Premature ejaculation has been defined as: the ejaculation occurred shortly after erection is attained; or ejaculation before or immediately after vaginal entry; or more loosely, the ejaculation at anytime before the male is ready, or even at any time before the female is ready.

Lobitz and Lopiceolo (1971) have found no difficulty in first having the male apply the squeeze treatment himself in solitary practice, prior to working with a partner.

Suggestion to the male

The client should be informed that any man, sexually deprived for a period of time, who is tense, sexually excited, and cannot maintain an erection for a prolonged period, will almost invariably ejaculate quickly. This is particularly true if there has been a prolonged separation from a partner, or the first time with a new partner.

The client is asked to redirect his attention to all the unique sensations that he experiences for stimulation of the penis inside the vagina. How does it feel when he changes over time?

A few suggestions regarding relaxation and breathing may also be helpful. Tense muscles and slow deep breathing seem to decrease such a probability.

Change in movement and position may also be suggested. Hard pelvic thrusting, by the man with above position is more likely to trigger ejaculation than any other behaviour. E.g. maintaining deep penetration while slowly moving in a relaxed circular movement, cannot only delay ejaculation, but it may also be highly arousing to a wife. Intermittent, slow and fast thrusting may also be used. Letting his partner know that it is time to rest and stopping movement when he feels the urge to ejaculate, can also be effective in delaying ejaculation. Once the urge subsides, slow movement may again be continued. Making several voluntary twitching movements of the penis while the male is resting may be helpful. Identifying the correct muscle for this may be done by having the client attempt to start and stop the flow of urine the next time he uses the bathroom. Certain positions may also be facilitate control. Such as the female sitting above and facing her partner.

Increase in the frequency of sexual contact, leading to orgasm and ejaculation is useful. This one suggestion may be the main effective element that underlines almost all other procedures that have been used in treatment in this area. Typically, the male who is concerned about early ejaculation, keeps putting off contact with his partner who also may be avoiding contact because of fast frustrations. By the time he finally does make contact, he is so easily aroused and highly excited, that it may take only a touch, a tap, or a whisper to “set him off”. Additionally, when he does attempt to engage in relations, he usually tries to keep all physical contact, whether it be his partner’s hands, mouth, or body, away from his penis until the last moment for fear of being “set off”. This is just the opposite of what he must do if he wants to learn to experience pleasurable tactile stimulations and wants to avoid immediate ejaculation.

Semen’s Technique Of Interrupted Masturbation

The man is asked to stimulate himself and when he feels the urge for ejaculation he should stop and rest till his urge goes away then he should start stimulating himself again. This should be done repeatedly until the final orgasm and discharge occurs.

While he is stimulating himself in this manner, he should as clearly and vividly as he can, fantasize engaging in genital intercourse with his partner. He should use lubricants in his self-stimulation in order to more closely approximate vaginal stimulation.

Squeeze Technique

As soon as full erection is achieved and the husband indicates that ejaculation is imminent the “squeeze technique” is employed. This consists of squeezing the penis with thumb placed on the frenulum, located on the inferior surface of the penis, and the first and second fingers are placed on the superior surface of the penis in a position immediately adjacent to one another, but on either side of coronal ridge. Pressure is applied by squeezing the thumb and the first two fingers together for 3 to 4 seconds. Rather strong pressure is indicated in order to achieve the required results. With this squeeze the husband will immediately loose his urge to ejaculate. He may also loose 10 to 30% of his full erection. The wife should allow an interval of fifteen to thirty seconds after the squeeze is finished and then return to achieve penile stimulation. Again, when full erection is achieved and husband indicates that ejaculation is about to come, the squeeze technique is re-applied.

Suggestion to the wife

It must be pointed out to the wife that if she is patient and willing to cooperate, her husband can learn to delay ejaculation. If she expresses anger, verbally or non-verbally, and belittles him, then the problem will continue or get worse. This problem, like other sex problems, is also a mental concern. Sexual interaction of the couple is the real cause and the cure also cannot be brought about without the active involvement and cooperation of both.

Generally speaking it may help to suggest increased frequency of sexual intercourse, as well as employ a wide range of mutually gratifying activities, which are possible without penetrating in the vagina with the penis.

The Treatment Of Premature Ejaculation

(Masters & Johnson Method)

The first 4 sessions of Sensate focus described for the treatment of psychiatric impotence are also suggested for this illness exactly in the same manner.

Session No. 1

History-taking involves more than the standard psychiatric interview. Basically it comprises of a detailed inventory of sexual attitudes and experiences in all phases of life alongwith similar data of the marital partner and their mutual psychological and sexual interaction.

After a complete physical examination, the genitals are also examined for the satisfaction of the patient, as well as to rule out any local pathology; most patients have a mistaken feeling that their genitals are either not fully developed or they have been deformed by masturbation and other sexual activity. In the vast majority of cases the genitals are absolutely normal and the patient should be informed of this in an emphatic manner, in order to alleviate all anxiety about this matter.

Session No. 2

The couple is told that the cause of sexual problems is mutually shared and the treatment of these problems can only be brought about by mutual efforts and co-operation. Attempt is made to resolve the misunderstanding and conflict between the husband and wife, if any, and to create an atmosphere of understanding, love and affection.

The anatomy and physiology of the male and female sex organs is demonstrated to them through explanation and use of pictures. Then it is pointed out to them that sex is pleasurable and that sex between husband and wife is considered equivalent to worship by Islam. They are also encouraged to express their feelings about sex to each other, as well as to the therapists, including feelings of pleasure in sex.

Session No. 3

They are both instructed in the sexual exercise called “sensate focus” by Masters and Johnson. The husband and wife should be completely relaxed in their bedroom and completely naked. The husband is instructed to fondle, massage and otherwise run with his hand the body of his wife in order to give her maximum pleasure. In this session the breast and the genitals are not touched. This should be continued as long as it is pleasurable for both the partners with a maximum of about half an hour. After that the wife is to perform the same pleasuring to her husband but the genitals are not touched. The husband and wife are to guide each other verbally and by their hands as to the parts of the body and methods of touching that give the most pleasure.

The couple should use their favorite perfume and the bed room should be properly decorated, in order to increase the sexual and sensate stimulation.

Session No. 4

The experience and feelings of the previous session are discussed. If it was not pleasurable it should be repeated, otherwise the partners are now allowed to touch the genitals and the breast in addition to the whole body. In order to facilitate the stimulation of the penis by the wife it is suggested that she apply a little olive oil for that purpose. The husband and wife are now encouraged to have a good look at the sexual anatomy of their partner, specially the husband who is asked to have a close look at his wife’s genitals so that no more doubts about the exact structure linger in his mind. Husband and wife must also guide the stroking hand of their partner and indicate directly the parts of the body and the type of stroking that gives the maximum pleasure especially in the area of the genitals.

Session No. 5

This session should always be preceded by session no 4. The wife should sit down with her legs separated widely and her back against the wall or the head-board of the bed. The husband should be down between that legs in such a way that his pelvis touches hers while his knees are bent and spread out, so that the wife has free access to the husband’s genital organs. The wife should stroke the legs, body and penis of the husband to encourage penile erection. A little olive oil may be applied to the penis.

As soon as full erection is achieved and the husband indicates that ejaculation is imminent the “squeeze technique” is employed. This consists of squeezing the penis with the thumb placed on frenulum, located on the inferior surface of the penis, and the first and second fingers are placed on the superior surface of the penis in a position immediately adjacent to one another, but on either side of the coronal ridge. Pressure is applied by squeezing the thumb and first two fingers together for 3 to 4 seconds. Rather strong pressure is indicated in order to achieve the required results. With this squeeze the husband will immediately loose his urge to ejaculate. He may also loose 10 to 30% of his full erection. The wife should allow an interval of 15 to 30 seconds after the squeeze is finished and then return to achieve penile stimulation. Again, when full erection is achieved and husband indicates that ejaculation is about to come, the squeeze technique is reapplied. Alternating between periods of applied pressure and sexual stimulation, a period of 15 to 20 minutes of sex play may be experienced, without a male ejaculatory episode. At first the wife applies the pressure when the husband indicates that he is having the feeling of imminent ejaculation, but later his levels of sexual excitation become known to her and she learns to apply the squeeze technique by observing his reactions to sexual stimuli.

Session No. 6

Repeat session four and five. Then the male is asked to lie flat on his back and the female to mount in a superior position, her knees placed approximately at his nipple line and parallel to his trunk. The wife should lean over her male at 45 angle so that she is able to insert the penis and later to move to and from on the penile shaft. After employing the squeeze technique 2 or 3 times, she should insert the penis in the vagina and sit quietly in a motionless manner. If the husband feels ejaculation coming on, the wife should elevate from the penile shaft, hold the penis, apply the squeeze technique for 3 to 4 seconds and re interest the penis.

Session No. 7

Repeat session four, five and six. When the penis is in the vagina of the wife who is mounted in the superior position, the husband is encouraged to provide some pelvic thrusting, just sufficient to maintain his erection. By this method 15 to 20 minutes of intra-vaginal containment can be maintained without ejaculatory demand.

Session No. 8

Repeat session four, five, six & seven. At this stage female pelvic thrusting is also initiated in a slow non-demanding manner and later with full freedom of expression and then organic expression will become natural potential.

Session No. 9

Once confidence in the female superior position has been established, with the woman enjoying the sensate pleasure of pelvic play with the intravaginally contained penis, the marital unit is directed to convert the female superior position to a lateral coital position.

The position is considered the best for female orgasm and male ejaculatory, control and should be used often, especially in the first six months following the treatments.
The squeeze technique should also be employed during this prior at least once a week prior to coitus. The remainder of the marital units sexual opportunities during the week are encouraged to develop in a natural unconstrained fashion.

It is also suggested that the couple take advantage of the wife’s menstrual period each month to provide at least one session of 15 to 20 minutes devoted specially to male sexual stimulation with manual manipulation and repetitive applications of the squeeze techniqu