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CASE STORY
MICHAEL: A CASE OF COMING TOO SOON (PREMATURE EJACULATION)
Michael, a 34-year old, tall, husky male, found me through the Internet. He called me and hesitantly asked if I dealt with men who came too soon. I reassured him that I did because coming too soon, or premature ejaculation, is the most common sexual problem that men experience. Michael made an appointment to see me the next week.
Michael confided a sexual history filled with unfulfilled expectations, many disappointments, and a bewildered attitude as to what makes relationships work. A college graduate who had always excelled in school, he neglected developing his social skills and he judged himself a “nerd”.
Michael seldom dated in high school. In college, his contact with women had been infrequent and generally unsuccessful. He belonged to a fraternity and managed to get dates for some of the fraternity parties. On those occasions, heavy drinking made him less self-conscious and enabled him to be more aggressive sexually with his dates. A few times, he was able to carry petting with his date to intercourse. Each time, his excitement, the alcohol, and the fear that his date would change her mind, made him come just as he entered her. He felt frustrated and ashamed at his lack of control of his orgasms. He started to fear and avoid initiating sexual contact.
After college, Michael landed a coveted job as a writer at a top newspaper. There he met another writer, a bright, sensitive young woman, Julie, who admired his writing and seemed to like him. They started a friendship that developed into dating. Dating led to sexual intimacy. Michael’s fears of sexual inadequacy were reinforced as once again he found himself unable to control his ejaculations. Julie told Michael that his coming as soon as he entered her left her disappointed and frustrated. She started to wonder if there was something wrong with her; she started to doubt if she was any good in bed; and she started to voice doubts to Michael as to whether he was just using her for sex.
Michael confessed to me that he was just as frustrated and disappointed as Julie was. He wondered what was wrong with him. He felt humiliated and ashamed. His anxiety about initiating sex increased. His increased anxiety made him come even faster. He was caught in a vicious cycle. This is when he decided to get help and he called me.
Growing up, Michael didn’t feel close to his parents or to his only sibling, a younger sister. Michael spoke of growing up emotionally isolated in a home where feelings were not expressed or encouraged. Both of his parents worked and there was little time spent together except for church attendance. Michael learned that to please his parents he had to make them “look good” by excelling at school and at his religious training. He spent his childhood and adolescence completely devoted to excelling at these at the expense of developing social and relationship skills. He confessed that the lack of communication and the emotional distance he experienced at home left him withdrawn and anxious about relationships.
On our second session, with tears glistening in his eyes, Michael told me that he was finally falling in love but felt inadequate as a sexual partner and anxious about entering into a relationship. The silence about sex at home and the messages he received from his religious training at church, made Michael assume that sex was taboo, bad, and shameful. Growing up, he tried to ignore his sexual urges but when they became overwhelming, he masturbated. He felt so ashamed, guilty, and anxious about being caught masturbating that he would rush to come wanting to get it over as fast as possible. Michael continued this style of masturbating until now. Unintentionally, he had become an expert at rapid ejaculations.
My first two sessions with Michael involved evaluating his problem and educating him on some of the reasons for his coming too soon. High levels of excitement, combined with high anxiety, which he said he experienced, in many instances lead naturally to rapid ejaculation. His masturbation style, guilt ridden, quick, and goal oriented, also set a pattern for rapid ejaculations. Now, he had no control over his orgasms.
I explained to Michael that in treatment, premature ejaculation is approached as the absence of voluntary control of orgasms. The best way to gain control over his ejaculations was to increase his awareness of his sensations while having intercourse. This is contrary to what he had been doing: trying to distract himself from his sensations while engaging in intercourse. Not being aware of the sensations that precede orgasm, he was unable to anticipate and control when he came.
I told Michael that effective treatment for rapid ejaculation often involves use of an antidepressant in conjunction with sex therapy. Antidepressant medication for men who have problems with erections is not recommended. However, Michael had no erectile problems, so I asked him to see his physician for evaluation for antidepressant medication. His physician prescribed Prozac, which Michael started to take immediately.
Next, I instructed Michael to do masturbation exercises to increase his awareness of the sensations that come before ejaculation. Michael was to do these exercises alone, in private, not with a partner.
Masturbation Exercises:
- Pay attention to your level of arousal. When you feel you are about to come, stop stroking, stop touching yourself for a moment.
- Let the arousal ebb slightly before starting to stroke again.
- Repeat a few times and see how long you can stimulate yourself each time before you have to back off.
- After practicing masturbating and backing off for fifteen minutes or so, allow yourself to come.
Michael practiced the above exercises daily for a week, using no lubricant to masturbate. He felt he was gaining awareness and control of his ejaculations. Next, I asked him to repeat the exercises using lubrication. He did so daily for another week. Michael was gaining confidence in his ability to anticipate when to stop stimulation so he wouldn’t come before he wanted to.
Next, I asked Michael if he felt he had progressed enough in his ability to anticipate his ejaculations to include Julie in his treatment. He was very hesitant to ask her for her cooperation. I reminded him that he had told me that they were both very disappointed and frustrated with his rapid orgasms. I suggested that he had nothing to lose by asking her for her help in the next stage of his treatment. He reluctantly agreed to ask her.
Julie was delighted as the prospect of having what she called “regular sex” with Michael and enthusiastically agreed to help him. Julie came to the next session and I instructed them on the next exercise. Julie was to masturbate Michael without lubricant. Michael was to tell her to stop when he felt he was about to come. He would let the arousal ebb. She would start again and stop when Michael asked her to. They were to do this for about fifteen minutes. NO PENETRATION WAS TO BE ATTEMPTED. If they wanted to, they could masturbate each other, or themselves, to orgasm after the exercise was completed.
After doing the above exercises without lubrication for several days, Julie and Michael were to repeat the exercises with lubrication. After three or four successful daily practices using lubrication, Michael was ready for intercourse.
To insure as much control as possible, I instructed them to have intercourse with Julie on top. After Julie guides Michael’s penis into her vagina, he lies still, not thrusting, moving her up and down until he’s near orgasm. They stop moving. When the urge to come ebbs, they start again. They do this three times. On the fourth time, he can thrust until he comes.
It took six weeks for Michael to achieve some control of his ejaculations. I warned him that this was a gradual process. With practice, he would be able to prolong coming for longer periods. In the meantime, he and Julie were satisfied with the progress Michael had made. They approached sex now with excitement and confidence instead of anxiety and feelings of inadequacy.
Michael achieved his goal of control over his ejaculations. Treatment for premature ejaculation was successfully completed.
SEXPERT’S COMMENTS
The ideas about sex that Michael was exposed to growing up, lack of sex education, silence about sex at home, and religious teachings that led Michael to assume sex was bad and shameful, set the stage for Michael’s eventual problems with rapid ejaculation. Michael’s guilt about masturbating led him to learn to ejaculate quickly to avoid possible detection of this “shameful” act. He continued this style of masturbating into adulthood creating a habit of rapid ejaculations that was difficult to break once he started to engage in intercourse. Each time he engaged in intercourse and came too soon added to his anxiety the next time he dared to become sexually intimate. By the time he started to date Julie, Michael had a history of rapid ejaculations and severe anxiety about coming too soon.
To break his old habit, Michael had to learn to masturbate differently. The exercises he practiced during therapy made Michael focus on all the sensations of arousal he experienced while masturbating. Becoming aware of his sensations allowed him to know when he was about to come. This awareness gradually gave him control of his ejaculations. As he gained control over his orgasms, Michael’s anxiety about engaging in intercourse subsided.
Generally, treatment for rapid ejaculation is highly successful. However, control over ejaculations is often not the only issue involved in rapid orgasms. In Michael’s case, his lack of sexual experience and his lack of successful intimate relationships made him anxious every time he started to become intimate with a woman. His anxiety made his problem of coming too soon worse, adding to his anxiety the next time. Sex and relationship counseling is effective in dealing with this vicious cycle.
SUMMARY
Premature, or rapid ejaculation, is the most common sexual problem that men experience. Some surveys report that as many as 60% of males have periodic concerns about rapid ejaculation.
Prematurely ejaculating men reach orgasm so rapidly that lovemaking is often disappointing for both partners.
One major cause of rapid ejaculation is anxiety, which is perpetuated every time intercourse leads to coming too soon.
Treatment for premature ejaculation is highly effective and often involves medication and sex therapy.
Treatment for premature ejaculation doesn’t necessarily require having a partner.
If you feel that you need more counseling for your difficulties than was offered
in the case story, you may contact me
about your specific problem via email
counseling or telephone counseling.
THANK YOU FOR YOUR INTEREST IN SEXPERT COUNSELOR.
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