Fellowship in Sexology WNHO, Pune India WhatsApp 9822006427. 1. Squeeze technique – this is a modification of the stop-start process. Instead of letting go of the penis at the feeling of ejaculation, the female partner holds the penis between the index and middle fingers. The thumb is placed on the frenulum, and the two fingers are placed on the frenulum and the two fingers on the opposite side of the coronal ridge. The female partner squeezes the thumb and fingers for 4 seconds. The pressure makes the man lose his erections. After about 30 seconds, the again manipulates the man to full erection and repeats the squeeze technique. After doing this 2-3 times, the male adopts the women above position and inserts the penis into the vagina. The no motion technique and later the two and four motion technique are adopted as described above. Retarded or absent ejaculation: It is less common and has several possible organic causes. However, it may be caused entirely by psychological or emotional factors that are amenable to behavior therapy psychotherapy. Retrograde ejaculation: is due to bladder neck incompetence. It invariably occurs after transurethral resection of the prostate and may appear in diabetic autonomic neuropathy or para-aortic lymphadenectomy. Delayed ejaculation: or failed emission due to spinal trauma and surgical procedures such as radical prostatectomy, proctocolectomy, or para-aortic lymphadenopathy. Inhibited ejaculation is the psychological variant of delayed ejaculation. Ejaculation usually occurs rapidly with solitary masturbation but not during intercourse. Many psychological factors may be responsible, including fear of pregnancy, guilt, and depressed or repressed hostility towards the partner. Painful ejaculation: can be caused by acute genitourinary infection, particularly acute prostatitis or seminal vasculitis. It may also have a psychogenic basis. Infection can treat with antibiotics, NSAIDs, prostatic pain. 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 pressing this penis at the point where it joins the scrotum. It can be squeezed at the correct movement. The squeeze is to be maintained for 4-8 seconds; similar to the earlier method, they admit that it should not be used as an alternative to the standard way. As it is not as effective. Important Considerations for this therapy; 1. Time and repeated practice are 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 longer, and failures are expected in the initial stages. One of the significant problems faced before entering this therapy is that ‘other issues must 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 correctly. In India, motivating the man to come and openly discuss these issues with his partner is very difficult. PHARMACOLOGICAL The first choice, as mentioned before, is behavioural, but pharmacotherapy can be concurrently used for better results. 1. ANAESTHETICAGENTS 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's ability to ejaculate only after what seems to him to be an ‘excessive’ time. It is usually reported when the man requires ½ an hour or more of vigorous coital thrusting. Interestingly, most of these men do not seem to have any difficulties with an erection but sometimes seem to hold them back. 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 familiar story from the couple is that the woman becomes weary and uninterested once she has had her orgasm, and the man becomes tired and exhausted, fatigue which is frustrating for the couple. The Treatment three steps process helps treat delayed ejaculation. -Teaching masturbating to the point of ejaculation as a solo activity. -Masturbation to the point of ejaculation with a partner. -Finally, a coital connection with ejaculation is to be established. This is easier said than done, and the following aspects must 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 that should initially be used for short periods. Encourage the partner to stimulate the penis with sufficient force and speed, as many men use vigorous stimulation that the female may not understand. Use fantasy to evoke psychological stimulus as many men ‘use’ only mechanical arousal methods. -Those who cannot fantasies could be advised to use erotic videos.