-IBIS-1.5.0-
tx
reproductive system
premature ejaculation
psychospiritual approaches

metaphors and correlations

• "Who wants to leave?" (Mindell)
• Lack of voluntary control over the ejaculatory reflex is related to male conditioning of the sexual response. Most males learn about their sexual responses through masturbation, and usually develop a pattern of stimulating themselves relatively rapidly and reaching orgasm in a hurry, with some measure of guilt and little accurate sex information. For the majority of men, this rapid response becomes habituated. Because of the intense arousal typical of their first shared experiences, most males ejaculate quickly in their initial instances of coitus. The end result of this conditioning is a linear response to their own sexual responsiveness. Men progress from the absence of arousal, through the stages of sexual excitement, and directly to orgasm, with little hesitation or modulation along the way. They may feel disappointed and frustrated by their lack of control, but since they are still experiencing the pleasure or orgasm, they may not be urgently motivated to seek help with the condition. Often it is continuing problems with lack of ejaculatory control in a sexual partnership that leads to relationship conflicts and desire for change, or further anxiety. (Kelly, p. 372)
• "Societally imposed standards of sexual performance reach almost mythological proportions for some people. They become convinced that all normal men get rock-hard erections on demand and have sexual intercourse for hours in every imaginable position without reaching orgasm, while their female partners writhe about in the throes of one orgasm after another". (Kelly, p. 375)
Performance pressure is often rooted in an excessive need to please a partner. It is not unusual for a heterosexual man to assume that he is responsible for bringing pleasure to a woman. One may also have a nagging insecurity generating continual worry that one's partner may become sexually bored or interested in someone else. All sources of anxiety are likely to interfere with sexual responsiveness at some level. These real or imagined pressures may result in fear of failure, which in turn leads to anxiety that interferes with some phase of sexual response, which ultimately produces sexual dysfunction, thus creating a cycle of continuing dysfunction reinforced by fear of failure. (Kelly, p. 376)
Communication: Many dysfunctions are rooted in relationship problems. Communication difficulties may be relatively uncomplicated at first, such as failure to let partner know which types of stimulation are particularly enjoyable and which might be better avoided. Loving relationships have complex dynamics, and both the joys and discord of relationship usually get played out in the sexual arena. If power struggles, trust issues, or a pattern of rejection has emerged, the possibilities of sexual dysfunction are enormous. Subtle games of sexual sabotage designed to tease, frustrate, anger, and turn off one's partner, will mask some of the deeper relational problems in couples. Effective therapeutic outcome may depend on untangling of a complex web of physical, psychological (childhood learning, unconscious intrapsychic factors, etc.), and relationship causes. (Kelly, p. 377)

Chinese psychophysiology:
Kidney ~ Shen stores Jing (Essence) and governs birth, growth, reproduction, development, and aging; houses the Zhi (Will); expresses ambition and focus; provides the "Fire of Life" through its Yang functions; provides the nourishing and stabilizing qualities of Yin and Water that balance the Yang and the Fiery qualities; nourishes the brain to sustain concentration, clear thinking, and memory; facilitates inspiration by grasping and pulling down the Qi; carries the constitutional endowment from the parents; manifests through the reproductive function, particularly the internal aspects of the reproductive organs, and governs the process of passing on life to offspring; and displays the effects of sexual dissipation (especially excessive ejaculation), overwork, aging, chronic debilitation, and extreme stress.
»
Healthy expressions are gentleness, groundedness, and endurance.
» Kidney Xu (Deficiency) signs include indecisiveness; confused speech; dreams of trees submerged under water; cold feet and legs; abundant sweating (Seem, p. 28); fearfulness; apathy; chronic fatigue; discouragement; scatteredness; lack of will; negativity; impatience; difficult inhalation; low sex drive; lumbago; sciatica; and musculoskeletal irritation and inflammation, especially when worse from touch.
» Intense or prolonged fear depletes the Kidney. Often chronic anxiety may induce Xu (Deficiency) and then Fire within the Kidney. (Maciocia, p. 250) Overwork, sexual dissipation, parenting, simple aging, and a sedentary or excessively indulgent lifestyle all contribute significantly to Kidney Xu (Deficiency).

Liver ~ Gan is the home of the Hun (Ethereal Soul); it relates to decisiveness, control, and the principle of emergence; stores and cleanses the Xue (Blood); maintains smooth flow of Qi and Xue (Blood); has an intimate relationship with the genitals and Lower Warmer; and reflects emotional harmony and movement.
»
Healthy expressions are kindness, spontaneity, and ease of movement.
» Liver Xu (Deficiency) signs include impotence; pain in thighs, pelvic region, and throat; ready tendency to "the blahs" (Seem, p. 28); timidity; depression; irritability; vertigo; pruritus; dry eyes, skin, and/or tendons; asthma; aching at the waist; hernia; and difficulty raising head up and down.

Heart ~ Xin houses the Shen (Spirit) and reveals itself through the brightness in the eyes; governs Fire and Heat; rules the Xue (Blood) and its vessels and directs the circulation; opens into the tongue and controls speech; and relates to the integration of the organs and the personality.
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Healthy expressions are warmth, vitality, excitement, inner peace, love, and joy.
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Heart Xu (Deficiency) signs include sadness; absence of laughter; depression; fear; anxiety; shortness of breath (Seem, p. 28); cold feeling in the chest and limbs; palpitations; cold sweat; inability to speak; memory failure; nocturnal emissions; and restless sleep.
» The Heart is the Emperor of the bodily realm so that when the Heart is disturbed all the other organs will be disrupted.


therapies

behavior modification:
stop-start method: Emphasis is on helping the man to become aware of the inner subjective sensations that signal when his ejaculation is imminent. Men have pelvic sensations just prior to ejaculation that need to be identified, so that they may take some action to prevent orgasm before they pass the 'point of no return.' Using this technique, the man stops any stimulation when he feels the sensation of imminent orgasm. The sensations completely disappear quite rapidly, and stimulation may then be resumed. Most sex therapists recommend that the partner use slow manual stimulation on the man's penis at first. The man gives a prearranged signal to halt the stimulation when he feels orgasm approaching. Some therapists recommend that the partner add the squeeze technique at this point, giving a firm squeeze to the head of the penis with the thumb and forefingers for 3-4 seconds. This further diminishes the sensation of imminent orgasm. Over a period of time the man learns better control over his ejaculatory reflex and feels increased confidence in his sexual abilities. These behavioral exercises lead to the development of sexual patterns in which the man knows how to slow down and modulate his stimulation so that he takes longer to reach orgasm. He then gradually integrates his control into sexual relations with his partner. (Kelly, p. 386)
integration of squeeze technique (Masters and Johnson): Long periods of sex play without male orgasm are developed using the squeeze technique. The man will lose his urge to ejaculate and usually also looses 10-30% of his full erection. After 15-30 seconds, the woman again stimulates the penis to full erection and applies the squeeze technique. After two or three days of this practice, the man will develop sufficient control to permit progression to nondemanding intercourse. The man lies on his back and the woman kneels astride his body, facing him in the female-above position. After bringing the man to full erection and employing the squeeze technique two or three times, she inserts the penis into her vagina and remains motionless in order to provide no further stimulation. When the man's level of excitement threatens to escape his still shaky control, he is to communicate this to the woman, so that she can rise from the penis and again apply the squeeze technique. In subsequent days the man can provide just enough pelvic thrusting to maintain his erection, but not enough to bring about orgasm. In the final phase the couple can move to the lateral coital position (side by side) in which there is maximal opportunity for male orgasmic control. (DeLora, p. 475)
systematic desensitization: Person gradually unlearns the tension producing behaviors that are causing problems. (Kelly, p. 380)

hypnotherapy:
Uses relaxation and suggestion; often used as an adjunct to other treatment techniques. (Kelly, p. 379)

psychotherapy:
• Masters and Johnson treat both partners at the same time, using a marital-unit approach to any sexual dysfunction, as it is not a concern of only the husband or only the wife. They utilize a therapy team composed of both a male and female therapist to facilitate communications and rapport, as each patient has an ally of the same sex. During an intensive two week residential program all couples are seen each day, and are free from the usual demands of their everyday world, leaving them the time and energy to focus on resolution of their difficulties. The problems they encounter in carrying out their assignments may be dealt with immediately and resolved before they create yet another round of fears of failure. (DeLora, p. 473)

process paradigm: (experientially oriented)
• What is the symptom preventing me from doing? What is the symptom making me do? (see process interview: male reproductive system)

related materia medica listings:
the shadow and physical symptoms
state-dependent learning
converting a symptom to a signal
behavior modification techniques (see also systematic desensitization)
hypnotherapy
process paradigm


footnotes

Reprinted from The Foundations of Chinese Medicine, Maciocia, Giovanni, 1989, by permission of the publisher Churchill Livingstone, a division of Elsevier Limited.