Dr. Sandra Pertot,
Adapted from "When Your Sex Drives Don’t Match: Discover Your Libido Types to Create a Mutually Satisfying Sex Life". Marlowe & Co, 2007
One of the problems that arises from the failure to recognize the extent of individual variation in human sexuality is that a one-size-fits-all approach is adopted when someone complains of a particular problem. Unfortunately this means that the both the goals and the interventions suggested are not appropriate for quite a lot of people who consult sex therapists/
Consider the following examples: John, Tom, Alan, Richard, David, and Russell all described their sexual problem as premature ejaculation and wanted to know how to last longer. Although all of these men described their problem in the same way initially, it became clear as the assessment progressed that what was actually happening in their sex lives, and what they and their partners thought and felt about this, was quite different. This meant that the strategies to help each couple achieve greater sexual satisfaction also varied significantly:
· John was 23, had been in his first relationship for 2 years and had only had intercourse 3 times because he ejaculated prior to penetration on all other attempts. John had always ejaculated quickly, even with masturbation. Given the level of distress he felt about his continuing inability to last long enough to penetrate and the fact that in his case any behavioral program was unlikely to achieve any early benefit, the most effective and reliable treatment for him was the use of a medication that delays ejaculation. This enabled him to reliably achieve intercourse, thus decreasing his anxiety, and the couple was then able to explore other ways to improve their sexual enjoyment.
· Tom was in his mid-twenties, had previously had successful intercourse but with his current partner he often ejaculated immediately after penetration. Tom’s current partner loved giving him prolonged oral stimulation prior to intercourse which meant that he was very close to ejaculation by the time they proceeded to intercourse. On those occasions that the couple wanted him to last longer, she simply had to avoid giving this intense stimulation to the penis.
· Alan, 32, was married for 7 years and had always ejaculated 1-2 minutes after penetration. His wife Jill was upset that Alan came after a few thrusts because she was left unsatisfied, and this couple agreed to work together on a behavioral program to help him delay ejaculation, but at the same time they were also going to focus on alternatives to intercourse to help Jill achieve orgasm.
· Richard, 35, also had a long history of ejaculation within a couple of minutes of thrusting. His wife Kirsty could only reach orgasm during foreplay and she had tried to reassure him that she was happy with his performance, but he thought she was just being kind. With counseling he decided to accept how he was and to focus on his own pleasure during intercourse so that he enjoyed his orgasm when it happened.
· David, 28, was usually able to delay ejaculation for 5 minutes or more. His wife Amanda was quite critical of his performance because she needed prolonged thrusting to come to orgasm. The discussion in counseling revolved around the fact that his time to ejaculation was well within the normal range, and while David could certainly try the various options to help him last longer as Amanda expected, equally it was her responsibility to make an effort to come more quickly. This offered a new perspective to the couple that it is the responsibility of both partners to work through the barriers to sexual enjoyment on an equal but different basis.
· Russell, 37, could always consciously control his ejaculation to last for at least 10 minutes, but he felt inadequate because he believed that a good lover should be able to last for 15 or 20 minutes or even longer, and sometimes he was able to achieve this. His partner Diane said that this was usually not enjoyable for her and was sometimes even painful because if she did have orgasm with intercourse it usually only took her a few minutes. Unfortunately she had thought that there was something wrong with her because she felt this way, and so she had not told Russell how she felt. In this case both partners were happy to accept that their current sex life was good enough as it was.
An essential feature of this approach is to make a distinction between judgment and description in the initial explanation of the problem. For example, Amanda explained their sexual problem in judgmental terms when she criticized David for being selfish and not trying hard enough to last longer (even though he was able to delay ejaculation for several minutes) because she needed prolonged thrusting to come to orgasm. In this way she was taking the high moral ground, making David the problem and denying any role she might be playing, where in fact her attitude was part of the problem because it increased David’s sense of inadequacy and also avoided examining what she might do to improve the situation. A non-judgmental description of their problem is "I would like David to last longer."
© Sandra Pertot