How can I increase stimulation techniques to address delayed ejaculation?

Increasing Stimulation Techniques for Delayed Ejaculation

For men with delayed ejaculation, increasing stimulation techniques should be the first-line approach to enhance arousal and reduce ejaculatory latency. 1, 2

Understanding Delayed Ejaculation

Delayed ejaculation (DE) is defined as a consistent, bothersome inability to achieve ejaculation or excessive latency despite adequate sexual stimulation and the desire to ejaculate 1. This condition affects approximately 1-4% of men and can significantly impact sexual satisfaction, quality of life, and fertility 3.

Effective Stimulation Techniques

1. Enhanced Physical Stimulation

• Modify sexual positions to increase penile stimulation and sensation 2
• Increase intensity and duration of stimulation during foreplay and intercourse 1
• Focus on highly sensitive areas of the penis, particularly the frenulum and glans
• Experiment with different types of touch (pressure, speed, friction) to identify what provides maximum arousal

2. Vibratory Stimulation

• Use of vibrating devices on the penis, particularly effective for neurological causes of DE 2
• Penile vibratory stimulation (PVS) can be used as an adjunct treatment, especially for men with decreased penile sensitivity 4
• Start with low intensity and gradually increase as needed

3. Psychological Enhancement Techniques

• Fantasy utilization - encouraging mental focus on arousing thoughts during sexual activity
• Mindfulness practice - remaining present and focused on physical sensations
• Reducing performance anxiety through relaxation techniques before and during sexual activity
• Improving communication about sexual needs and preferences between partners 2

4. Sensory Focus Exercises

• Systematic desensitization to reduce anxiety associated with sexual performance
• Gradual exposure to increasingly stimulating sexual scenarios
• Partner involvement in stimulation techniques, which may improve outcomes 2

Practical Implementation

1. Start with non-genital stimulation and gradually progress to genital stimulation
2. Experiment with lubricants that enhance sensation (warming or tingling varieties)
3. Consider proper condom sizing - using a condom that's too small can reduce sensation and contribute to DE 5
4. Combine techniques - behavioral approaches work better when combined with other treatments 1
5. Practice regularly - consistent application of these techniques improves outcomes

Important Considerations

• Rule out medical causes before focusing solely on stimulation techniques, including medication side effects, hormonal imbalances, or neurological conditions 2
• Age is a significant factor in DE, with older men typically requiring more stimulation to achieve ejaculation 1
• Avoid surgical interventions as they should be considered experimental and may lead to permanent loss of penile sensation 1
• Consider referral to a sexual health specialist if stimulation techniques alone are insufficient 2
• Partner participation in therapy may be necessary for optimal results 3

Pharmacological Adjuncts to Consider

If stimulation techniques alone are insufficient, medications that may enhance ejaculatory response include:

• Pseudoephedrine (60-120 mg, 120-150 minutes before sex)
• Midodrine (5-40 mg, 30-120 minutes before sex)
• Oxytocin (24 IU intranasal/sublingual during sexual activity) 2

These medications should be considered secondary to stimulation techniques and used under medical supervision.