Adolescence

Adolescence

Adolescence is simply a transition stage from childhood to

adulthood. It is a stage which all young people go through to become biologically and sexually mature. In girls it may start as early as 9 or 10 years and in boys it begins around 12 or 13 years. Adolescence is a time of rapid change in the body, emotions, attitudes, values, intellect and relationship.

Adolescence changes are triggered by hormones of the pituitary gland and the gonads. The hormones bring about the development and maintenance of the secondary sex characteristics.

Adolescence are passionate people and are apt to be carried away by impulse. They can experience irrepressible joy or inconsolable sadness, gregariousness or loneliness, altruism or self-centeredness, insatiable curiosity , confidence or self doubt.

An adolescent is expected to

_ become independent of his/her parents.

_ establish a new social and working relationship with peers of both sexes as well as with adults.

_ adjust to sexual maturity and changing roles

_ decide on future goals.

Frigidity

Frigidity

Frigidity is inhibited sexual excitement during sexual activity. Frigid means cold. The term frigid refers to non-response to emotion, applied especially to inability on the part of the woman to feel sexual desire. A frigid female is devoid of sexual feelings and cannot achieve an orgasm.

Aphrodisiacs

                        These are substances thought to increase the sexual drive or ability of the individual. They are mainly desired by males.There is constant search for aphrodisiacs. Over the centuries human beings have used extracts of trees, roots, flowers, insects, animal parts, Spanish fly, strychnine, alcohol, and drugs for this purpose. However, according to scientific research there is no effective aphrodisiac available.

Foreplay

The best aphrodisiac can be a caring, sharing partner and foreplay. This is the stimulation of sensitive body parts to get the partners into the excitement stage. The sensitive body areas different  in individuals. Therefore the partners have to explore each other to find out sensitive areas that will lead to sexual excitement.

These areas could be the ear lobes, neck, lips, inside skin of the upper arms or things, toes, fingertips, soles of the feet, breasts, and genitals. These sensitive areas are called erogenous zones. These areas can be stimulated by stroking, squeezing, tickling, licking etc. the partners must communicate and express to each other what is pleasurable to them and what is not. A woman usually takes a longer time to get aroused than a man; so foreplay should take this into consideration.

Once the two partners have agreed to have a sexual relationship then it is the responsibility of each partner to satisfy the needs of the other. This should be done with care, understanding and respect.

Conception

Conception is the physical and physiological process of a sperm fusing with an ovum. Conception occurs as a result of sexual intercourse. The society requires a child to have a father and a mother, not just so that they contribute a sperm and  an egg cell, but so that they can nurture a child after it is born. Therefore, society expects children to be born in marriage. However, a man and a woman who are not married are capable of sexual intercourse and of making a baby. But this baby may be socially at disadvantage if brought up by a single biological parent.

When a man and a woman want to have a baby, vaginal intercourse provides a kind of sharing. The timing is important as the egg in a woman has a life span of only 12 to 24 hours. Hence, the period during which the egg and the sperm can unite is limited to about 2 days in a month, around the time of ovulation. May differ in some women. However, sperms are produced in millions each day, facilitating fertilization since only one sperm is required to fuse with the egg cell. The moment of the ovum by the sperm is called conception. It normally takes place in the outer part of the fallopian tube.

During vaginal intercourse the erect male penis enters the vagina of the female. Sperms are ejaculated near the cervix of the uterus. The sperms swim from the uterus into the fallopian tube and to the ovum. The head of the sperms enters the ovum and its tail is dropped off. The nuclei of the male and the female cells then fuse to form the zygote. This is called fertilization and leads to conception.

The directions for making a new baby are contained in the zygote. So both partners contribute to the characteristics of the baby.

Medico Legal Aspects of Sex Therapy

Medico Legal Aspects of Sex Therapy

INTRODUCTION

Sex and human sexuality are sensitive subject. To deal effectively with any problem of human sexuality , one has to constantly evaluate its merits and demerits from social , scientific , moral , ethical and most importantly from the legal angle. Following are some of the guidelines for therapist to keep in mind while dealing with clients with sexual problems.

CONSENT

Taking informed and expressed consent is of utmost importance while managing any patient. Examining and / or treating a patient without consent would amount to assault and battery which is punishable under criminal law irrespective of absence of negligence or successful outcome of treatment. The consent should be free willed, informed, intelligent , specific and express. Person giving consent should be competent to do so, failing which, consent should be obtained from the lawful guardian of the patient(In cases of minor and/or Mentally retarded).

EXAMINITION OF A FEMALE CLIENT

Besides obtaining a valid consent, in case of female patient, the therapist should always have a female assistant present when examining  a female patient This is important for the therapist in order to protect himself from a possible charge of indecent behaviour  molestation or even sexual offence like rape ect. Being llevelled against him . Mere presence of husband or any male companion of the female patient is not enough. A sex therapist, in particular, is most vulnerable and therefore should be most careful.

USE OF SURROGATE PARTNERS

Use of surrogate Partners for sex therapy is questionable both ethically as well as legally. Sexual involvement of the therapist is universally accepted as unethical. There have been a number of cases where the therapists themselves, having acted as surrogates, have been punished for sexual molestion of their patients. It may also invite a criminal charge of adultery in some countries, including India .there are cases on record where the therapists have been charged with and convicted of rape.

Unlike some other countries, the socio cultural set up in India is different. The laws governing sexual behaviour are neither liberal nor evolved as much as in some of the western countries. Besides, surrogacy is likened to prostitution by many. Even if one were to consider surrogate partner as a therapist, then the ethical code prevents   a sexual relationship with a client. Moreover, there is every possibility of a disease being transmitted. Particularly the HIV infection, in view of sex with multiple partners by a surrogate person.

Therapist should have uppermost in mind the special values of intimacy and love that our culture teaches us to nurture.

PROFESSIONAL COMPETENCY

It is the ethical responsibility of every sex therapist to maintain high standards of Professional competence and integrity. Competence without integrity or integrity without competence is an unsatisfactory compromise of professionalism. It is most important to protect the public and the other professionals from persons who represent themselves as sex therapists who are in fact lacking in competence and intergrity.

Competence in another primary discipline such as psychology,  psychiatry or counselling is not equivalent   to competence in sex therapy.

A sex therapist should possess adequate knowledge of the following:

            

1.    Sexual and reproductive anatomy and physiology.

2.   Developmental sexuality from a psychobiological point of view.

3.   Marital, Family and Interpersonal Relationship and Socio-cultural factors in sexual values

4.   Physiological and medical factors that may influence sexual functions such as pregnancy, contraception and fertility, illness, disability, medications .

5.   Multimodel  techniques and theory of sex therapy and psychotherapy.

6.   Pharmacology of the medications used to treat sexual dysfunctions particularly with respect to their adverse effects and interactions with the drugs being consumed for other ailments.

7.   Ethical issues in sex therapy and principles of evaluation and referral.

8.   Laws related to sexual behaviour.

POINTS TO BEAR IN MIND

·       All forms of sex therapy which violate the local laws should be handled with care recommending oral sex as a part of therapy is violative  of section 377 of the indian penal code which deal with unnatural sexual offences.

·       The Hippocratic oath forbids the physician to take advantage of the therapeutic context in order to engage in either homosexual or heterosexual relationship.

·       It is a universal rule that whenever dealing with reproductive functions is involved, express consent of both the spouses should be obtained.

·       Proof of competence is the ability to provide objective and responsible services to the clients.

·       There does exist a potential liability under the laws of the land prohibiting consensual conduct such as prostitution, fornication, lewd and lascivious behaviour and adultery which might arise from therapeutic or non- therapeutic sex research activities.

·       Sex between therapist and client is always unethical. No matter how therapeutic the rationale might appear, there is no justification for a therapist having sex with a client. The purpose of sex therapy is to improve function, not to change values or beliefs of the client.

PREMATURE EJACULATION INTRODUCTION

PREMATURE EJACULATION INTRODUCTION

Premature Ejaculation And Retarded Ejaculation

Premature Ejaculation has been recognized by modern medicine quite recently. Till 1913, this condition was not mentioned anywhere in medical literature. Dr. K Abraham was perhaps the first to call it ejaculation praecox. Earlier Victorian Physicians were more interested in nocturnal emissions and spermatorrhoea and the bad effect it produced on the mind and body of a person.

Definition of premature ejaculation by American Psychiatric Association and DSM-IV is given as ‘persistent or recurrent ejaculation with minimal sexual stimulation that occurs before, during or shortly after penetration and before the person wishes it.

This definition has variables like the word ‘minimal’ and a description of timing that cannot be standardized. A man may be perfectly happy if he ejaculates within half a minute whereas another may be unsatisfied even if he ejaculates after half an hour of coital activity. The definition also places emphasis on the man’s subjective feelings totally disregarding the female.

In India, our very own Kama-Sutra regards this condition as a normal variation. Here Vatsyayana outlines the ejaculatory response at three levels of duration. In both men and women, the duration of lasting or kala is given as short-timed, medium – timed and long – timed .

This is very well described in Kokashastra or Rati Rahasya. Here pandit Kokka gives three variations in men and women as per the duration for which the sexual act lasts. He classifies them as immediate, intermediate and delayed. According to him, this is just a variation and he suggests idea combinations for men and women based on this kala.

WHY PREMATURE EJACULATION? WHAT IS IT ‘PREMATURE’ TO?

It could be so called because due to the early ejaculation there is only partial experience of sexual Pleasure on part of the man which is followed by a refractory period wherein the man cannot get his interest and erection in sex for some period of time which is variable in different men. This results in the woman feeling unsatisfied as she is unable to experience her climax within that much period.

Why did this issue of premature ejaculation come up ? Animals do not seem to have premature ejaculation. This question has perhaps originated because of the ‘Pleasure’ component in human sexual activity.  As a result, men and women often complain of experiencing partial pleasures that is perceived only in the genitals and not in the mind. Some believe that sexual contact was in itself the first sin. Hence sex is considered as immoral and it results in considerable guilt and shame which can adversely affect a persons sexual behavior.

Multiple factors may be responsible for a man to experience a premature ejaculation. Some common causes cited are:

1       Excessive excitement in earlier sexual experiences.

2       Sexual  abstinence.

3       New partner

4       New setting, surrounding

5       Extremely responsive and assertive partner

6       Early experiences with friends or sex worker wherein the men is pressurized to ejaculate as early as possible

7       Anxiety states like,

          Will I ejaculate too fast ?

          Will I be able to satisfy my partner?

8       Marital disharmony with hostility towards partner.

TREATMENT OF PREMATURE EJACULATION

Various research have advocated different approaches for the treatment of premature ejaculation this could be classified as

1 Behavioral

a start stop method

b squeeze technique

2 Pharmacological

How to Solve Premature Ejaculation

How to Solve Premature Ejaculation

1BEHAVIORAL

Semans start-stop method

J.H Seman was the first offer treatment for this condition which he called –the start stop technique .Dr Helen Kaplan developed it extensively and used it to treat men with poor ejaculatory control, and who lacked the help of sexual partner. In Indian condition this method is useful as man are often reluctant to involved there partner in sex therapy

This exercised are useful if done with some degree of regularity. Mental and physical fatigue will act as constraints and it’s imperative to have proper privacy and leisure time which is rather difficult in today circumstances

Step1 self-exploration

Here the man learns about his sensual area of the body in an unburdened and un-regulated manner. When he is rested and relaxes

He undressed and lies on the bed .using the finger tips, he touches different part of his body starting with the face. This touching exercised is then extended to neck, arm, shoulder, chest, abdomen etc. Different stroke are to be tried out and tested for their sensitiveness.

The stimulation of the penis and scrotum is done intermittently and with varying degree of pressure using different type of strokes and grips on the penis the man learn to become aware of his pleasurable feelings. As this is only an exploratory test the man is advised not to masturbate to the point of ejaculation on this occasion as sexual turn-on is not what is desired but being aware of the pleasure of touch is crucial.

STEP 2 Self- Stimulation

Here the beginning is like the previous step wherein initially non-genital stimulation is done for about 10-15 minutes after the man feels relaxed and is sufficiently aroused he has to stimulate his genitals. This should be intermittent with other areas of the body also being touched. Being aware of the sensations generated within the body is important and so is the sensory focus on the sensations areas which include the penis, scrotum, perineum, inner thighs etc.

As the stimulation is increased, the man will start feeling sufficiently aroused to achieve a good erection. At this stage he has to deliberately slow down the tempo of stimulation for about 10 -15 seconds and then resume. After doing it 2-4 times, he can let go and ejaculate whenever he wants. During the ejaculations process he has to concentrate his attention on the physical sensations just before ejaculations occurs. This is the point of ejaculatory inevitability.

STEP 3 Introducing the Stop-Start method.

Following the practice of steps 1 and 2 for a few days, a change in pattern of stimulation is introduced. It involves deliberate total stopping of stimulation for about 10 – 15 seconds much before the level of high arousal is reached. After a slight loss of erection the stimulation is restarted. Slowly he has try to come as near as possible to the point of ejaculations inevitability and then stop – so that the urge to ejaculate disappears. The stop phase may have to be increased in highly sensitive subjects. Some men lose control and ejaculate but this teaches them to stop slightly earlier when they do the exercise next time. If ejaculation does occur the exercise is terminated. He has to be able to control himself for 3-4 such occasions and then the stimulation is continued to the point of ejaculation. At this stage the man has to concentrate on the pleasure aspect rather than trying to time himself as that may act as a distraction during climax. This procedure is to be repeated a number of times and it’s only then the man will slowly learn to control his ejaculation.

STEP 4 Stop- Start Method with lubrication

Some men tend to ejaculate prematurely only during sex. The reason attributed is that this probably occurs due to the enhanced sensitivity as a result of the wetness within the vagina due to lubrication.to enable a man to have this increased sensitivity during masturbation this step of the exercise advocates the use of a non- alcoholic, water-soluble lotion or jelly. These small changes are quite important as they mimic the factors that occur during sexual intercourse.   

STEP 5 Stop-Start Method with lubrication and Fantasy

Some men masturbate only by using the physical stimulus and their minds concentrate only on the pleasure aspect that they derive from penile stimulation. During sex, the presence of a partner is excessively stimulating which is sometimes a contributing factor for a premature ejaculation

                    For such men, adding a fantasy of their choice during the exercise enables them to simulate a real life situation and hence achieve still greater control.

 B. Squeeze Technique        

Masters and Johnson advice the innovative squeeze technique to stop the ejaculatory response. Based on detailed history taking, they devised a unique couple therapy where there is a graded increase in sexual stimulation and called it ‘Sensate Focus Method’ According to them many couples are able to cope successfully with reconditioning the man’s sexual response on their own so that sex becomes more relaxed and fulfilling. However in some situations, sex therapy is the best solution rather than trying a self help program. The squeeze technique demand the involvement of a co-operative partner whose role is to periodically apply a specific type of a non stimulatory pressure to the penis from early stages of sexual arousal to the pre-ejaculatory state. It interrupts the ejaculatory response so that the man slowly learns to achieve control. They state that most men do not benefit from trying to use the squeeze technique on themselves. It works only when the man doesn’t try to direct the action or instruct his partner as to when and how firmly to squeeze.

Step 1 learning to squeeze

                    For doing squeeze technique, the woman has to put the pad of her thumb on the frenulum of the penis while placing the first and the second fingers of the same hand on the opposite side of the shaft parallel to each other. These are placed slightly lower the coronal ridge. The woman then firmly squeezes the penis for about four seconds and lets it go.

Factors to be remembered are:

-Avoid pinching or scratching with fingernails.

-Pressure from front to back and not side to side.

-Only pads should be used and the complete finger is not to be wrapped around.

-Proper pressure is essential. More if it is firm, less if flaccid.  Suitable instructions essential.

-For early experimenting, it’s better if the man guides the woman by keeping his hand over hers.

-Pressure should be firm enough so that erection is lost in the process.

Step 2 using the squeeze during sex play where man is passive

Here the couple is advised to purposefully indulge in sex play for about 20-40 minutes. Here the degree of excitement is purposefully allowed to remain low and the squeeze is applied about 3-6 times during the whole encounter. Erection of the penis is not considered important. Some points to be noted are.

1 An excessively sensitive man ejaculate immediately after a woman touches his penis.

2 The woman should actively play with the penis between two squeezes.

3 Ejaculating despite the squeeze is considered normal.

4 Initially it is better to avoid any type of lubrication as it is counterproductive.

5   The Squeeze is to be kept separate and discreet from other type of foreplay. 

STEP 3 using the squeeze during sex play where both are active

Here the variation is that they have to take turns so that degree of stimulation for the man is now greater. Masters and Johnson strongly suggest that couples should do this step for at least three times before they move to the next step.

It helps to develop physical and psychological comfort between the couple with prolonged non- coital sexual stimulation. It also aids in annihilating the performance anxiety of the man as the periodic squeeze assist in preventing premature ejaculation.

STEP 4 Genital –to-Genital touching     

This is an essential step to make the man feel at ease wherein genital contact is established without a complete intercourse. After going through the initial steps as described above without ejaculation, the woman has to sit astride her partner, apply the squeeze and then get her vagina in close proximity to his penis. She has to use non-genital stimulation along with firm squeeze to the penis. She has to initiate the first direct contact with the vagina lips immediately after a squeeze.

Some men tend to lose control at this point. Whether or not this occurs the purpose of this exercise is to allow the man to feel comfortable with direct penis-vagina contact. It proves to be a learning experience for the man. In case he does not ejaculate the couple can proceed to the next step immediately.

STEP 5 Woman in control intercourse position

Now the woman is encouraged to sit astride with the man lying on his back. She has to intermittently use the squeeze on five to six occasions before attempting to insert the penis in her vagina. Use of some lubricant to stimulate the penis is advised. Once erection without ejaculation is achieved for a satisfactory period of time she squeezes the penis and inserts it in her vagina. She has to sit still without any movements and both have to focus on their physical sensations.

It’s imperative that the woman be in total control during this process. After the man is able to control ejaculation at the end 15-20 seconds the woman removes the penis and applies the squeeze once again and reinserts the penis. Now after staying still for some more time she begins a slow thrust pattern. Gradually over a period of time the thrusting speed is increased along with the time. It is normal to expect a few failures wherein the man may ejaculate prematurely, but slowly over a period of time he learns to control himself.

First Night Failure

INTRODUCTION

The First Night or “honeymoon night” of marriage traditionally means the First Sexual encounter for an Indian couple. It is the moment when society legally permits the consummation of the union of man with women. The First night is the most awaited night In one’s Life.

Unfortunately, as sexologists, we come across a large number of clients failing on their night. The ‘First Night Failure’ often results in sexual dysfunctions, social maladjustments, marital disharmony and even divorce.

WHY FAILURE?

The first night has been given special importance from ancient days. Our Sanskrit Literature gives detailed descriptions and exotic fantasies woven around the first night. In the Kumar Sambhava, Kalidasa takes liberty in describing the love dalliance of the newly wedded Shiv and Uma.

Our cinema has glorified the first night. The entry of the Bridegroom in the decorated bedroom, flower bedecked beds, the bride, veil, glass of milk, sweets and the magic moment begins!!        Today, a large number of novels in vernacular languages are available under erotic titles glamourising the sexual raptures of the First Night. So the first night become the most special night of a young couple’s life i.e the ‘Golden Night’.                                                                             

   In our culture, till today in many parts of India, adolescent boys and girls are not allowed to interact with each other socially (except in some tribal societies) once the girls attains puberty. Marriages are Fixing by elders. There is hardly any change of courting. The first night in reality becomes the ‘First Encounter’ to know each other.                                                                       

    Some young individuals are scared to death about their performance on the first night. their fear is doubled by misguiding friends, yellow books, white self-advertised pamphlets by quacks and blue films. They have a feeling of sexual inadequacy, ’Kamjori’ or believe that they have become impotent and life has come to an end.

One of the most worrying question on a man’s mind whether on the ‘First Night’ he will succeed in breaking the ‘virginal seal’ with bang, as this is supposed to make a successful marriage. Because of this Fear, many eligible bachelors avoid marriage.                                   Sometime they end up buying so called sex tonic advertised in lay press or even rejuvenators even prescribed by consultants. To avoid ‘first night’ Failures some of them even visit prostitutes to test their potency!!                                                                                                          

      A women enter into the first night with anxiety, tension, fear and a variety of other emotions. The greatest worry on the mind of the bride is how she will fare in the ‘virginity test’.

Virginity is considered a virtue. It is a sign of purity. In some societies, the couple is expected to show the bed cover stained with blood after first night as proof of Virginity!

Thus, the bedroom, instead of being the foundation for developing tenderness, care, warmth, affection, life long love, pleasure bond, trust, intimacy and relationship, turns into a laboratory for testing potency and virginity.

The west got the honeymoon problem i.e. first night failures. One dose not even find a mention of first night failure in any standard text book of sexual medicine or in Diagnostic and Statistical manual(DSM-IV)

WESTERN VIEWS

Dr Wadell B pomeroy,Co-author of the Kinsey’s report, describes premarital intercourse as a training ground for marriage. Lessons learnt without feeling of guilt and fear and the knowledge of good techniques, go a long way in developing relationship. Urge to have intercourse is like any other urges,e.g. playing tennis, swimming or dancing, riding a horse or doing anything which gives pleasure. Premarital intercourse, unlike masturbation, is a means of interaction with another human being and consequently is a means of learning how to live with people. Sometime, it is learnt too late after marriage that they are not suited to each other sexually.

PREVALENCE

The ‘first night’ performance as still an important event in one’s life. Failure can lead to disaster!

It is difficult to statistically because of want of actual reporting and documentation. One can say 20% to 30% of couples who seek sex therapy have failure on their first night or at the time of first sexual contact.

AETIOLOGY

The sexual behavior in human being is the outcome of learning and conditioning Sex being considered a taboo, there is hardly any apportunity for learning. Therefore, ignorance, myths and misconceptions about sex prevail.                                                                                                   The most common etiology factor for first night failure in marriage is ignorance about male and female anatomy and facts of sex act. Some couples have unrealistic expectations of sex act.

Other cause of first night failure is tight foreskin in male, tough hymen in female and dyspareunia, etc 

FIRST NIGHT BLUES

 1 Psychological

Inadequate sexual information

Restrictive upbringing

 A.sex is dirty

B.women who enjoy sex are disreputable

Guilt

Sexual myths

Fear of pain, failure, not satisfying partner

Fear of STD/HIV/AIDS

2 Organic

Dysfunction in the partner e.g.vaginismus

Tight foreskin

If failure occurs on the first attempt, the first thing comes in mind ‘Am I impotent?’ The more he tries. The more he fails. He feels something is terribly wrong with him. He feels that due to his past Habit of masturbation, he has lost his vitality, vigour and potency.He stops furtur sexual advances. It starts a vicious cycle of performance anxiety and ‘spectatorating’ and failure.

CONSEQUENCES

-          They may avoid sexual activity.

-          They may continue to have only foreplay.

-          They may have good relationship in other aspects of life.

-          Some may suffer from anxiety/depression.

-          Impotency

-          They may make allegations at each other leading to marital conflicts,[i] separation or divorce

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Squeeze Technique In Premature Ejaculation

BASILAR SQUEEZE

The standard squeeze involved pressing the penis near the glans which means interruption during penetrative sex.

Masters and Johnson devised a modified version of the squeeze to overcome this problem. They called it the basilar squeeze. This involves the pressing of this penis at the point where it joins the scrotum. It can be squeeze at the correct movement.

The squeeze is to be maintained for 4-8 second similar to the earlier method .they admits that it should not be used as an alternative to the standard method. As it is not as effective.

Important Considerations for this therapy;

1. Time and repeated practice is essential to achieve ejaculatory control.

2. ‘Refresher Course’ is required if gains made earlier are lost due to lack of time.

3. Do not expect total control each time. Some failures are bound to occur.

4. Change of position i.e. woman -0n- top to side-by side to man-on-top is to be done slowly over a longer period of time and failures are to be expected in the initial stages.

One of the major problems faced before entering into this therapy is that ‘other issues have to be resolved. They are: dislike for each other, anger, alcohol, tobacco, or drug abuse, infidelity, distrust, mental or physical torture, economic strain, etc. Medical conditions also have to be diagnosed and treated properly. In India, motivating the man to come and openly discuss these issues with his partner is very difficult.

II PHARMACOLOGICAL

The first choice as mentioned before is behavioral but pharmacotherapy can be concurrently used for better results.

1. ANAESTHETIC AGENTS

Excessive sensitivity of the penis especially the glans has been thought to be one of the causes of premature ejaculation. Local anesthetics have been used with the intention of reducing sensory input from the penis thereby delaying ejaculation.

RETARDED EJACULATION

Retarded ejaculation is defined as the man being able to ejaculate only after what seems to him to be an ‘excessive’ period of time. It is usually reported when the man requires ½ an hour or more of vigorous coital thrusting. It is interesting to note that most of these men do not seem to have any difficulties with erection but sometimes seems to hold them back and they are unable to trigger the ejaculatory reflex at the proper time.

This is a very common symptom in men who are regular abusers of recreational drugs or alcohol. The usual story from the couple is that the woman becomes weary and uninterested ones she has had her orgasm and the man becomes tried, exhausted and fatigue which is frustrating for the couple.

TREATMENT

A three steps process is useful in treating delayed ejaculation.

-Teaching masturbating to the point of ejaculation as a solo activity.

-Masturbation to the point of ejaculation with a partner.

-Finally, coital connection with ejaculation to be established.

This is easier said than done and the following aspects have to be considered.

-Allay fears, anxieties and myths about masturbating in both partners.

-Liberal use of lubricating jelly during masturbation.

-Mechanical means of stimulation with vibrators is useful stimulation which should initially be used for short periods.

-Encouragement of the partner to stimulate the penis with sufficient force and speed as many men use vigorous stimulation which the female may not understand.

-Use of fantasy to evoke psychological stimulus as many men ‘use’ only mechanical arousal methods.

-Those who cannot fantasies, could be advised to use erotic videos.

-Drugs like midodrine may help.