Shrink rap

Meet the panel

The abusive coworker  |  The procrastinator
The loner  |  The commitment phobe
The rejected gay son  |  The cutter
The crime victim  |  The serial dater
The fast and the furious  |  The coaster

{Dilemma 9}

The fast and the furious
I’m a 23-year-old man who has problems in bed. I lost my virginity to my high-school girlfriend six years ago. At college, I only had two sexual partners—the first one was more of a hookup and the second one might’ve gone somewhere, but we couldn’t find a rhythm. Actually, I usually came as soon as we got undressed. She finally got pretty frustrated and broke it off. Since graduation, I’ve had a few dates and whenever I think it’s going to happen, I’ve tried to think about George Bush, but I either come anyway or feel too removed. I’m embarrassed and it’s blocking me from getting close to a woman again. What can I do?

Sari Eckler Cooper: Lack of ejaculatory control is one of the most common and “fixable” problems that sex therapists treat. One helpful exercise is called the Stop/Start technique. While masturbating, he should rate his arousal state between zero and ten (nine representing the beginning of his orgasm) so he begins to gain awareness as to where he is in the process. When he reaches a four, he should stop stimulating himself for anywhere from 10 to 60 seconds and then begin stimulating himself again until he has reached the four or five mark on his scale and then stop again. During each pause, he should take deep, relaxing breaths to stay in tune with his body (in session, I would teach him how to breathe deeply so he is able to slow the process down and eventually connect with a partner). After three to four starts and stops, he can proceed to ejaculate. He may wish to tell his partner or girlfriend that he’s working on lengthening his lovemaking time. Choosing a girlfriend with whom he could develop enough intimacy to discuss his needs will also allow him to create more trust and comfort in the relationship and relieve him of any remaining anxiety.

Jill Chiara: The patient and therapist need to explore his feelings surrounding sexual relating, and how he was made to feel about sex from early on. Did his parents convey that sex was shameful or immoral? Were they too embarrassed to speak about the subject? Did he receive the message that relating sexually was negative in some way? Also, his relationship with siblings and peers while growing up may be relevant to the patient’s issues with performing sexually. If this patient has not already ruled out any medical reasons for his difficulties, he should have a thorough examination by a physician. Using cognitive-behavioral therapy would help this man to identify and modify patterns of “automatic” thoughts that trigger his feelings in sexual situations in order to have more fulfilling relations with women.