Sex Tune-Up Therapy with Biofeedback
Sex
Tune­Up
Therapy
With
Biofeedback
Impotence is hot. Impotence has come out of the closet. Millions of people are speaking about the unspeakable. Guys
are admitting (at least to their doctors) that their erections are not all that they could be. Viagra sales are breaking
records. Pfizer's stock is hot.
Daily we have media accounts of Viagra - its successes, possible value to women, short supply, abuses, black market,
possibly even deaths.
The spotlight of public attention has been focused on impotence with this breakthrough.
But is Viagra (or any of the other physical/chemical treatments for impotence) the complete answer? Can it alone
repair the damaging psychological effects caused by erection failure? Can it alone allow both partners to relax, stop
worrying, and focus on the sensual aspects of their lovemaking experience? Even if they haven't touched each other
for months or even years? How do you re-initiate a sexual relationship once erections have been restored?
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Sex Tune-Up Therapy with Biofeedback
This detailed program will take you through a series of simple steps and exercises that will return to you and your
partner the full enjoyment and satisfaction a sexual experience can bring.
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Sex Tune-Up Therapy with Biofeedback
Table
of
Contents
SEX
TUNE‐UP
THERAPY
WITH
BIOFEEDBACK ............................................................................................................................... 2
OVERVIEW .................................................................................................................................................................................. 6
MY
BACKGROUND....................................................................................................................................................................... 6
INTRODUCTION........................................................................................................................................................................... 9
HOW
THIS
PROGRAM
WILL
HELP .............................................................................................................................................. 12
RELATIONSHIPS,
SEX
AND
PEAK
EXPERIENCE ............................................................................................................................ 14
PEAK
EXPERIENCE ..................................................................................................................................................................... 16
OVERVIEW
OF
THE
PROGRAM .................................................................................................................................................. 19
HOW
YOUR
MIND
AFFECTS
YOUR
ERECTIONS........................................................................................................................... 22
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Sex Tune-Up Therapy with Biofeedback
QUESTIONS
AND
ANSWERS....................................................................................................................................................... 24
THE
TRAINING
PROGRAM ......................................................................................................................................................... 33
THE
30
DAY
PROGRAM.............................................................................................................................................................. 40
THE
PCG
EXERCISES: .................................................................................................................................................................. 47
APPENDIX
A .............................................................................................................................................................................. 60
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Sex Tune-Up Therapy with Biofeedback
Overview
This program is designed to add the necessary psychological component to a couple's sex life that has been enhanced
by erection facilitating drugs like Viagra, Muse, Caverjet, or other erection restoring treatments.
My
Background
•
I am a clinical psychologist with a special interest in anxiety disorders and stress.
•
Ten years ago I formed a partnership with Dr. Irwin Kuzmarov, a urologist, and Dr. Alex Skamene, an
endocrinologist, in a Male Sexual Dysfunction Clinic in Montreal.
•
We felt a multidisciplinary approach was most likely to allow us to comprehensively assess and treat our
patients for their sexual problems.
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Sex Tune-Up Therapy with Biofeedback
•
Over the years I have assessed and treated hundreds of men for their sexual problems.
•
I realized that although in many cases there was a clear physical reason for their erection problem, their
psychological reactions to these problems often compounded them.
•
I developed a ''Sex Tune-Up Therapy" for our clinical patient that was designed to take advantage of the
psychological principles that could enhance our patients’ responses to their erection restoring physical
treatments.
•
With great and satisfying frequency our patients reported that not only were their erections restored, but they
and their partners were experiencing pleasure in their sexual relations that were equal to, and in some cases
better than, what they had experienced when they first met.
•
We even found that the men who participated in the “Sex Tune-up Therapy'' and followed the prescribed
exercises required lower dose of alprostadil to achieve full erections.
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Sex Tune-Up Therapy with Biofeedback
•
I think this is because with their negative emotions eliminated, and our patients being more relaxed and more
sensitive to the sensual experience of their sexual interaction, the penile artery and muscle relaxed, allowing
better blood flow.
•
As a result, the medication had less work to do and a smaller dose was required.
•
In a sense, our patients were working with their medication, not against it.
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Sex Tune-Up Therapy with Biofeedback
Introduction
Viagra gives men back their erections, but it doesn't necessarily give a couple back the satisfying sex life they had
before erections become difficult, short-lived, or impossible.
This program explains how sexual relations deteriorate as erections become an issue, and completes the process begun
by the erection restoring drug in allowing a couple to once again have a mutually rich and satisfying sex life.
It includes:
1. An audio program lecture on the psychological effects of erectile dysfunction (ED) designed to be listened to
by the couple.
2. Training in a relaxation technique by means of biofeedback using the GSR2 a highly accurate biofeedback
instrument.
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Sex Tune-Up Therapy with Biofeedback
3. Positive imagery exercises to begin the positive change process.
4. Training in a simple exercise that will increase the pleasure of ejaculation.
5. Instruction in a series of couple sex therapy exercises, designed to heighten both partners sexual experience
and maximize the mutual benefit of the enhanced erection.
It is important to follow the various elements in the program in the correct sequence in order to derive the maximum
benefit. This manual, the accompanying audio program and the GSR2 biofeedback instruments will carefully train you
step by step until you and your partner have mastered these sexual pleasure enhancing techniques.
The problem of male impotence has been with us for many centuries. All sorts of folk remedies and other weird and
wonderful cures purported to solve this embarrassing and pleasure robbing problem have been offered.
We are in a new era. We understand the physiological and psychological problems of impotence better than ever
before. Millions of men and their sexual partners have and will benefit from these breakthroughs.
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Sex Tune-Up Therapy with Biofeedback
This program is designed to complete the therapy begun by a prescription of Sildenafil (Viagra) or alprostadil (Muse,
Caverjet). These physical treatments begin the process of improving the blood supply to the penis. I have found, in my
10 years as a partner in a male impotence clinic, that the psychological side of impotence is frequently inadequately
addressed. Although we are able to give men their erections back, they and their partners may not regain full
enjoyment of their sexual experience.
This unique biofeedback program is designed to educate you about the psychological side of impotence: how it
independently affects blood flow to the penis, and how a simple set of exercises and techniques can greatly add to the
quality of your sexual experience.
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Sex Tune-Up Therapy with Biofeedback
How
This
Program
Will
Help
Through the months or years of difficulty achieving or maintaining your erection you have developed a series of
negative emotional reactions associated with the sexual experience.
1. Tension, anxiety - developed through the frustration and disappointment of not experiencing a completely
satisfying sexual experience.
2. Worry about failure - thoughts focused on the possibility of things not going well: not maintaining your
erection, not ejaculating, not pleasing your partner.
3. Rushing - for guys who could get a partial or temporary erection, a tendency to rush to penetrate, and possibly
to ejaculate before the erection is lost.
4. Not psychologically close to your partner - as a reaction to your failure experiences, you have focused your
attention less on being close to your partner and more on your performance.
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Sex Tune-Up Therapy with Biofeedback
5. Not attending to the sensual, sexual aspects of the experience - as you focused more and more on your
physical performance you became less and less aware of the touch, sight, sounds and smells of the experience.
6. A feeling of tension has arisen between you and your partner when sexual matters are broached as you both
react to the series of frustrating experiences you have both experienced with the other in recent times.
These reactions will not necessarily change by themselves when your erection is restored.
You can assure the return of a completely mutually satisfying sexual experience by following the simple steps in this
program.
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Sex Tune-Up Therapy with Biofeedback
Relationships,
Sex
And
Peak
Experience
Many guys, when they are first married, complain that there is not enough sex in their marriage - this especially when
the children are first born. Their wives complain there is not enough affection and attention in their relationship. He
says he would be more affectionate if there was more sex. She says she would have more sex if she felt they were
closer.
While she may find his sexual requests inconvenient, and possibly annoying, at least she knows that she is attractive
and desirable to him. With age, if he develops an erection dysfunction, he may avoid sex and all other intimate
physical contact in an attempt to avoid another failure experience. She may react by feeling that he doesn't really find
her sexually attractive anymore - she's not sexy enough to give him an erection and besides, he doesn't even want to
try to have intercourse with her. They may find their relationship quite emotionally cool.
This is an area of friction that can occur in a marriage that is the direct result of his erectile difficulties. Of course there
are a huge variety of other problem that can crop up in a marriage that can diminish the closeness and intimacy that a
couple once experienced.
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Sex Tune-Up Therapy with Biofeedback
Giving a guy back his erection will not itself improve a bad relationship. It will not by itself even lead to a highly
mutually satisfactory sexual experience. But it can be a start.
If the series of exercises in this program is followed, there is an excellent chance that the couple will begin
experiencing highly stimulating and pleasurable sexual encounters. These sexual relations might result in each having
a "peak experience."
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Sex Tune-Up Therapy with Biofeedback
Peak
Experience
A peak experience is the most powerful pleasurable state that a person can have. It is defined as a highly intense
experience where time seems to stand still. All attention and concentration are focused on one thing. Although other
stimuli may be present, the individual's concentration is so narrowed and highly focused that they are far in the
background.
Many athletes have peak experiences playing their sport, often when they are at the top of their form and playing the
best games of their lives. A pitcher may be so concentrated on the batter, his catcher, and the feel of the baseball in his
hand that he is only vaguely aware of the crowd in the stadium or the score of the game.
These experiences are so powerful and pleasurable that they keep athletes playing sports far beyond the time that they
need the money or the fame. There's just nothing that can compare to the pure pleasure of this experience.
Sex can achieve peak experience status. The moment of orgasm for many people fulfills the definition of peak
experience. It can be a powerful, all encompassing experience that entirely focuses the mind.
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Sex Tune-Up Therapy with Biofeedback
But orgasms tend to be very brief. Imagine a sexual encounter where foreplay and penetration are experienced in this
way. Each partner is focused on the sensation they are experiencing while simultaneously highly aware of their
partner. All their senses are open and alive - touch, smell hearing, sounds, and sights. Thought is temporarily
suspended as the sexual union is experienced directly. In this situation, the sexual experience is as much journey as the
destination.
When couples first meet and fall in love, just being together can be a peak experience. Frequently, their lovemaking
achieves this too. Compare them to the couple, struggling with his erectile dysfunction. The experiences could not be
further apart.
Once his erection is restored, couples can tune up their sexual relations to allow peak experiences. The emotional
closeness that results from a shared peak experience can go a long way to enhancing their relationship and motivating
them to work on solving other problems.
No relationship is perfect. But sexual problems can exaggerate areas of conflict by causing both partners to experience
a variety of negative emotions in that situation. The frustration, self and other blame resulting from repeated
unsatisfying and unsatisfactory sexual encounters can exaggerate areas of conflict.
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Sex Tune-Up Therapy with Biofeedback
But a series of close, intimate sexual encounters where each partner is sensitive to the others' needs while
simultaneously experiencing a high level of sexual pleasure themselves is a powerful bonding experience. It can help
erase or offset other areas of marital friction.
The couple will feel closer, and this may motivate other positive interactions - more affection, more cooperation, more
consideration, and more compromise. Starting with a restored erection we've come all the way to better marriage.
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Sex Tune-Up Therapy with Biofeedback
Overview
Of
The
Program
CD 1, track 1”Introduction. Listen to by Couple.” It is designed to be listened to by the couple.
The purpose of the lecture is to explain:
1. How the male sexual response works:
• The erection process
• The ejaculation process
1a. How Viagra (or alprostadil) works and how they are different
2. Why erections fail
3. Factors compounding erection failure
4. When Viagra fails
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Sex Tune-Up Therapy with Biofeedback
5. Problems couples face in re-initiating their sexual relationship once erections are restored
The next step is to learn how to relax:
•
First individually with the help of the GSR2 biofeedback device (CD 1 track 3)
•
Then together as a couple (CD 1, track 3 & 4)
•
Along with this you will begin a series of positive imagery exercises to begin to establish a positive mental
attitude toward your sexual experience (CD 2, track 3 &4)
•
You and your partner will both learn a pubocoxygeal muscle strengthening exercise. It is designed to increase
the intensity of sensation when you ejaculate (and may help maintain your erection). It is designed to increase
her vaginal muscle tone, which will increase both of your pleasurable friction during intercourse.
•
You will then be guided through the sensate focus #1 massage exercise. This non-genital massage is designed
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Sex Tune-Up Therapy with Biofeedback
to advance the process of being relaxed together while being physically intimate. It will also assist in the
process of verbal communication in the sexual area. (CD 1, track 2)
•
Finally you will be guided through the sensate focus #2 massage exercise. This genital massage is designed to
add a sexually stimulating experience to the comfortable relaxed state the couple has achieved via the previous
exercises. (CD 1, track 2)
•
Optionally you can use the program, which will train you to control your ejaculation in order to extend the
pleasure of intercourse for both. This is especially helpful for premature ejaculators.
•
The last chapter will put it all together - fully integrate all the elements of both your physical erection restoring
treatment and the psychological therapy you have experienced with this program.
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Sex Tune-Up Therapy with Biofeedback
How
Your
Mind
Affects
Your
Erections
Erectile dysfunction is estimated to affect 30 million American men. It is the result of certain chronic illnesses
(diabetes, heart disease) or simply growing older. As a man begins to notice he is having increasing difficulty
penetrating his partner or may not remain erect long enough to ejaculate in his partner, a series of negative
psychological states are stimulated.
1. Performance Anxiety: The man begins to worry about his erection, fearing it won't work well this time and
will embarrass him and/or disappoint his partner.
2. Spectatoring: During foreplay, and penetration, the man no longer is completely engrossed in the pleasurable
experience but is observing and evaluating himself, assessing the quality of his erection.
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Sex Tune-Up Therapy with Biofeedback
3. Avoiding Sex and Intimacy: As the fear of a performance failure grows, many men will avoid sex entirely.
They may even avoid any other form of physical intimacy (hugging, kissing) because they don't want to start
something they can't finish"
4. Diminished Self-Esteem and Depression: For some men, their inability to consistently achieve an erection
adequate for penetration leads them to devalue their worth and manhood. This self- criticism leads to a
diminished self-esteem and can lead to depressed mood.
5. Marital Conflict: Erectile dysfunction can challenge the female partner's self worth as she blames herself for
not being "sexy" enough to give her man an erection. Or she may accuse him of infidelity, his poor
performance and lack of sexual appetite being a sign of his being satisfied sexually else- where. Or the lack of
the mutually pleasurable experience of sexual contact may lead the partners to be less emotionally close and
involved with each other.
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Sex Tune-Up Therapy with Biofeedback
Questions
And
Answers
Q.
A.
How does the male sexual response work?
1. Erections and ejaculation are two separate processes.
2. As erections fail men can still be sexually stimulated to the point of ejaculation.
Q.
A.
How do you get an erection?
1. Brain signals stimulate the release of C-GMP in the penis.
2. C-GMP makes muscles in the spongy erectile tissue relax.
3. Blood flows into the spongy erectile tissue and the penis begins to stiffen.
4. As the penis stiffens the veins that drain the blood from the penis are squeezed shut maintaining the
erection.
Q.
A.
How does an erection end?
1. Ejaculation stimulates PDE-5, which is an enzyme that breaks down C-GMP
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Sex Tune-Up Therapy with Biofeedback
2. Penile arteries contract, carrying less blood.
3. Spongy erectile tissue tightens up expelling trapped blood.
4. Penile veins drain away the excess blood that caused the erection.
Q.
A.
What other factors can cause an erection to end?
1. Imagine that you are enjoying sexual intercourse with your partner with a good erection and excellent
penetration. Suddenly, with a loud crash, someone comes flying through the door. Of course within
seconds, you lose your erection. This is called External Distraction.
2. Imagine again that you are enjoying intercourse. The thought crosses your mind what if I lose my erection
and I disappoint my partner and myself'. This thought makes you feel anxious and uncomfortable. Likely,
within seconds, you lose your erection. This is called Worry and Anxiety about Performance.
3. Imagine again that you are enjoying intercourse with a partner you have known for a short time. During
penetration she says she's seeing another man and doesn't want to continue the relationship with you. What
effect do you think this will have on your erection? This is an example of a Relationship Problem
Affecting Erections.
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Sex Tune-Up Therapy with Biofeedback
Q.
A.
How do these psychological events affect the chemistry of erections?
Despite the different reasons for the erection ending, the chemistry and physiology are likely the same. An
increase in PDE-5 causes a breakdown of C-GMP, which reduces arterial blood flow into the penis, and the
muscles in the spongy erectile tissue contract helping to expel the trapped blood that was causing the erection.
The veins draining the penis carry away the blood that maintained the erection.
Q.
A.
How does Viagra work?
Viagra (sildenafil citrate) interferes with the enzyme PDE-5. You will recall that PDE-5 itself breaks down CGMP which is what triggers the erection process, so there is more C-GMP available to produce the erection.
When sexual stimulation is added, which begins the blood flowing in the now quite relaxed penile arteries,
erections occur. Ejaculation takes place; an increase in PDE-5 over- rides the interfering effects of Viagra and
reduces the amount of C-GMP which results in the loss of the erection.
Q.
A.
How does Alprostadil (Muse, Caverjet) work?
Alprostadil is a drug, which attracts blood to it by causing the arteries, which carry blood, to expand.
Alprostadil has to be introduced directly into the penis in order to be effective.
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Sex Tune-Up Therapy with Biofeedback
This can be done in two different ways
1. An injection directly into the base of the penis (Caverjet).
2. Introducing it into the urethra (Muse).
In either case, the effect is the same. Blood is drawn to the penis and an erection is produced. This erection will be
maintained until the drug is metabolized. It doesn't matter what happens (even ejaculation) the presence of the
alprostadil overrides the process by which erections are lost.
Q.
A.
What is the difference between Viagra and Alprostadil?
Both cause the penile artery to relax and carry more blood.
•
Alprostadil is an active agent - the artery is relaxed and blood is drawn to it.
•
Viagra is a passive agent - it just relaxes the artery and the smooth penile muscle.
•
Sexual stimulation must be added in order to get the blood to flow.
•
After ejaculation alprostadil will continue to draw blood to the penis until it has been metabolized - so the
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Sex Tune-Up Therapy with Biofeedback
erection will be maintained. After ejaculation, Viagra usually cannot overcome the extra PDE-5 that is
produced which then interferes with the C-GMP and the erection is lost in the normal way.
Q.
A.
Why do men's erections decline with age?
The statistics are clear - as men age the quality of their erections decline, sometimes to the point of not being
able to penetrate their partner. The penile artery may become occluded with plaque (in the same way as
coronary arteries clog up causing heart attacks). This rust in the pipes was the main explanation for declining
erections until Viagra came along. We now know all about C-GMP and PDE-5, it is likely that as men age
either C-GMP levels decrease or PDE-5 levels increase. As we already know C-GMP levels are the key to
erections, the more C-GMP the better the erection.
Q.
A.
What can you do to improve your erections?
It is clear from the preceding that age, chemistry, and your own psychological state all affect erections.
Anything that is bad for your heart (i.e. causes occlusion of coronary arteries) similarly can be expected to be
bad for your erections; a high cholesterol diet, too much stress, not enough exercise, excess alcohol and
cigarette smoking are all known cardiac risk factors. Changing these should help your erections. Getting
erections depends on the penile artery being relaxed and the muscle in the spongy erectile tissue being relaxed.
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Sex Tune-Up Therapy with Biofeedback
If you can begin your sexual experience in a physically relaxed state, this will assist you in getting the best
possible erection.
As erections begin to decline, how is a bad situation made worse?
•
We now know how erections are produced, how they are lost and how aging decreases them.
•
As a man begins to have difficulty getting good erections (especially if they are not firm enough to allow
penetration or at least last long enough to allow ejaculation), certain psychological reactions make a bad
situation worse.
Imagine a guy who has for years enjoyed a normal and satisfying sexual relationship with his partner. He has noticed
that his erections are less firm than they used to be, but they are still adequate to allow a normal intercourse
experience. Then one time his erection is just not firm enough to allow penetration. He struggles to penetrate, almost
gets it in, but it slips out and loses his erection entirely. He's embarrassed, concerned frustrated. Typically his partner
is consoling, understanding, and encouraging.
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Sex Tune-Up Therapy with Biofeedback
Now, it's the next time. He probably is experiencing some "anticipatory anxiety" as he wonders and worries how he
will perform this time. As he begins foreplay he is likely more aware of his erection and may actually check it to see
how he's doing. All this is diminishing his enjoyment of the sexual and sensual pleasure of being with his partner.
What effect is all this having on the physiology and chemistry that causes an, erection?
1.
His anxiety and worry are constricting his penile artery and tightening the muscle in his erectile tissue either
directly or possibly by increasing the amount of PDE-5 which reduces the available C-GMP
2.
He probably has only a marginal amount of blood flow available in his penis due to the effect of age or
disease.
3.
So the normal negative emotional reaction to an erectile failure is making a bad situation worse by further
diminishing the blood supply necessary to produce an erection.
Of course subsequent attempts at intercourse only continue this vicious cycle as one failure experience predicts and
causes the next failure.
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Sex Tune-Up Therapy with Biofeedback
Most men will only try and fail a few times and then avoid the whole situation ("I don't want to start something I can't
finish"). Often they will desist from any form of physical contact with their partners.
What happens when erections are restored?
After months (or more often years) of not being able to acquire an erection sufficient for penetration, some men (many
more now that Viagra has been so well publicized) seek help from their doctor. They will likely be given a
prescription for Viagra.
And now the big night! He takes his Viagra on an empty stomach (as recommended) one hour before he plans to get
together with his partner. He announces to her that this is the night." They may not even have touched each other in
months. He wonders if it will work, as memories of his previous failures come flooding back into his mind. She feels a
bit uncomfortable because there has been so little physical affection between them for so long and wonders if she will
be able to enjoy the experience.
If Viagra works it will give him his erections back but it may not restore the couple’s old enjoyment of their shared
sexual experience.
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Sex Tune-Up Therapy with Biofeedback
What follows is a program of a series of simple, gradual steps designed to work with Viagra or alprostadil to fully
restore the mutual enjoyment of the sexual experience.
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Sex Tune-Up Therapy with Biofeedback
The
Training
Program
•
This is a one month program involving daily exercises some of which you will do on your own and other ones you
will do together with your partner.
•
Based on my experience in our male impotence clinic, by the end of the month you and your partner will be
experiencing significantly increased sexual pleasure.
•
This is a time log of each week's exercise.
The Beginning - Week 1
1. Listen together with your partner to an explanation of the program. (CD1, track 1)
2. Begin daily practice of biofeedback assisted relaxation. (CD1, track 3 & 4)
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Sex Tune-Up Therapy with Biofeedback
3. Begin daily relaxation practice together with your spouse. (CD 2, track 1 &2)
4. Begin daily pubocoxygeal (PCG), muscle training exercises.
The Next Step - Week 2
1. Begin relaxed breathing training with the GSR2
2. Begin visualization training assisted by the GSR2 (CD2, tracks 3 & 4)
3. Begin sensate focus 1. (CD 1, track 2)
4. Continue daily PCG exercises.
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Sex Tune-Up Therapy with Biofeedback
Sexual Stimulation - Week 3
1. Continue daily relaxing with the GSR2.
2. Begin sensate focus II.
3. Continue daily relaxation exercises.
4. Continue visualization imagery exercises. (CD 2, tracks 3&4)
Putting it all Together - Week 4
1. Continue daily relaxation exercises.
2. Continue daily PCG exercises.
It may seem like a lot of work but it all amounts to one hour per day. Think of that hour as an investment, which will
pay off in future years of sexual pleasure for both you and your partner.
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Sex Tune-Up Therapy with Biofeedback
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Sex Tune-Up Therapy with Biofeedback
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Sex Tune-Up Therapy with Biofeedback
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Sex Tune-Up Therapy with Biofeedback
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Sex Tune-Up Therapy with Biofeedback
The
30
Day
Program
This program is designed to be completed in 30 days of daily practice. You will have a time commitment of less than
one hour per day. There may be some days where you just can't do the full practice or can't get to it at all.
When that happens the next day simply practice the exercises scheduled for your missed or incomplete day.
Remember, you are building your sexual pleasure on a solid foundation and it is important to construct it well without
any gaps or flaws.
As the program begins I advise you and your spouse not to attempt sexual intercourse until you reach week 4 of the
program. This will allow you to fully concentrate on your exercises and heighten your anticipation, and ultimately
pleasure, when intercourse takes place.
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Sex Tune-Up Therapy with Biofeedback
Week
1
Put on CD 1, track 1 and listen to it together with your partner. This audio track will introduce both of you to the
program and explain about erectile problems and how the 30 day program will benefit your sexual experience.
Relaxation
As we have learned, relaxation is the basis of all good sexual functioning. It allows blood to flow and muscles to relax
in your genital area. It allows your mind to be free of worry and to be able to be receptive to the feel, sights, sounds
and smells of the sexual situation.
Learning how to relax with biofeedback is a mental and physical skill, which once learned will not be forgotten (like
learning to ride a bicycle). Using the GSR2 biofeedback instrument, you will quickly learn deep-relaxation.
Biofeedback
What is biofeedback? Biofeedback measures your body's reaction to emotional and physical stress with great
sensitivity and ''feeds back" changes in your moment to moment tension levels by means of a tone. Decreasing tone
levels indicate increasing relaxation; increasing tone levels indicate increasing tension. Simple isn't it!
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Sex Tune-Up Therapy with Biofeedback
Guided by your heightened awareness and using the relaxation audio program you will learn how to relax deeply and
control and eliminate stress and tension and allow your mind and body to be fully receptive to your sexual experience.
What is GSR biofeedback?
Galvanic Skin Resistance (GSR) is simply the opening and closing of the pores of the skin of your hands and feet.
Since these pores are controlled by your nervous system, monitoring their activity allows you to be fully aware of the
activity of your autonomic nervous system. You can't directly monitor your autonomic activity but the GSR
biofeedback will tell you if your nervous system is more relaxed (tone goes down) or more stressed and tense (tone
goes up). Put on CD 1, track 3 and learn how to use the GSR2.
Relaxation Practice assisted by GSR2 biofeedback
As you see in your practice time log, relaxation practice will become part of your daily homework for improving your
sex life. Regular practice will reduce your overall stress levels and benefit your sexual functioning. Relaxing before a
sexual encounter will allow you to begin that experience with your mind clear and your penile muscles and blood
vessels relaxed.
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Sex Tune-Up Therapy with Biofeedback
Tips for making relaxation practice part your daily routine.
It doesn't matter when you do your practice. Find a comfortable place that is reasonably quiet. Give yourself enough
time - the exercise takes about 10 minutes. Most people find that if they schedule their practice at a regular time each
day they are most likely to get to do it. It is better to actually write it into your schedule so that this has a priority and
will not be pushed aside by other events or obligations.
I suggest you seriously consider making this practice a regular part of your life once the program is over. People who
practice relaxation/biofeedback regularly have been shown to be less stressed in general and to recover from stressful
experiences more quickly.
Relaxing with your spouse.
CD 2, tracks 1&2 will take you and your spouse through a relaxation exercise similar in some ways to the one you use
on your own (CD 1, tracks 3&4). The goal of this exercise is to begin reversing the tension and negative expectations
that have become associated with sexual encounters.
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Sex Tune-Up Therapy with Biofeedback
This exercise is best done in bed lying side by side. You may even hold hands. Use a CD player with two headphones
or even better one with a speaker. You should avoid going on to a sexual encounter after your mutual relaxation
experience (although you may very well want to because you are both feeling so relaxed and comfortable together).
Remember, we want to rebuild your sex life on the solid foundation of relaxation. Sexual relations will come later.
Give this step the time and practice to do its work.
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Sex Tune-Up Therapy with Biofeedback
Week
2
Pubocoxygeal (PCG) Exercises.
Read through this explanation of the importance of this muscle for both of your sex lives and begin practicing this
simple exercise as directed.
Pubocoxygeal exercises for you and your partner.
Both men and women have pubocoxygeal muscles (PCG) and, among other things, they have a great influence on
sexual pleasure.
•
The importance of this muscle for women's sexual pleasure was discovered accidentally by a gynaecologist
named Dr. Kegel.
•
After pregnancy some women had difficulty controlling their bladder sphincter and he found these exercises
improved their incontinence.
•
Many women who used this exercise found it had the additional effect of tightening their vagina thus allowing
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more pleasurable sexual intercourse for them and their partners.
•
I adapted these Kegel exercises for men in our sexual dysfunction clinic when I realized that the muscles
controlling a man's ejaculation often become weak and less powerful due to age and lack of use.
•
Many of my patients who used these exercises reported that their ejaculation was more forceful, could be
delayed a bit longer, and was more pleasurable.
•
Some men even noted that their erections were better (possibly due to the increased blood flow to the genital
area that occurs when practicing the exercise).
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The
PCG
Exercises:
1. Identifying the PCG muscles:
• Think of the muscles you would use if you wanted to interrupt the flow of your urine.
• Squeeze these muscles right now.
• They are you PCG muscles.
2. Checking to make sure you have the correct muscles:
 While urinating, squeeze the muscles once.
 If the flow of urine is stopped, you have identified your PCG muscles.
 Do not practice the exercise while you are urinating. This is just to check that you have the correct muscles.
3. The Exercise:
 Squeeze your PCG muscles and hold them tense for 10 seconds.
 Relax them for 10 seconds.
 Continue to do this for a total of 10 times.
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


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
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You may find that, initially the muscles become quite fatigued and shaky toward the last few contractions.
Discontinue the exercise if the muscles are too tired, even if you haven't reached 10 times.
As you continue to practice these 10 exercises, the muscles will become stronger and you will be able to
perform all 10 contractions.
Your goal is to practice these 10 contractions a told of 6 times per day, every day.
You can do the exercises any place, any time - they are invisible - no one knows when you are doing them.
If you find them helpful, the exercises should be continued indefinitely although they can be done less
frequently once the muscle are strong.
4. Tips for regular practice:
 Although the exercises are simple, easy to do, and can be done anywhere, anytime, many people have
difficulty remembering to practice them 6 times per day.
 People who are successful in getting into the habit of regularly doing these exercises report they set up cues or
associations to remind them to do them.
 For example, one patient was reminded to do them every time he came to a stop light, another each time he
ate; still another at commercial breaks while watching TV.
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


Some people find that a time reminder is the best way to help them perform these exercises.
So they will practice every even hour or at other pre - designated times.
You may find it a little difficult to get into the habit of practicing at first but stick with it. The
more you try the easier it is to remind yourself.
When you begin to see the change in your sexual pleasure this will greatly increase your
motivation to remember to do your exercises.
Week
2
Relaxed breathing training with the GSR2.
You are now ready for the next step in your personal goal to be able to relax at will during the sexual
experience. While your initial sensate focus exercises will be preceded with a formal relaxation
exercise (the couples relaxation exercise CD2, tracks 1&2) when you get into the actual stimulation
phases it will be important for you to be able to easily quickly, and from memory relax away any
worry, tension, anxiety, or other negative emotions that interfere with the quality of your sexual
experience.
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This Breathing Relaxation technique is ideal for that task. Follow these simple instructions and begin practicing daily.
This exercise now replaces your first relaxation exercise.
Relaxed Controlled Breathing with GSR2.
Breath control is among the oldest relaxation techniques. It is used in many different cultures and is a valuable method
of gaining mastery over your stress or arousal levels. Breathing is a function which is both involuntary (breathing
while sleeping) and voluntary (taking a deep breath before diving). Unless you consciously control your breathing, it
will reflect your unconscious emotions. Exercising voluntary control over your breathing is an important step in
learning to master relaxation techniques. Relaxed controlled breathing is important because:
1. It promotes deep relaxation which is essential for visualization.
2. You use less effort to inhale the same or more oxygen.
3. Your gas exchange is much more efficient.
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The Relaxed Breathing Cycle.
To begin the breathing cycle, first you must exhale completely. Initially, for the first few minutes, to learn this
technique, you may wish to make a sound as you exhale whispering "Haaah" very softly. Allow your chest to fall,
expelling the air. MOST IMPORTANT, continue the exhalation by contracting your stomach in expelling the
remainder of the air in your lungs. At this point let the air flow back in by allowing your stomach (abdomen) to relax
and widen. (It looks like you are filling your abdomen with air, but in fact, it is your lungs). Continue to inhale
allowing your chest to expand slightly. Then repeat the exhalation cycle by allowing your chest to fall gently, feeling
the air flowing out.
If you are lying down, your chest and stomach will fall naturally because of gravity and you will not have to pull your
stomach in. However, as you begin your inhalation you should expand your stomach voluntary allowing the air to flow
in.
Important! Breathe through your nose, if it feels comfortable. Allow your jaw to relax. Allow your breathing to be
effortless. Remember that breathing is a rhythmic cycle. Never force it; simply observe it happening and experience it.
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When practicing diaphragmatic breathing using the GSR2, the tone will increase slightly as you inhale. If it increases
significantly, you are trying too hard. Focus on your exhalation and allow your inhalation to occur effortlessly.
Sensate
Focus
I
This is one of the sexual exercises first developed by the famous sex therapists Masters and Johnson. It is desired to
take the couple's relaxation one step deeper.
It involves each giving the other a massage for 5 to 10 minutes. The sequence is the following; First, relax together
using CD 2, tracks 1&2. Then decide who will be first giving the massage. The massage should be given lying on the
bed with the massager straddling or to the side. This massage is to be a NON-GENITAL massage. The goal is
relaxation, not sexual arousal. No breasts, vaginas or penises should be included in the message.
You may find yourself getting quite sexually aroused as you relax with the pleasant massage you are giving or
receiving. See if you can relax away the feeling. There's ample time for that in Sensate Focus II.
Your goal is to provide your partner with the most pleasant relaxing massage possible. In order to do that, you will
have to get feedback from your partner about what body parts are most enjoyable and how best to give the massage.
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Your partner can't possibly know how you most enjoy their massage unless you communicate your preferences.
Visualization Training Assisted by the GSR2.
The ability to visualize a future event is a powerful psychological technique that increases the likelihood of its possible
outcome. Psychologists consulting to professional sports teams use this technique extensively. For example, many
perfectionist athletes, highly motivated to play outstanding games, will be very self critical when they play poorly or
make a mistake.
Their self criticism creates negative emotions, and trying to hard to succeed often results in their tightening up, and not
being able to play loose and confident. Sound familiar?
CD 2, tracks 3&4 takes you through an imaginary sexual experience while you will rehearse being relaxed, confident,
and focused on the sensual aspects of the experience.
Some people are naturally great visualizers; others have to work on developing that skill. The visualization technique
is useful to the extent that you can vividly imagine the experience.
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To give you an idea about how visualization works, try the following exercise. How many windows are there in your
home or apartment? Don't know? Take an imaginary trip around your place and count the windows. You see - you can
visualize.
Now let's try something else. Visit your kitchen, in your “mind's eye”. Scan your kitchen mentally. You may “see” it
in colour, black and white, feel it with your body or just think about it. Now in your mind, go to your refrigerator and
take out a lemon. It is cold to the touch. Hold it to your nose and smell the familiar tangy fragrance.
Pick up a knife, put the lemon on the cutting blade and cut it in half. Hear it crunch. Pick up one half and squeeze it
into your mouth.
You can SEE, HEAR, TASTE, and SMELL this entire scene. Close your eyes for a moment and experience these
sensations NOW.
What did you experience? Probably you're salivating NOW.
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This is an example of how your thoughts and images affect your body. This is an example of the power of thought and
the power of visualization.
Put on your visualization audio program now and go through the exercise.
Week
3
Sensate Focus II.
You are now ready to add a sexual element to your massages. Begin with relaxing together (CD 2, tracks 1&2). Then
start to massage your partner, just as in Sensate Focus I. But now you are allowed to include genital parts.
Your goal, receiving the massage, is to remain relaxed and focused on the pleasant sensations. You may find yourself
becoming quite aroused. You may find you are getting a better erection than you usually do without the help of your
erection assisting medications.
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It is very important that you avoid two things:
1. Sexual intercourse is not an option during these exercises! The goal is to train you to stop thinking of the next
step in sexual situations and just focus on the pleasures of the moment. So this exercise has no performance
goal or possibility. If you can't fail you don't have to worry or evaluate yourself.
2. But you still may find yourself evaluating yourself. This is a remnant from your “bad old days” when you
were struggling to get an erection and hoping to penetrate. And that's exactly what this exercise is designed to
help you to stop doing.
Your goal in this exercise is to begin to approach a "peak state" - to be relaxed, entirely focused on the sensual
pleasure of the experience without any negative thoughts or feeling intruding. You and your partner may, if either of
you wish, experience orgasm or ejaculation.
Dealing with Negative Thoughts and Feelings - A Worry Stopping Strategy
Despite your desire not to, you may experience negative thoughts and feelings during the Sensate focus exercises. You
may:
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1. Find yourself worrying that you are not relaxed enough.
2. Worry you are not sexually aroused enough.
3. Worry that your erection is not as good as you would like it to be.
4. Find your thoughts drifting to other things and not focused only on the present experience.
When this happens, there is a very simple strategy. Focus on your breathing and take 20 - 30 seconds to breathe and
feel exactly the way you do when you practice your breathing-relaxation exercises. This will re - focus your mind and
relax your body. Then tune back into the pleasant massage you are experiencing.
Week
4
Putting It All Together
You've come a long way in the past 3 weeks. Now it's time to put all the elements of your sexual relationship together.
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Step 1
 Take your erection enhancing medication (e.g.: Viagra on an empty stomach one hour before you plan to get
together). Or if you are using alprostadil (Caverjet or Muse) take that shortly before you plan to be together.
Step 2
 Relax together using CD 2, tracks 1&2 as a preparation for your sexual experience.
Step 3
 Begin a Sensate Focus II massage. You should first be the massager and your partner the recipient. This
massage should not last more than a few minutes. Then your partner should massage you for a few minutes.
This can lead to a mutual stimulation foreplay experience.

You will probably find you are beginning to get an erection. Resist the temptation to rush to penetrate. If you
find yourself worrying about whether everything will go all right use your worry stopping strategies.

Your goal is to ''stay in the moment" and be fully aware of this powerful sensual experience.
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
As you and your partner become more sexually aroused, you can both choose the time to penetrate. Allow
yourself to again fully experience the sensation of your penis penetrating your partner's vagina.

You may find some old thoughts jumping into your mind. What if I lose my erection? What if I disappoint her
again?

If these or other worries occur, use your breathing-relaxation worry stopping technique to stay in the moment.
As you continue your sexual experiences, and deal effectively with these worries, they will occur less and less
frequently and finally not at all.

If you have a history of premature ejaculation turn to that section and consider using that training program to
improve your ejaculatory control.

Your goal is to begin to experience your sexual union as a "peak experience" (you may want to go back and
re-read that section).
Enjoy!
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Appendix
A
Ejaculatory Control Training Program.
If you had a tendency to ejaculate prematurely before your erection problems or if you began ejaculating too quickly
during the period of your erection difficulties you will likely find this to be a problem once your erections are restored.
Premature ejaculation is easily converted to ejaculatory control by following the steps outlined below.
With your erection restoring medication you may find that even if you ejaculate you will not lose your erection until
the medication wears off. The value of your learning how to delay your ejaculation is that it will prolong your own
sexual pleasure, heighten it, thus providing your partner with an even more intensely pleasurable sexual experience.
Or you may find that, just like before your erection problems you lose your erection after you ejaculate. And the length
of time you are able to remain erect while your penis is in your partner's vagina is not sufficiently long to allow her to
experience orgasm. Or to allow you a lengthy and fully satisfying peak experience.
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Premature Ejaculation (P.E.) and ejaculatory control. Important Facts.
•
Ejaculation occurs when your sexual excitement passes a point called ''ejaculatory inevitability"
•
For many men this point is reached just before they penetrate, as they are penetrating, or within minutes of
penetrating. Many men would like the sexual experience to last longer and almost all of their female
counterparts would agree (women typically require a longer time to achieve orgasm).
•
Many men take the point of ejaculatory inevitability as a given, fixed unchangeable point and have no idea
that a few simple techniques can give them control over when they ejaculate.
•
The one proven way not to control your ejaculation is to worry and be anxious about it.
•
Both worrying and anxiety actually stimulate the sexual arousal system and push you closer to (and eventually
over) the point of ejaculatory inevitability.
•
Conversely any activity that lowers your excitement will control your sexual arousal which will control your
ejaculation.
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•
There are three techniques, which can be used individually or in combination to control your sexual
excitement.
1. Breathing-relaxation: by focusing on your breathing, slowing it down and relaxing your muscles you will
lower your sexual arousal and control your ejaculation.
2. Distraction: any neutral thought (what you ate for dinner, that big project at work) will distract you from the
sexually exciting stimuli that are increasing your sexual arousal, and help keep you away from the point of
ejaculatory inevitability
3. Reduce physical stimulation: the friction of your penis as it moves back and forth in your partner's vagina is
powerfully sexually arousing. Stopping this temporarily or withdrawing completely will reduce your sexual
arousal.
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Learning How to Use best Techniques in The Actual Sexual Situation.
You have to know how and when to do one or more of these techniques in the actual sexual situation. The theoretical
knowledge of them is only the first step to achieving ejaculatory control. And you should know that if you reach the
point of ejaculatory inevitability, nothing will help. Relax and enjoy your ejaculation and try again next time.
Remember: practice makes perfect.
What follows is a simple set of exercises designed to develop these skills and your correct timing of their application.
Step 1
Relaxation training assisted by the GSR2 (in manual). Practice this technique until you feel proficient at it.
Step 2
Breathing training (in manual). Do the same as #1.
Step 3
Masturbation practice.
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1. Begin masturbating.
2. Feel yourself becoming more sexually aroused.
3. Stop stimulating yourself by:
a) Stop rubbing and/or,
b) Focusing on breathing slowly and relaxing your muscles and/or,
c) Shifting your thinking to something neutral.
4. If must have done this before you reached the point of ejaculatory inevitability you will find you are losing your
sexual excitement and have not ejaculated.
5. If you have done this too late there is nothing you can do to prevent yourself from ejaculating. Relax; enjoy it and
better luck next time.
6. Resume stimulating yourself and repeat step 3 if you didn't ejaculate.
7. Having lowered your sexual excitement twice and controlled your ejaculation, stimulate yourself again and allow
yourself to ejaculate.
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8. Practice this 2-3 times per week for three week. As your practice continues you should be trying to rely less on
stopping rubbing yourself (the goal is to just slow down the rubbing and lighten the pressure) and more and more
on breathing - relaxation and distraction. When you apply this technique to the actual intercourse situation you
will find that your partner enjoys this variation in your rate of thrusting.
8a. Some men need to proceed through their masturbation training in two stages:
1. Masturbate without lubrication.
2. When that is mastered, add lubrication (like K-Y lubricant).
The reason for this is that for some men the sensation of the lubrication of their partner’s vagina is such a powerfully
conditioned sexual stimulant that they instantly, upon penetration, have an overwhelming urges to ejaculate.
9. During the three weeks of your masturbation training you and your partner will be doing something different.
a. Explain to her that you are going to be following a program designed to allow you to penetrate longer by
giving you control over your ejaculation.
b. During this time you would like her cooperation in refraining from sexual intercourse when you get
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together.
c. And that you would like to substitute relaxing non-genital message (you each take turns massaging the
other).
d. The goal of this exercise is to create a non-pressured, reliving physical interaction on which the next steps
in this program will be based.
After you have practiced masturbating alone and engaged in non-genital massage with your partner for 3 weeks, you
are ready for the next step.
10. When you are together, ask your paper to stimulate your penis.
11. When you feel the now-familiar warning sign that you are approaching the point of ejaculatory inevitability have
your partner stop (or slow down) the stimulation while you breathe-relax and/or distract yourself.
12. Initially you might have to have her stop stimulating you entirely but as you continue this practice your goal is to
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allow the stimulation to continue at a reduced rate while controlling your sexual arousal by breathing, relaxing and
distraction.
13. Do this twice and the third time allow yourself to ejaculate.
14. During this phase of your ejaculatory control training (which for most men lasts 2-4 weeks if they are having
sexual contact with their paper 2-3 times per week) most men stimulate their partner to orgasm before or after their
ejaculatory control practice.
14a. Some men need to proceed through this partner masturbation experience in two or three stages.
Stage 1: partner stimulates without lubrication.
Stage 2: partner stimulates with lubrication (like K-Y lubricant).
Stage 3: partner stimulates orally.
The reason is the same as during the personal masturbation training - to slowly get used to the lubrication sensation.
15. You are now ready to apply what you have learned to the actual intercourse situation.
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16. As you and your partner engage in foreplay, monitor your sexual arousal. Use your three ejaculatory control
techniques singly or in combination to control your sexual arousal to avoid reaching the point of ejaculatory
inevitability.
17. You may find that, at first, once penetrated, you have to completely withdraw your penis from your partner's
vagina in order to reduce your sexual arousal.
18. But fairly soon you should find you are able to stay penetrated either not thrusting or thrusting slowly and further
control your sexual arousal by breathing-relaxation and/or distraction.
19. As you develop control over your ejaculation you will find your sexual experience enters a new level - as you
allow your arousal to increase, but then back off "just in time to prevent ejaculation'' and as you learn to balance
on the edge" of ejaculatory inevitability. The length of time of the penetration experience, your variation in
movement and your own prolonged sexual excitement will allow you and your partner to experience a whole new
level of sexual pleasure. You may significantly extend the peak sexual experience for yourself and your partner.
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