Three Examples of Issues You Might Work On with a Sex Therapist:
(from Sexual Dysfunction)
is the involuntary contracting of the vaginal muscles. The muscles
in the lower vaginal canal, the pelvic floor muscles - especially the pubococcygeal muscles, and in some cases the inner thighs, constrict and lock
close. Vaginal penetration becomes painful or impossible.
A number of
things can cause Vaginismus: a physical condition that causes pain during
vaginal entry, leading you to dread penetration and clench your muscles to
prevent it; or psychological factors such as a somatic response to sexual
assault or negative messages about sex.
Treatment and Healing
important to determine any physical cause of vaginismus, such as an STI, vaginal
adhesions, uterine cysts, vaginal dryness, scar tissue, endometriosis, etc.
careful note of your symptoms: when do they occur; if there is pain, where is
it; is there any symptomatic manifestation a like a rash, or a discharge?
thorough pelvic examination and share your observations with your doctor.
If there is
no evident physical cause, then duress, fear, or some other psychological factor
may be involved. If this is the case, nurture yourself with tons of love and
patience. If your symptoms persist, consider seeing a supportive, experienced
counselor or joining a support group.
treatment for Vaginismus is gentle, gradual, methodic relaxation of the tense
vaginal muscles. This is done by very gradually inserting size-gradated
phallic-shaped dilators into the vaginal canal.
with the smallest dilator, you will ease it slowly into the vagina and allow it
to remain until it is comfortable. You will do this for about fifteen minutes
three or four times a day, for as long as it takes to relax the vaginal muscles.
can move your pelvis and masturbate, you are ready to insert a slightly larger
dilator, and then a slightly bigger one than that, until the vagina is
comfortable with a penis-sized dilator.
process can take several weeks, and may be accompanied by supportive counseling,
depending on your needs.
a warm, quite, relaxing bath. Do some deep relaxation breathing.
bedroom or chosen place to focus on this exercise comfortable, safe, and
private. Be sure that you won’t be interrupted.
share choice to share your healing process with a partner, choose carefully.
Only be with someone you trust to be caring and nurturing, who you can relax
with and feel certain that they won’t place any pressure on you to “get better”.
breathing into and exhaling through the
vaginal canal. Then using your hands or a vibrator, massage your external vaginal
muscles gently. Don’t forget your favorite warm lubrication.
clitoral orgasm; manually, with a vibrator, through oral sex, or however you
wish. This will help relax your muscles.
insert the first, smallest dilator. Do not force. Breathe with it, relax, and go
very slowly. Once it is inserted, just allow yourself to become accustomed to
its feel. Do this three or four times a day for about fifteen minutes.
ready – and it may take several sessions before you are – begin moving your
pelvis pleasurably and practice
contraction and releases.
feel comfortable with this, masturbate to orgasm.
feels comfortable, you can insert the next size dilator, and go through the same
you can work through all the sizes and can try inserting a penis or a partners’
strap-on. Use lots of lubrication, and go very slowly, stopping to relax if your
muscles begin to tense.
patient. There is no hurry.
Treating Premature Ejaculation (from Sexual Dysfunction)
1. The first step is to
cultivate equanimity and compassion towards yourself. It will take time to
change an ingrained behavior pattern, or treat a physical condition. Be patient.
2. Begin with dry
masturbation. That is, masturbation without the use of any lubrication,
3. Study how it feels when
you approach your “point of no return” (PONR) when ejaculation becomes
involuntary. When you’ve identified this moment,
practice stopping your ejaculation 15-20
seconds before it occurs by pressing firmly on the penis shaft right
under the penile gland /coronal ridge,
with your thumb on the bottom and your opposing fingers pressing on top. Use
both hands if you need to. Hold this for thirty seconds or as long as needed to
relax the impulse to ejaculate.
You can also use a firm grip
at the base of the penis, and/or contract your pelvis muscles.
4. Breathe deeply and evenly
to slow your respiration and help you relax your sexual excitation level.
Thinking boring or unrelated, decidedly unsexual thoughts may help you as well.
Baseball scores. Old dentures sitting in a glass of dirty water. Whatever
6. Do this exercise three
times in a row. The fourth time, allow yourself to ejaculate.
7. Practice this at least
once a day until you gain control over the impulse to ejaculate.
8. When you are comfortably
in control masturbating with dry lubrication, add lubrication, and repeat this
process until you again feel comfortable with prolonging ejaculation.
9. Once you’re comfortable
with your ejaculatory control during lubricated manual stimulation, you can try
penetrating a toy vagina or anus with your penis. Apply the same technique
you’ve developed, using your hand or pelvic muscles to stop ejaculation 15-20
seconds before the PONR.
10. Try shallow penetration,
entering only the first third of the vagina or anus. Most of your partners
pleasure nerves are in this area, and you may find it easier to control
ejaculation and highly pleasurable to concentrate penetration here.
11. Also experiment with
modifying your movement pattern when approaching the PONR. For example, try
circular pelvic movements rather than direct thrusts, and changing your rhythm.
12. When you are comfortable with this on your own, it’s time to include your partner. It’s essential that your partner
be patient and informed, with a clear understanding of what their supportive
role will be.
13. Teach your partner how
to stimulate your penis. When the PONR is approaching, show them how and where
to press to stop ejaculation. Practice until you feel comfortable with this
14. You can also apply this
technique with oral stimulation.
When you are comfortable together with your partner’s ability to sense
and stop your PONR, it’s time to learn how to penetrate your partner. Begin
by “stuffing” your penis inside your partners vagina or anus before it is fully
erect, and just accustom yourself to the feeling of being inside them without
This will be easier if you
are in a position where you don’t have to put weight on your arms, such as lying
on your back while your partner straddles you, or spooning.
16. When you are comfortably
being still together, experiment with controlled breathing, shallow thrusting
and modified movement patterns while
applying the technique of stopping ejaculation 15-20 seconds before the PONR.
Practice until you feel able to control ejaculation.
If this exercise doesn’t
work for you, don’t worry! Changing our own behavior patterns is very hard for most of us. You may benefit the most from working with a sex
therapist on your ED.
Medical treatment usually
involves the use of a class of
selective serotonin reuptake inhibitor anti-depressants that
prolong ejaculation. These drugs include Prozac, Zoloft, and Paxil, all of which
may take up to ten days before becoming effective.
If they don’t help, your
doctor may prescribe the tricyclic anti-depressant Anafranil, which has also
demonstrated some ability to alleviate PE.
Homeopathic supplements have
also achieved some success.
Topical anesthetic creams
may be applied to numb the penis, which can aid the ability to have a prolonged
erection without ejaculation. These creams should be rinsed off the penis
entirely before making penile contact with a partner.
The use of
condoms can also desensitize the penis and help prolong ejaculation.
Condoms containing the numbing agents’ benzocaine or lidocaine intensify their
Premature ejaculation may be
a symptom of physical illness. It’s always a good idea to talk to your doctor
about persistent PE, for your peace of mind
Performance anxiety occurs when we can’t relax and enjoy ourselves
spontaneously during sex, usually because
about how our sexual execution “rates”. We have these niggling concerns:
Want someone to talk to about it? If
you need help, ask.