Until the past couple of decades, it was believed that rapid ejaculation was simply due to a learned inability to stop orgasm. This led to treatments geared to reteach control of the process.
Behavioral modification sounds complex, but may really be as simple as “doing something different.” Many men will attempt to distract themselves from the overwhelming stimulation of the moment. This may involve performing mental mathematical calculations, or thinking unpleasant thoughts. Humorist Dave Barry recommends thinking of a female he feels could overwhelm any stimulation.8 Although he names his own, most men can think of something else to distract them. This approach is less than ideal. Sex is supposed to be a pleasurable experience, so if all the thoughts involved are so negative, enjoyment is sure to suffer.

Attempts at decreasing sensation are another common ploy. Layering several condoms one atop another makes sense, but rarely makes a difference. Masturbation before intercourse makes more sense because of the refractory period (as described previously), but risks thereafter making it too difficult to achieve an erection. If this occurs, performance anxiety may simply add to the problem.

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The most common behavioral recommendation is the stop-start technique. This is just like it sounds. The patient and partner are instructed to start intercourse but stop all movement or other stimulating behavior when he feels orgasm is imminent. The technique obviously requires the man be motivated to stop the orgasm at the right moment, which sometimes takes more willpower than can be gathered in the heat of the moment. It also requires a patient and supportive partner. Each time the man feels that orgasm is approaching, everyone stops moving to allow the feeling to pass. With practice, he may learn to recognize the sensation and how to suppress it. Sometimes the partner can end up feeling “used” as if in a clinical experiment, so good communication is crucial.

The squeeze technique takes advantage of the nervous system’s tendency to shut down sensation when overwhelmed. When the man recognizes impending orgasm, he is supposed to withdraw the penis from the vagina and squeeze the glans tightly. This overwhelms the sensations leading to orgasm and delays ejaculation if successful. The biggest problem with this technique is the withdrawal itself. This final stimulation of the penis pulling out of the vagina is often enough to push orgasm beyond inevitability. If so, this ends up being essentially the same act as the withdrawal technique of birth control and can lead to further frustration, as the man ejaculates outside the vagina to the frustration of both parties.

Quiet vagina is essentially a version of the stop-start technique for men who are prone to orgasm immediately upon penetration. The woman gently inserts the penis into the vagina, then sits astride the man without movement or thrusting. This is designed to desensitize him to the stimulating sensations of the vagina. Once mastered, the couple is slowly advanced to the stop-start technique.

In the past decade, a neurobiological explanation has replaced other theories on the cause of rapid ejaculation. It is now believed that, for most men, there is a physical reason they have difficulty delaying ejaculation. Instead of just being “in the head” or due to a learned inability to control orgasm, most men probably have an innate neurobiological reason making them more prone to early release.

Orgasm is essentially a neuropsychological event leading to the release of semen. The same event happens in women without emission, obviously, and few women complain of having orgasms too rapidly. The difference seems to be that men detumesce (lose the erection) soon after orgasm, whereas women can continue to have intercourse and may have further orgasms. Life is not fair. If the man could continue to have intercourse after orgasm, it is unlikely there would be any complaint from either partner.

Orgasm occurs when stimulation reaches a point of inevitability. Emission releases semen into the prostate and posterior urethra, yielding the sensation that notifies the man that an orgasm will follow within seconds. Not recognizing this approaching inevitability appears to be part of the problem with rapid ejaculation.

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