Treatment of ejaculatory incompetence follows the basic approach described for treatment of premature ejaculation. Once the couple interest in sensate focus has been secured, the next step is direct approach to penile stimulation.
Instead of using the squeeze technique to avoid ejaculatory response as with the premature ejaculator, the female partner is encouraged to manipulate the penis demandingly, specifically asking for verbal or physical direction in stimulative techniques that may be particularly appealing to the individual male.
Care should be taken to employ the moisturizing lotions to avoid penile irritation.
The first step in therapy for the incompetent ejaculator is for his wife to force ejaculation manually. It may take several days to accomplish this purpose.
The important concept:
There is no rush for sex. The mere act of ejaculation accomplished with the aid of the female partner is a long step in the right direction. Once he has ejaculated in response to any form of stimulation acceptable to her, the male no longer will tend to withdraw psychologically from her ministrations.
When she has brought him pleasure, he identifies with her, for the first time in the marriage as a pleasure symbol rather than as a threat or as an objectionable, perhaps contaminated, sexual image.
Three of the 17 men had never been able to masturbate to ejaculation before entering therapy. For the remainder, masturbation had been the major form of sexual tension release, but the men had infrequently included their wives as contributors to their release mechanisms (4 of 17). By denying their wives the privilege of participating in the ejaculatory experience, even if occasioned manually, they further froze the possibility of a successful sexual relationship.
As might be expected, some of the wives had no real interest in relieving their husbands through means other than successful intercourse connection. Although only three men constrained their ejaculatory processes to frustrate their wives, many more were accused of this motivation by their partners.
Since ejaculatory incompetence is a relatively rare clinical entity, few members of the general public have heard of it. When wives did not understand that their husbands were involved in a form of sexual inadequacy, as evidenced by their ejaculatory incompetence, they were reluctant to participate in any sexual approach designed, in their minds, only as a means for male relief.
The tremendous advantage of dealing with both members of the husband and wife in approaching the concerns of sexual dysfunction has no better example than in treating ejaculatory incompetence. If one dealt only with the hush, and, and the wife received her information second-hand, if at all, her rebellion would continue in a large percentage of cases.
For the husband to suggest specific manipulative techniques at the direction of his therapist does not carry the weight of authority or enlist the degree of wifely cooperation that an adequate explanation can elicit when given to both members of the husband and wife as equal participants in the therapeutic program.
Inevitably, since education is always the procedure of choice, the husband and wife must be dealt with directly. When these techniques of direct confrontation are employed, the wife's cooperation improves immeasurably.
Once the wife has been made fully aware of techniques that simultaneously tease and stimulate her husband, great variation is available in measures to relieve the problem of ejaculatory incompetence. As a first step, the husband should be encouraged to approach his wife sexually in order to provide her with release from sexual tensions accrued during the stimulative sessions she has conducted for her husband.
The basic give-to-get apply to the concerns of the incompetent ejaculator. He must feel not only the stimulation of his wife's sexual approach, but, in addition, he must be stimulated sexually by her obvious pleasure responses to his direct sexual approaches.
Every possible advantage should be taken of this multiplicity of sexually stimulative physiological and psychological influences in order to achieve regularity of ejaculation for males faced with ejaculatory incompetence.
After establishing competence in ejaculatory function with masturbatory techniques, the next step toward intravaginal ejaculatory response is in order. Male partners are stimulated to a high degree of sexual excitation by their wives' direct physical manipulation of the penis.
As the male closely approaches the first stage of orgasmic return (the stage of ejaculatory inevitability), rapid intromission of the penis should be accomplished by the wife in, the female-superior position. She should continue penile stimulation during the attempted intromission.
Once the coital connection is established, a demanding style of female pelvic thrusting against the captive penis should be instituted immediately. Usually this teasing, technique is sufficient to accomplish ejaculation shortly after intromission. If the male does not ejaculate shortly after intromission under the designated circumstances, pelvic thrusting should cease.
The wife should terminate the coital connection and return to the demanding manual stimulation. As the husband, now conditioned to masturbatory response, reaches the stage of ejaculatory inevitability, he should notify his wife.
She should remain in the female-superior position while demandingly manipulating the penis, and from this positional advantage quickly reinsert the penis into the vagina at her husband's direction.
It matters not if she is a little too late in her intromission efforts. If the stage of inevitability has been reached and some of the ejaculate escapes during the intromissive process the first few times the technique is employed, there is no cause for concern.
Even if but a few drops, of ejaculate are accepted intravaginally, the mental block against intravaginal ejaculation, will suffer some cracks. Every partial success at intravaginal ejaculation should be underscored in a positive fashion, and rite obvious therapeutic progress should be emphasized in all discussions with the distressed husband and wife.
In short order most of the ejaculate will be delivered within the vagina and the husbandˇŻs mental block neutralized or removed.
With the first intravaginal ejaculatory episode, the marriage has been consummated. This is a moment of rare reward for the wife of any man suffering from ejaculatory incompetence. Some wives referred to the Foundation have waited more than ten years, to consummate their marriages.
Their levels of psychosexual frustration during these barren years are beyond comprehension, despite their relative facility at multi orgasmic release of sexual tensions during their coital patterning.
Whether or not the wife is particularly stimulated sexually at this stage of the therapeutic program is of little or no importance. She has had her moments in the past of pure tension release, and she has much to gain if her husband's ejaculatory block can be obviated. The important fact is that the unit, with full communication, works well together.
Proper application of effective stimulative techniques, the incompetent ejaculator usually has been enabled to consummate his marriage. After three or four such episodes of rapid intravaginal penetration as the male is ejaculating, confidence in intravaginal ejaculatory performance will have been established. Then every effort is made to increase female partner involvement by including a period of voluntarily lowered levels of male sexual excitation before coital connection is initiated.
In this way, a lengthened period of intravaginal penile containment is encouraged, for it has a specific purpose. The male's fears of continuing as an incompetent ejaculator have been dimmed or negated, both in view of his recent intravaginal ejaculatory success and the fact that he is controlling his ejaculatory response voluntarily to accommodate and not frustrate his wife.
Needless to say, her fears for his facility of sexual performance disappear even more rapidly than do his performance concerns after the initial episode of intravaginal ejaculation.
The male usually experiences high levels of sexual excitation in the therapeutic sequence as opposed to feeling very little sexual interest during prior experience with involuntary ejaculatory incompetence. Taking advantage of his pleasure in these subjective changes and acceptance of the therapeutic program as devoted to his psychosexual security, every professional effort should be directed toward reconstitution of the marriage on a healthy, communicative basis.
Weaponry necessary to reinstitute the destroyed channels of communication within the marriage is described, and its usage is supported by direct exchange between cotherapists and patients at every session.