ISD Treatment. So how can the man (and the couple) revitalize sexual
desire? The keys are to rebuild positive anticipation of sharing pleasure and eroticism; to value your partner as your intimate, erotic friend; to adopt the Good-Enough Sex model of pleasure-oriented couple sex; to experiment with blending self-entrancement arousal, partner-interaction arousal, and role-enactment arousal; to change health behaviors so you have more sexual energy; to view intercourse as a natural continuation of erotic flow and a special erotic technique, not a pass–fail test; to emphasize a variable, flexible approach to couple sexuality; to utilize testosterone to enhance sexual desire; and to maintain a regular rhythm of sensual, playful, and erotic connection and intercourse.
Ejaculatory Inhibition (EI)
Ejaculatory inhibition (EI) is the unspoken male sexual dysfunction, often misunderstood as ED. Among men over age 50, EI affects as many as 1 in 8 men. Again, the best assessment/treatment model is a couple psycho-biosocial approach. There are many possible causes and dimensions of EI from depression, to excessive masturbation, to side effects of medications to fatigue. The most common cause is not valuing couple sex, instead falling into a mechanical intercourse routine that is no longer exciting and arousing. Men typically transition to intercourse at the start of an erection, with a subjective arousal of 4 or 5, and approach intercourse as simply a matter of thrusting. When orgasm isn’t attained, the result is frustration and loss of erection.
EI Treatment. Key treatment strategies include using multiple methods of stimulation during both pleasuring and intercourse; piggybacking your arousal on your partner’s; transitioning to intercourse when you have higher subjective arousal (7 or 8); using erotic fantasies to heighten subjective arousal; being aware of and using orgasm triggers (i.e., the cues/resources you use during masturbation to allow you to let go and “come”); making requests of your partner for erotic stimulation as well as taking personal and sexual risks (including self-stimulation mixed with partner stimulation to enhance arousal); and allowing yourself to go with the erotic flow rather than try to force orgasm.