“If only it would last”

I hear it from men, and I especially hear it from their disappointed partners.  “If only it would last.”

Premature ejaculation (PE) is very, very common. About a third of all men (and their partners, sadly) are plagued by this problem.

The good news is that for most men PE is fixable. It may take some work, but with some effort most can overcome it.

In a moment, I’ll outline some exercises that can help you or your partner.

But in a world of quick pharmaceutical fixes — Viagra, Levitra and Cialis come to mind for men who suffer from erectile dysfunction — there are now medications being developed that will fix most PE. Some men are already using SSRIs, which are principally prescribed as antidepressants, to very effectively slow things down. In the UK there are tests underway of a “new” drug that contains the active ingredient tramadol hydrochloride which has been used for pain relief since the 1970s but has now been redesigned for treatment of PE. Those tests look promising and I’m betting we’ll see it available commercially in Britain and elsewhere soon.

There is now also a brand new topical anesthetic spray, Promescent, which is approved by the FDA. It contains Lidocaine. It works by decreasing penile sensitivity — but doesn’t inhibit the engorgement of the spongy tissue that makes the penis erect — and so prolongs sexual activity and delays ejaculation.  Desensitization may not sound like a good thing but if it helps with staying power many couples are willing to give it a try. This is an over the counter product–no prescription required.

Also, a new medical procedure for PE is in the works, developed by Dr. David Prologo (yes, his name really is Prolong-o) at University Hospitals Case Medical Center in Cleveland.  Recent research has found that many patients with premature ejaculation have a higher than average number of dorsal penile nerve (PDN) branches, accounting for their sensitivity and therefore their getting off too fast.  What Prologo discovered is that by freezing the DPN it can effectively dull the brain’s response to sexual stimulation, giving the patient a longer time before ejaculating without causing erection problems.  He has performed four surgeries to date, three with 100 percent satisfaction and the fourth showing  some significant improvement.

The old ‘tried and true’ treatments for ED come in the form of exercises. There are two types.

I like for guys who have partners to work with both, unless they do not ordinarily masturbate.  In that case, just work with the Squeeze Method.

The Squeeze Method (with a partner, or solo)

[1] This is best done by a couple, but the man can do it alone by masturbation if there is no partner or the partner is not willing to participate.
[2] The couple starts by being as relaxed as they can, and free from distractions.
[3] The couple kiss and caress until the man is aroused, and then the partner takes his penis in hand and begins stroking it.
[4] The man concentrates on his feelings of arousal, to increase his sexual awareness. (He does not try to think of other things in an attempt to distract himself from ejaculation).
[5] When he feels he is about to ejaculate, he signals to his partner.
[6] The partner immediately stops stimulating him and applies firm but gentle pressure around the penis where the glans (head) meets the shaft. The partner keeps applying the pressure for 10-20 seconds.
[7] The partner then lets go, and they wait without doing anything for about 30 seconds.
[8] The procedure is repeated several times before ejaculation is allowed to occur.

The Stop-Start Technique (solo)

[1] The man sets time aside to be private and to masturbate with dry hands.
[2] He slowly strokes almost to the point of ejaculation and then stops before the point where ejaculation is inevitable.
[3] He should do this three times.
[4] On the fourth time, he is permitted to ejaculate.
Learning to be aware of where the ‘point of no return’ is may take some effort. It takes time to build control.  That’s where practice comes in.

Once a man has achieved the measure of control needed to make it through the above four steps successfully it’s time to go through the same process but with a wet hand using lubricant to make the feel slicker and more like ‘the real thing.’

Six likely reasons you’re alone

From day to day I see all sorts of people about a broad range of sex and relationship issues.  I do therapy.  In my practice, because of my eclectic background and training, this includes a wide range of “interventions.”

One thing I generally don’t do is “give advice.” People’s real issues are rarely so simple and easy to answer. But people want them to be simple, so they still ask.

One of the most common questions I get from women is, “Why can’t I seem to find (or find and keep) that special someone?”  The question is usually followed by some words of self-explanation, a common-sense rationalization to explain “why I am alone.”

We humans seem by nature to be compelled to figure things out. We want to understand why things are the way they are and why they aren’t the way we wish they were or hope they might be. It’s hard for us to not have an answer.

I recently read a refreshingly frank and perceptive article by Tracy McMillan. She’s a TV writer, not a therapist.  Taking on the topic “Why You’re Not Married” she has come up with six likely reasons: 1) You’re a bitch; 2) You’re shallow; 3) You’re a slut; 4) You’re a liar; 5) You’re selfish; and/or 6) You’re not good enough.

McMillan is no misogynist and what she has to say is no self-help column drivel.  She has looked squarely at her own life and observed the lives of women around her. What she means by each of her six reasons is likely not what you think.  Her explanations are, I believe, more perceptive than not.  Perhaps more importantly, they are always thought-provoking.

McMillan’s real purpose seems to be to get women to think in a new, more deeply honest way.  She wants to shake off the easy answers, those rationalizations that make it more or less okay to not be okay with being single.

Treat yourself to a good read. I’d love to hear your feedback. You can post it here for all to read, or send it to me privately and in confidence at drdavidroth@gmail.com .

Here’s Tracy McMillan’s “Why You’re Not Married.”

“If only I had a hot lover”

“If only I had a hot lover,” she said to me.

If only everyone had a hot lover, I thought.  But that wouldn’t solve this woman’s problem, or most people’s problems.  It sounded good though.

When people come to me they nearly always identify a “problem” that is rarely the real problem. Most often it’s a symptom of a problem they themselves cannot see. Very often it’s one that is part of what I refer to as ‘core material.’ Core material is not just stuff that’s in our heads. It’s psychological, emotional, spiritual, physical, interpersonal, social. It is tied to our very identity, which is why it’s too risky to look at directly.  Sometimes it is entirely inaccessible to us, and for good reason. It would be too painful or hard to make sense of to face head on. Sometimes, we’re deeply invested in not knowing what’s really going on there.

And so without intentionally doing so we fashion for ourselves rationalizations, and rationalizations about our rationalizations, to make sense of things that are messy, contradictory or simply beyond our ken.  That’s why we come up with solutions such as, “If only I had a hot lover.” It gives us imaginary control over the otherwise uncontrollable.

This young woman wanted to see me because, as she put it, even though she met and dated men she was attracted to, she lacked a desire for sex and when she had it she felt unsatisfied.  Especially if one has had clumsy, incompetent, selfish or boring  lovers, seeking and finding a “hot” one makes a very defensible commonsense solution.  And, depending on the person, it might even offer some hope for better sex and more fulfilling intimacy.

But in my experience it is rarely the answer.

On being alone, and (not) finding someone

Every so often someone will come to me and say I just want to find someone, someone who is right for me.  Or they’ll ask me quite directly So where is Mr./Ms. Right?

This is a particularly vexing problem and a very common one. Like most things commonplace, we don’t usually ask ourselves how it got to be this way. It just is. We may have our own theories based on our own life choices and individual circumstances.  But the truth is that the epidemic of being alone is a very contemporary phenomenon.

I’ve heard every rationalization out there. They’re usually focused on the first person singular. I spent so many years focused on school and career…. It’s just so hard for me to meet people…. Everyone else my age seems to have scooped up the good ones…. I never meet people who want me for ME. They’re just after my…. I’m not going to settle for someone who isn’t…. If I could only get myself to do such-and-such, the right person would be attracted to me. The list goes on and on.

While there may be some truth in these assertions, it’s fair to say that we live in a society and a time where insulating ourselves from vulnerability is not only possible for us as individuals but a given. Isolation is more common than not. Many of us, especially in North America and particularly in the US, have grown up encouraged to make our own way. It’s embedded in the mythology of the American pioneering spirit. I use the term ‘mythology’ precisely because appealing as it may be it defies the historic truth.

The vast majority of pioneers in America and elsewhere have been collaborators, not solitary individuals. Few have ever chosen a new path and fewer still have gone it alone.

As a culture, we have institutionalized the Self Alone. The quintessential American value of independence is as foolish and self-destructive as jumping off a cliff to catch the wind and soar: it sounds wonderful and it’s tempting but ultimately leads to a deadly, solitary splat.

We are by nature fundamentally interdependent, not independent. Self(ish)ness under the guise of freedom may have some short-term benefits – feel the excitement, the exhilaration, the invigorating breeze – but ultimately they prove insufficient. When the truth sets in, it’s nothing nice.

Every culture has its myths. Most prove helpful, some are destructive. Fortunately, cultures change and adapt. If a society is to survive, let alone thrive, its myths change and adapt or simply fade or are relegated to the status of quaint artifacts.  Our society, our “world,” imagines itself a certain way. It is in part an illusion where the Self “freely” makes (or believes it makes) choices – until a powerful reality sets in. I am alone. Damn, I’m alone. I don’t want to be alone. I want to be with someone who gets me, and appreciates me, and cares about me, and… loves me.  I want someone who will stay with me, for more than just tonight  / this year / until the kids are out of the house / until I run out of surgical options to maintain the illusion of eternal youth.

This is not an indictment of anyone; it’s simply the acknowledgment of fact. We mostly just go about our lives without thinking much about it. We buy into what those around us believe and do. That means many of us feel and are very alone. Our freedom of solitude becomes a prison of loneliness with rationalizations about how we got in with no way out.

Few of us spend our lives questioning the given. When we do, we tend to question in a way that is comfortable for us so that we can feel we are at least somewhat in control of our lives. Even those who pride themselves on being open-minded are usually only open-minded to possibilities that intuitively, naturally attract them.  We have limits to what we’ll question, where we’ll go, what we’ll even begin to consider for our lives.

There is ancient wisdom in the biblical assertion attributed to God: It is not good for a person to be alone. But in a Self Alone world how is Ms./Mr. Right to be found?  And is it a matter of finding—or is this a false assumption we readily make?

How is one to become and stay and be happy un-alone?

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