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When the male is approached pelvically, stimulative techniques are best conducted with the wife's back placed against the headboard of her bed (possibly supported with pillows), her legs spread, and with the husband resting on his back, his head directed toward the foot of the bed, with his pelvis placed between her legs, his legs over hers, so that she may have free access to his genital organs.

In this particular position the wife, responding to therapeutic direction with full .understanding of the male performance fears involved, should approach her husband directly to encourage penile erection. As soon as full erection is achieved, the "squeeze technique" is employed.

The concept of a direct approach to the premature ejaculator's pelvic organs in an attempt to teach control was first introduced by James Semans.

The "squeeze technique" develops when the female partner's thumb is placed on the frenulum, located on the inferior (ventral) surface of the circumcised penis, and the first and second fingers are placed on the superior (dorsal) surface of the penis in a position immediately adjacent to one another on either side of the coronal ridge.

Pressure is applied by squeezing the thumb and first two fingers together for an elapsed time of 3 to 4 seconds. If the man is uncircumcised, the coronal ridge still can be palpated and the first and second fingers correctly positioned. An approximation of frenulum positioning must be estimated for thumb placement.

In either event, using an artificial model, cotherapists should make sure that the anatomical orientation so necessary to effective use of this technique is absolutely clear to both husband and wife. If there is any residual confusion on the wife's part as to the anatomical specifics of the squeeze technique and ejaculatory control does not develop, professional explanation and direction is presumed at fault.

Rather strong pressure is indicated in order to achieve the required results with the squeeze technique. As the man responds to sufficient pressure applied in the manner described, he will immediately lose his urge to ejaculate.

He may also lose 10 to 30 percent of his full erection. The wife should allow an interval of 15 to 30 seconds after releasing the applied pressure to the coronal ridge area of the penis and then return to active penile stimulation.

Again when full erection is achieved the squeeze technique is reinstituted. Alternating between periods of specifically applied pressure and reconstitution of sexually stimulative techniques, a period of 1 5 to 20 minutes of sex play may be experienced without a male ejaculatory episode, something unknown to the couple in prior sexual performance.

Ejaculatory urge

There may be some wifely apprehension as to the amount of pressure that may safely be applied to the penis without eliciting physical distress from her husband. The amount of pressure necessary to depress a man's ejaculatory urge would be somewhat painful if the penis were in a flaccid state, but causes no similar level of discomfort when the penis is erect.

If the wife still expresses concern over application of pressure, the husband should place his fingers over hers and apply sufficient pressure through her fingers to guide her to the required result.

Showing his wife the degree of pressure that can be applied without resultant physical distress relieves her concern for his welfare and in turn improves the unit's level of non verbal communication. As stated, pressure should be applied with the squeeze technique for a period of no more than 3 to 4 seconds.

If a positive clinical result is to be returned, it will be apparent in the loss of the husband's ejaculatory urge within this brief period of time.

Sexual excitement

Experience suggests that the male be brought to a low level of sexual excitement and depressed from his incipient ejaculatory urge with the squeeze technique four or five times during the first training session. Aside from obvious control improvement, the greatest return from use of the squeeze technique is improved communication both at verbal and nonverbal levels for the couple.

At first the wife applies pressure at her husband's direction, but soon his levels of sexual excitation become obvious to her, and she learns to apply the squeeze technique by observing his reactions to sexual stimuli.

Obviously the basic therapeutic concept involved in the squeeze technique is to enable the premature ejaculator to establish objectively a state of sexual excitation that he not only can identify but also can maintain indefinitely without ejaculation. He must be able to delay voluntarily that level of sexual excitation from which he cannot withdraw, the stage of ejaculatory inevitability.

For most premature ejaculators

Prior to experiencing physical response to the squeeze technique, any significant level of sexual stimulation usually has resulted in a quick leap toward ejaculatory inevitability. Once in the first stage of orgasmic experience, a man cannot be diverted or stopped from a total ejaculatory response.

As the result of the first day's exposure to the squeeze technique, the husband's fears for ejaculatory control and the wife's for her husband's inadequate sexual performance will be somewhat abated.

Following the typical "healthy skepticism" concepts of the therapy program, husband and wife, while employing the squeeze technique, demonstrate for each other that complete cooperation, under proper therapeutic direction, can establish ejaculatory control.

This self-demonstration of ejaculatory control markedly improves unit confidence and certainly is a major step toward re-establishing communication and terminating the cold war between the marital antagonists.

Establishing security of response relative to the squeeze technique is but the first step in a therapeutic progression that moves from onset of successful ejaculatory control under manipulative influence to a controlled coital process. Usually two or three days of husband and wife cooperation are necessary to establish full ejaculatory control with the squeeze technique under manipulative conditions. The next step in progression of ejaculatory control involves non demanding intromission.

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