems.
However, other people have pointed out that Apfelbaum’s model is based on the analysis of only one group of men and his conclusions may not be transferable to other men.
And guess what? You get what you look for, so to speak. A significant percentage of men who have trouble ejaculating have signs of obsessive-compulsive disorder, anxiety disorder and paraphilia.
Here, delayed ejaculation may be the result of inhibited arousal and desire towards a sexual partner or even sexual intercourse itself.
But as always, such a desire deficit is only one part of other, deeper, unconscious issues which need to be uncovered and treated.
Traumatic Masturbatory Syndrome
Another possible objection to Apfelbaum’s work is that he suggested one of the key diagnostic signs of delayed ejaculation is that a man would only find his own erotic touch arousing.
In other words, he actually prefers some kind of autosexual experience — which means masturbation by himself — to any other form of homosexual or heterosexual involvement.
As we’ve already mentioned, many men with delayed ejaculation do have what’s called an idiosyncratic way of masturbating, but these men don’t generally claim to get greater enjoyment from masturbation than from sex with a partner.
All that we can say is that they can – and do – reach orgasm more easily through masturbation than through sex. In fact, masturbation is often the only way in which they can achieve ejaculation.
So this may mean that masturbation is an alternative to sexual intercourse, some kind of compensation, rather than a true preference.
And indeed, men in this situation often express an intense desire for intercourse and orgasm with a sexual partner, and say that this desire puts even more pressure on them – not less.
Treatment According To Bernard Apfelbaum
Bernhard Apfelbaum has suggested using the principles of treatment for anorgasmia in women to make a man aware of issues such as his unconscious refusal to enjoy sex. This avoids applying too much therapeutic pressure.
Instead of thinking as the man being unable to give during sex (that is, unable to “give” his ejaculation and orgasm), we should try thinking of the man as unable to take sexual pleasure.
And we should also honor the man’s strong desire to please his lover, his desire to be in control, and his perfectionism, as crucial parts of the treatment.
Uh? What’s that, you ask? Well, men who cannot achieve orgasm during sex are often unable to take, to be selfish, or to have orgasms “for themselves”: for them, satisfying their partner is all-important.
Men may quickly get an erection, but usually do not ask for or receive additional stimulation; this means they try to enjoy sex with only low to moderate levels of sexual arousal.
And that slows and impedes any progress towards higher levels of arousal, which in turn delays or prevents their own orgasm and means they can’t ejaculate inside their partner.
The right thing here is to help men see they are not trying to achieve an orgasm “for their partner” but for themselves . As many women are locked in this belief system too, they also need to be encouraged to accept that their partner’s delayed ejaculation is not a form of rejection; rather, it reflects the fact that he is trying “too hard” to have an orgasm for her.
Apfelbaum’s approach is about encouraging a man with delayed ejaculation to express his feelings, so that he can become aware of his lack of arousal.
When that happens, he can overcome the pressure he feels to perform sexually in certain ways.
And a therapist can help by skillfully providing him with new interpretations to explain away his wrong beliefs and open the door to a new understanding of sex. And he can use new and more exciting thoughts, feelings and behaviors to get aroused more easily.
So here’s the thing: in treating delayed ejaculation, we must be aware of the different causes of the condition. Both of the concepts described above are true – but perhaps for different groups of men.
One approach looks at the unconscious forces which stop a man experiencing the unification of sexual experience with his partner. The other approach addresses behavioral factors and unhelpful mental attitudes.
For normal sexual function, you need to deal with both. In the program setting out treatment for delayed ejaculation on this website, I explain these two approaches and give you both the emotional insights and the tools for behavioral change that can bring about normal climax during intercourse!
And something else- it’s really good for a man with sexual problems to step into his male power. Some kind of initiation rite or celebration of masculinity is what I’m thinking here.
Video – Cognitive behavioral treatment
From a cognitive-behavioral therapy view, the basic aim is to identify what makes the man anxious so that the therapist and client can come up with new ways to reduce fear.
The aim is always to increase erotic arousal and find the man’s orgasm triggers, but, changing thoughts, beliefs and sexual attitudes is just as important. Here are some crucial aspects of this program:
1) Increased intimacy between the two partners is likely to reduce performance pressure on the man. This can be achieved by using mutual pleasuring techniques to increase verbal and physical intimacy, and overcome inhibition and sexual isolation.
2) An “automatic” erection does not prove a man is ready to have sex. His sexual arousal may be too low. A good treatment plan is to give a man permission to enjoy sexual pleasure and to help him to see his ejaculation as the natural end point of his sexual arousal.
3) As treatment for delayed ejaculation proceeds, a man learns to be more direct in his requests for stimulation and starts to enjoy erotic feelings. By being more “selfish”, he will get more aroused and is more likely to enjoy an orgasm during sex.
4) A great help in the treatment of DE can be using several forms of stimulation and knowing what will trigger a man’s orgasm. This might include fantasy, testis stimulation or playing with his own or his partner’s breast or anal area during sex.
5) Orgasm triggers are very variable from person to person, but you can find many of your own by seeing what you fantasize about during masturbation. Working up to intercourse (and the aim of intravaginal ejaculation) is a slow process, with a couple only starting intercourse when they are both highly aroused.
Cognitive-behavioral strategies are made up of three parts: (1) forming a connected and close intimate sexual team, (2) enjoying comfort with sexual pleasuring, and (3) increasing the level of erotic stimulation.
1 If a man and his partner form an intimate “team”, the performance pressure which the man feels will be a lot lower.
And helping each other enjoy pleasure produces more intimacy and this overcomes inhibition and the sense of being separate. This is crucial to overcoming delayed ejaculation.
2. An erection does not mean a man is ready for intercourse. He may need to be more aroused. A man may need to see how he can enjoy sexual pleasure and gradually become more aroused arousal, so that he knows ejaculation is the expected end point of gradually increasing levels of arousal.
The more direct the man can be about asking his partner for sexual stimulation, and the more he can enjoy his erotic feelings, the more confident he will be of his ability to enjoy sex in every way. That means he is more likely to enjoy high levels of arousal that will take him to orgasm.
The need to be selfish, to seek out his own pleasure, is a key factor in recovering his orgasmic capacity and overcoming late ejaculation.
3. There are many ways of getting more stimulation and arousal: to enjoy sexual fantasies during partner sex, to stimulate the testes, perineum, anus and nipples are just some of these. Each man can discover his individual orgasm triggers.
A man who is hoping to find an effective treatment to overcome delayed ejaculation should not initiate sexual intercourse until he’s very aroused.
It’s important for each partner to ask themselves what’s at risk if the man changes the way he responds during sex.
There will certainly be some consequences if the symptoms of slow ejaculation disappear, though what may happen will be different from couple to couple.
For example, the woman might wonder if the man will search out new sexual experiences with other women. She might wonder if he will desire her as much as he does now. And so on. A couple need to talk about these issues openly, because doing so will increase intimacy.
When treating slow ejaculation, a couple need to look at their erotic life together. One of the biggest questions is what happens when they start to work on their sexual issues.
If they have a boring sexual life, and an inhibited attitude to sex, bringing some of heir hidden and dark sexual shadows into the light may make their sex lives more vibrant, flowing and exciting.
Men with ejaculatory delays often show too much concern for their partner as a way of hiding the things they fear. Changing the focus of attention from the couple’s conflicts with each other onto each partner’s own sexual conflicts and fears can be very illuminating!
It’s exciting to discover new erotic worlds, but it can also be scary and lead to defensiveness, fear and guilt.
A man overcoming delayed ejaculation will become aware of his own sexual fears which have been hidden by his symptoms.
A very good way of getting to the bottom of a person’s unmet or unexpressed wishes or desires is to have them imagine being completely self-centered in sex, with no need to think of the partner, and ask “What would be an ideal sexual scenario for you if this were true?”