In part one of our session with Dr. Michael Perelman, we discussed what the Sexual Tipping Point (STP)® model is and how it relates to sexual function.

In part two, we discuss how to determine a sexual status and different sexual dysfunctions affecting men.

Determining a Sexual Status

In order to identify key STP factors, you need to first determine a “sex status.”

This isn’t a questionnaire or test. It’s simply laying out the history of your sexual experiences and details about those experiences to uncover more about your sexual functioning.

A good “sexual status” creates a picture in your mind about what you experience before, during and after sex, which can lead to identifying the bio-medical, psychosocial or cultural factors that are contributing to sexual dysfunction.

Occasionally, there could be factors like drug use, depression or marital conflict that require different or additional treatment before addressing the sexual dysfunction.

“Sexual Status” Exam

Identifying a “sexual status” is done with a sex therapist an essentially is an evaluation of your current sexual capacity and behavior.

After laying out your history and details about your sexual functions, a therapist will offer suggestions or homework that you’ll then review together. Those suggestions will also act as a therapeutic probe which will help your therapist pivot and adjust treatment specific to you and your experiences.

Throughout treatment, a person’s “sexual status” will continue to change.

Treating Premature Ejaculation

Men with premature ejaculation (PE) typically lack skill in identifying premonitory sensations (PS), and/or lack ability to adequately manage their body’s response to that sensation(s) regardless of other factors.

Treating symptoms of PE with both counseling and medication can greatly benefit a patient. Medical approaches — such as pills, topical creams and sprays — emphasize symptomatic improvement. Such an approach does not usually result in long-term learning. Relationship conflict may often lead to discontinuation of their use and relapse.

Working through discerning what sensations trigger the emission and how a man’s body responds to those sensations can be done with a combination of treatments.

Three Common Errors with Premature Ejaculation

Discerning Premonitory Sensation

Some men cannot discern the premonitory sensation. These indicators — such as muscle tension, increased heart rate and testicular elevation — come on too fast for awareness. Some men recognize the sensation but ignore it to avoid cumming too soon.

Confusing Premonitory Sensation and Emission

By the time a man has the feeling “uh-oh I’m going to cum,” he has already passed the sensation phase and is in the emission phase. At this point, it’s too late to slow down or stop.

Ejection and Orgasming

With premature ejaculation, surpassing the premonitory sensation point makes ejection inevitable. Trying to hold back will only result in an unsatisfactory orgasm.

Treating Delayed Ejaculation

The treatments for delayed ejaculation differ from premature ejaculation in that there aren’t medical treatments that are as applicable.

Initially, a sexual experience for a female can be exciting because the delayed ejaculation will often provide her enough time to climax, but will often turn frustrating when the male doesn’t reach climax.

Masturbation patterns become conditioned and if the manner the partner stimulates a man is too different from how he pleases himself, a condition of secondary delayed ejaculations may develop. In fact, most men with DE can masturbate to orgasm themselves, but find ejaculating in response to partnered sex difficult or impossible.

Especially as men age, masturbation can also delay the ability to ejaculate within the same day and at the same frequency they once did.

The solution for delayed ejaculation is typically decreasing the ejaculatory frequency while finding ways to increase erotic thought utilizing the STP model. Delaying masturbatory activity will cause the desire for release to increase and the stimulation needed to ejaculate during partnered sex seem easier.

Dr. Perelman’s blog The Sexual Tipping Point for Psychology Today covers a variety of male sexual dysfunctions and ways to improve your sex life.

If you’re looking for counseling on your own sex life or couples counseling for you and your partner, contact us today to get started.