Techniques to Prolong Ejaculation Time

Premature ejaculation (PE) is the most common sexual dysfunction that negatively affects men's sexual life. Although there are medical (drug) and surgical options in treatment, **behavioral therapies** always form the basis and the first step of PE treatment. Behavioral therapies focus on the person learning to control their sexual arousal level and ejaculation reflex.

These therapies are usually applied under the guidance of a sexual therapist or urology specialist and carry the potential to offer long-term solutions without the need for medication or surgery. Two well-known and scientifically proven techniques are the **"Stop-Start"** and **"Squeeze"** techniques.

So, exactly how are these techniques applied? How does the process of learning ejaculation control work, and what is the role of the partner in these therapies? In this article, we will discuss in detail the behavioral therapy methods, application steps, and success rates, which are the cornerstones of premature ejaculation treatment.

Main Goal of Behavioral Therapies

The main goal of behavioral therapies is for the man to learn to recognize the intense arousal threshold (the feeling of inevitable ejaculation) felt just before the ejaculation process and to manage this threshold consciously.

1. Developing Awareness: The aim is for the person to perceive their sexual arousal levels as *first, second*, and *third* gears and to take control before reaching the third gear (the point of inevitable ejaculation).
2. Reconditioning: By teaching to take control of the ejaculation reflex, it is to reprogram the automatic response given by the penis to excessive sensitivity.

These techniques are usually applied with partner involvement because the partner's support and patience play a critical role in the success of the treatment process.

Stop-Start Technique (Semans Technique)

Developed by psychotherapist James Semans, this technique helps the person recognize and control their arousal level.

Application Steps:

1. Starting Stimulation: Sexual activity (masturbation or stimulation by partner manually/orally) is started.
2. Stopping Point: The moment the person realizes that the feeling of ejaculation is becoming inevitable (third gear), sexual stimulation is completely **stopped**.
3. Waiting: Wait for 30 seconds to 1 minute until the arousal level drops to a controllable point (first gear). During this time, the feeling of arousal will decrease.
4. Restarting: Once control is achieved, stimulation is started again.
5. Repeating: This cycle is repeated three or four times, including during sexual intercourse, until the desired ejaculation occurs.

This technique gives the man the ability to recognize pre-ejaculation feelings and suppress these feelings.

Squeeze Technique (Masters and Johnson Technique)

Developed by Masters and Johnson, this technique aims to prevent the ejaculation reflex with a physical intervention to the penis when the feeling of ejaculation reaches the most intense level.

Application Steps:

1. Starting Stimulation: As in the Stop-Start technique, sexual activity is started.
2. Intervention Point: Stimulation is stopped the moment the feeling that ejaculation is inevitable (third gear) comes.
3. Squeezing: The partner or the person themselves **squeezes firmly** the soft area just below the head of the penis (glans) (just below the frenulum) with the thumb on top and the other two fingers below, maintaining this pressure for 3-4 seconds.
4. Relaxing: When the squeezing process is finished, the arousal level should have significantly decreased.
5. Repeating: Until ejaculation is under control, this cycle is repeated three or four times until the desired ejaculation occurs.

The squeeze technique helps the man increase his sense of control by mechanically interrupting the ejaculation reflex.

Role of the Partner in the Treatment Process

The partner's understanding, patience, and active participation are vital for the success of behavioral therapies.

• Supportive Role: The partner should not judge the man, should be patient, and express developments in the process with supportive language.
• Communication: The couple should establish open and honest communication about arousal levels and stop/start moments.
• Change of Focus: In the early stages of therapy, the couple's focus should shift from delaying ejaculation to sexual pleasure and intimacy. "Sensate Focus Exercises" can also be included in the process under therapist guidance.

Advantages and Disadvantages of Behavioral Therapies

Common Misconceptions

Common misconceptions about behavioral therapies:

• False: Behavioral therapies only work for psychological PE.
  • True: Even in organic PE, it can be used as support for drug treatments and increases general control as it provides the skill to manage the ejaculation threshold.
• False: I can learn these techniques on my own, no need for a therapist.
  • True: A therapist ensures the technique is applied correctly, monitors your progress, and helps you overcome psychological barriers such as anxiety and loss of self-confidence in the process.
• False: The squeeze technique damages the penis.
  • True: When applied with the correct technique and sufficient firmness, it does not cause permanent damage to the penile tissue or erection. The aim is the instantaneous interruption of the reflex.

Conclusion / Summary

Behavioral therapies in the treatment of premature ejaculation are a fundamental and effective method where the person learns to control their own body and arousal level. Especially the **Stop-Start** and **Squeeze** techniques help the person prolong sexual activity time by raising the ejaculation threshold.