This document discusses individual therapy versus couple therapy for treating premature ejaculation. It notes that premature ejaculation is often a couple issue rather than just a problem with the male partner. Proper evaluation of the couple can determine whether individual or couple therapy is most appropriate. Couple therapy techniques are described to improve emotional intimacy, such as non-sexual touching, sexual touching including clitoral stimulation, and learning to penetrate only on demand once arousal has occurred. The goal is to help the female partner achieve orgasm more quickly to paradoxically help treat premature ejaculation issues.
Premature Ejaculation individual or couple therapyajayanvaru
THERE IS ABSOLUTE PREMATURE EJACULAION MALE PARTNER IS UNABLE TO PENETRATE OR WITHIN FEW SECONDS EJACULATION TAKES PLACE
BUT IN MOST CASES IT IS COUPLE ISSUE
OUR AIM IS TO FIND
Is it carpenter issue
or issue of wood
or both
PME can be considered as a couple issue in most cases
Tantric Sex is a New Age practice that stems out of traditional Hindu Tantra. Essentially, tantric sex is prolonged lovemaking to achieve and transcend the human orgasm. It is about building very slowly towards orgasm so that it may be extended and eventually surpassed. It focuses on touch, gaze, breath, and all aspects of sex equally, not only penetration. Tantra is not orgasm-centric, it attempts to make the entire experience an erotic experience of arousal that is much more than a means to an end.
Here are 6 Powerful Tricks to Last Longer in Bed Naturally without pills so you can overcome early ejaculation and last longer tonight.
************Other Search Terms***************
how to last longer in bed
how to last longer
last longer in bed
how to last longer in bed for men
how to last longer during sex
lasting longer in bed
last longer
lasting longer
tips to last longer in bed
how to last longer in bed naturally
tricks to last longer in bed
last longer in bed tips
last longer in bed naturally
tips for lasting longer
last longer in bed for men
ways to last longer
what can i do to last longer in bed
last longer in bed techniques
last longer during intercourse
you can last longer
men last longer in bed
tips on how to last longer in bed
last longer in bed exercises
how do you last longer
i want to last longer in bed
training yourself to last longer in bed
The Anterior Chest Wall Release was originally called the Thoracic Inlet Release, which is semantically misleading and anatomically incorrect. The fascia throughout the anterior and posterior chest wall is the only known physical structure that can be affected during this release.
Premature Ejaculation individual or couple therapyajayanvaru
THERE IS ABSOLUTE PREMATURE EJACULAION MALE PARTNER IS UNABLE TO PENETRATE OR WITHIN FEW SECONDS EJACULATION TAKES PLACE
BUT IN MOST CASES IT IS COUPLE ISSUE
OUR AIM IS TO FIND
Is it carpenter issue
or issue of wood
or both
PME can be considered as a couple issue in most cases
Tantric Sex is a New Age practice that stems out of traditional Hindu Tantra. Essentially, tantric sex is prolonged lovemaking to achieve and transcend the human orgasm. It is about building very slowly towards orgasm so that it may be extended and eventually surpassed. It focuses on touch, gaze, breath, and all aspects of sex equally, not only penetration. Tantra is not orgasm-centric, it attempts to make the entire experience an erotic experience of arousal that is much more than a means to an end.
Here are 6 Powerful Tricks to Last Longer in Bed Naturally without pills so you can overcome early ejaculation and last longer tonight.
************Other Search Terms***************
how to last longer in bed
how to last longer
last longer in bed
how to last longer in bed for men
how to last longer during sex
lasting longer in bed
last longer
lasting longer
tips to last longer in bed
how to last longer in bed naturally
tricks to last longer in bed
last longer in bed tips
last longer in bed naturally
tips for lasting longer
last longer in bed for men
ways to last longer
what can i do to last longer in bed
last longer in bed techniques
last longer during intercourse
you can last longer
men last longer in bed
tips on how to last longer in bed
last longer in bed exercises
how do you last longer
i want to last longer in bed
training yourself to last longer in bed
The Anterior Chest Wall Release was originally called the Thoracic Inlet Release, which is semantically misleading and anatomically incorrect. The fascia throughout the anterior and posterior chest wall is the only known physical structure that can be affected during this release.
Here are some of the tips for men to last longer during sex. The causes and symptoms are also listed. Check it now and know if you are a one minute guy or not. An average man should be able to last for 6 minutes in bed.
In this article, we will guide why you deserve to orgasm with your partner and the common mistakes that you will be doing while trying to orgasm with your partner.
If you have experienced a similar thing and you are not able to do so. Then, first of all, nothing is wrong with you. It’s very common to orgasm yourself, but find it difficult to do the same with your partner? Here, the anatomy of sex plays a very important role. In Layman language, it refers to the both the external sexual organs, like the vulva and penis, and the internal organs involved in reproduction, like the uterus and seminal vesicle. We categorize this anatomy as either female or male, but not necessarily the person. So, to improve the level of Anatomy of sex you must focus on your diet, physical body and fitness and a healthy internal body system.
Why Orgasm with A Partner Matters?
Orgasming a partner can be a satisfaction or an enjoyable experience for both partners. Making your partner orgasm is partly depends on the feelings between each other, comfort level, and the level of communication during the sexual practice. Good sex is considered when both partners are happy with each other. You have to talk to your partner that what makes her feel good, what turns you on, what to keep doing, and what to stop.
Whether it happens at the same time with your partner or not, there are a lot of benefits to having an orgasm.
1. Orgasm helps in reducing stress levels. It helps in improving quality sleep and increases the estrogen level in women.
2. Frequent orgasm in men can help them to decrease the risk of prostate cancer and even provides a long lifespan.
3. Having an orgasm with the partner simultaneously helps to improve the bonding level with each other and to get closer in a relationship.
After giving you the importance of an orgasm in a healthy relationship, now let’s discuss the reasons why you’re not able to orgasm with your partner.
Why you are not able to orgasm with your partner?
Here are some of the reasons why you were not able to orgasm with your partner.
1. Lack of Communication: Communication is very important during sex. Having proper communication with each other encourages your partner to do what feels good to you and avoid things that are not working. Sexual communication is a skill, the more you practice the better you will be.
2. Problem in the Relationship: Having an orgasm during sex fully depends on how effective is your relationship with the partner. If you are not happy with your relationship, then your mind is rapidly not thinking about the orgasm and happiness with your partner. You are just doing so as your partner said so. The first step towards having an orgasm with your partner is to be happy, relaxed, and in a comfort mode.
3. Distraction: It is essential to dedicate attentively to an erotic stimulus for reaching orgasm. Distractions can reduce the arousal level to a point where orgasm is simply not possible.
this presentation is about a sexual disorder, which will help students to know about and will provide them with the guidance about the treatment of painful intercourse or Genito-pelvic pain penetration disorder.
SHARE Presentation: Sexuality and Intimacy after Cancer with Dr. Mindy Schiffmanbkling
The diagnosis and treatment of breast or ovarian cancer can profoundly affect body image, intimacy, and sexuality, leading to concerns about feeling and being desirable, as well as fears of negative reactions from partners. Dr. Mindy R. Schiffman, Clinical Psychologist and Sex Therapist, NYU Langone Fertility Center, will discuss ways to counter the emotional and sexual fallout of a cancer diagnosis and treatment.
Premature ejaculation is the most common male sexual dysfunction. It affects about a third of men at various times in their lives, with little variation depending on age and continent.
Overview and Management of Vaginismus in Malaysia. Case-based discussion. 2nd National Mind and Body Seminar: Vaginismus Dare to Treat at Putrajaya, 27th October 2017.
Health Benefits of Female MasturbationMedisys Kart
Unlike the male masturbation, female masturbation is really not much discussed or even acknowledged. However, there are some of the benefits of female masturbation discussed in presentation.
A New Revolutionary Concept Via Sound therapy embedded with pure scalar frequencies.
THE FUTURE OF MEDICINE IS HERE...
CLICK ON THE LINK BELOW TO SEE MORE DETAILS:
http://717154d0.app.clickbankbuilder.com/public/pages/a8bc122c-177f-4a62-8cac-224dff7c2565.html?hop=0
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Here are some of the tips for men to last longer during sex. The causes and symptoms are also listed. Check it now and know if you are a one minute guy or not. An average man should be able to last for 6 minutes in bed.
In this article, we will guide why you deserve to orgasm with your partner and the common mistakes that you will be doing while trying to orgasm with your partner.
If you have experienced a similar thing and you are not able to do so. Then, first of all, nothing is wrong with you. It’s very common to orgasm yourself, but find it difficult to do the same with your partner? Here, the anatomy of sex plays a very important role. In Layman language, it refers to the both the external sexual organs, like the vulva and penis, and the internal organs involved in reproduction, like the uterus and seminal vesicle. We categorize this anatomy as either female or male, but not necessarily the person. So, to improve the level of Anatomy of sex you must focus on your diet, physical body and fitness and a healthy internal body system.
Why Orgasm with A Partner Matters?
Orgasming a partner can be a satisfaction or an enjoyable experience for both partners. Making your partner orgasm is partly depends on the feelings between each other, comfort level, and the level of communication during the sexual practice. Good sex is considered when both partners are happy with each other. You have to talk to your partner that what makes her feel good, what turns you on, what to keep doing, and what to stop.
Whether it happens at the same time with your partner or not, there are a lot of benefits to having an orgasm.
1. Orgasm helps in reducing stress levels. It helps in improving quality sleep and increases the estrogen level in women.
2. Frequent orgasm in men can help them to decrease the risk of prostate cancer and even provides a long lifespan.
3. Having an orgasm with the partner simultaneously helps to improve the bonding level with each other and to get closer in a relationship.
After giving you the importance of an orgasm in a healthy relationship, now let’s discuss the reasons why you’re not able to orgasm with your partner.
Why you are not able to orgasm with your partner?
Here are some of the reasons why you were not able to orgasm with your partner.
1. Lack of Communication: Communication is very important during sex. Having proper communication with each other encourages your partner to do what feels good to you and avoid things that are not working. Sexual communication is a skill, the more you practice the better you will be.
2. Problem in the Relationship: Having an orgasm during sex fully depends on how effective is your relationship with the partner. If you are not happy with your relationship, then your mind is rapidly not thinking about the orgasm and happiness with your partner. You are just doing so as your partner said so. The first step towards having an orgasm with your partner is to be happy, relaxed, and in a comfort mode.
3. Distraction: It is essential to dedicate attentively to an erotic stimulus for reaching orgasm. Distractions can reduce the arousal level to a point where orgasm is simply not possible.
this presentation is about a sexual disorder, which will help students to know about and will provide them with the guidance about the treatment of painful intercourse or Genito-pelvic pain penetration disorder.
SHARE Presentation: Sexuality and Intimacy after Cancer with Dr. Mindy Schiffmanbkling
The diagnosis and treatment of breast or ovarian cancer can profoundly affect body image, intimacy, and sexuality, leading to concerns about feeling and being desirable, as well as fears of negative reactions from partners. Dr. Mindy R. Schiffman, Clinical Psychologist and Sex Therapist, NYU Langone Fertility Center, will discuss ways to counter the emotional and sexual fallout of a cancer diagnosis and treatment.
Premature ejaculation is the most common male sexual dysfunction. It affects about a third of men at various times in their lives, with little variation depending on age and continent.
Overview and Management of Vaginismus in Malaysia. Case-based discussion. 2nd National Mind and Body Seminar: Vaginismus Dare to Treat at Putrajaya, 27th October 2017.
Health Benefits of Female MasturbationMedisys Kart
Unlike the male masturbation, female masturbation is really not much discussed or even acknowledged. However, there are some of the benefits of female masturbation discussed in presentation.
A New Revolutionary Concept Via Sound therapy embedded with pure scalar frequencies.
THE FUTURE OF MEDICINE IS HERE...
CLICK ON THE LINK BELOW TO SEE MORE DETAILS:
http://717154d0.app.clickbankbuilder.com/public/pages/a8bc122c-177f-4a62-8cac-224dff7c2565.html?hop=0
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
For Better Surat #ℂall #Girl Service ❤85270-49040❤ Surat #ℂall #Girls
Pme individual or couple therapy
1. PREMATURE EJACULATION
INDIVIDUAL THERAPY V/S COUPLE
THERAPY
DR : AJAYAN VARUGHESE
CHAIRMAN INTERNATIONAL ASSOCIATION OF SEXUAL MEDICINE PRACTITIONERS
(MODERN MEDICINE )IASMP (MM)
DIRECTOR ISRM
M.B.B.S,
M.Sc Applied Psychology
P.G.C.C (Psychiatry and Psychosexual Medicine)
P.G.D.H.Sc ( Reproductive and Sexual medicine)
2. PREMATURE EJACULATION
• Premature Ejaculation (PE) occurs when a
man ejaculates before he or his partner
want climax to happen.
• Primary PE- the problem starts with their first
sexual experience
• Secondary PE -it happens after a period of
normal sexual functioning.
3.
4.
5.
6.
7. A 2008 survey of Canadian and American
therapists stated that the average time
for heterosexual intercourse was 7
minutes.
1 TO 2 MINUTES SHORT
3 TO 7 MINUTES ADEQUATE
7 TO 13 MINUTES DESIRABLE
13 TO 30 MINUTES TOO LONG
8. Kindly note in
Germany women gets 7.4
minutes and men ejaculates at
6.9 minutes. Here women
doesn’t get sexual orgasm but
we cannot consider male
partner do have any problem.
9. • THERE IS ABSOLUTE PREMATURE EJACULAION MALE
PARTNER IS UNABLE TO PENETRATE OR WITHIN FEW
SECONDS EJACULATION TAKES PLACE
• BUT IN MOST CASES IT IS COUPLE ISSUE
• OUR AIM IS TO FIND
• Is it carpenter issue
• or issue of wood
• or both
PME can be considered as a couple issue in most cases
10. Limitations of Psychotherapy for PE
➢Lack immediacy
❖Therapy takes time to be effective
➢Efficacy
❖Good initially
❖Tends to diminish over time
➢More difficult to treat men not in stable relationships
❖Having a motivated and supportive partner is
helpful
➢Time consuming and costly
11. Dapoxetine and Paroxetine are effective on demand
basis
OFF LABEL DRUG Tramadol is also effective (on
demand)
MAIN DRAWBACK IS ALL OF THESE DRUGS
INDUCES ED
SSRI
12. HOW TO SELECT THE COUPLE FOR THERAPY
PROPER DATA COLLECTION FROM THE COUPLE CAN HELP US
WHETHER INDIVIDUAL THERAPY OR
COUPLE THERAPY IS REQUIRED
ABSOLUTE PME CAN BE MANAGED BY INDIVIDUAL THERAPY
(Treating the Male partner)
If the female partner need TOO LONG time to achieve orgasm it
can be managed by treating female partner
(it cannot be considered as PME ..)
ALL OTHER PME CAN BE MANAGED BY COUPLE THERAPY
13. Instead of treating male partner alone we have
to treat female partner or we have to start couple
therapy.
14. If the male partner can attain 7 to
13 minutes we have to include
female partner also in therapy
15. Can sexual orgasm attained earlier by
any method?
There is no pharmacotherapy .
But there are some
behavioral techniques.
17. IMPROVING
Emotional intimacy
is a time consuming process
By improving
emotional
intimacy time
for attaining
sexual
orgasm Can
be reduced.
18. METHODS TO IMPROVE Emotional intimacy
1. Promotion
2. Nonsexual touch
3. Sexual touch
4. Clitoral and Nipple ...stimulation
5. Penetrate on demand only
6. Valedictory
19. PROMOTION
Women are different from men
Ask what she needs to be happy
and listen.
Women typically need listening,
not solutions (she is already competent).
Never ask a woman to get to the point.
21. Never the spouse feel that
male partner is Lying, cheating
Male partner must be able to say sorry
even if he does not commit the mistakes
Do Not blame her for all the trouble
even if she commits a mistake
22. 1. Avoid pattern of bad relationships
2. She should not feel that
You are ambivalent
3. NO Physical Trauma
4. NO Emotional Trauma
23. Praise her
eg: The food You have prepared was So
tasty (of course the spouse must lie)
25. NON SEXUAL TOUCH
Her skin is 10Xs more sensitive.
Touching is a subtle , powerful and
complex form of communication
correct touching helps to advance the
relationship
26. WHERE TO TOUCH
START with a light brief touch on the arm
to draw attention
Perform each touch at least twice before progressing
to the next level Advance in the following order
Hand squeeze, Holding brief knee touch Arm
over shoulder
PROGRESS TO HUGGING
27. Touching
gently on
toes and foot
can improve
the emotional
intimacy
BECAUSE GENITALS
ARE VERY CLOSE TO
BIG TOE IN BRAIN
28. Non sexual touch should
continue for 1-2 weeks
If the tuning is perfect
GO FOR SEXUAL TOUCH
30. Clitoris and Vagina
the Queens of Female sex organ
Stimulation of clitoris
1 . simply rubbing the clitoris with one hand
palpating the breast with other hand
2 .“Masturbating” the clitoris with one hand
palpating the breast with other hand
31. start with breast and labium
soft touch is beneficial
duration 10-15 metes
during this period verbal
communication is advocated
32. 1) Simply rubbing the clitoris with one hand
palpating the breast with other hand
(Never do any painful activities)
During this method gradual mood elevation from
the female partner can be seen
Check the Vagina for Lubrication
33. • Clitoral stimulation
• Hold the clitoris with your two fingers
stimulate it with to and fro movement
ask the patient whether you are being
sexually excited
• After completing this check for the
Lubrication without putting the finger
inside
• if lubrication is there
-- it is a good sign
34. If she feels comfortable continue the clitoral
stimulation Now the male partner can penetrate the
finger in the vagina and stimulate her.
35. 2 “Masturbating” the clitoris with one
hand palpating the breast with other hand
Hold the shaft of the clitoris with thumb and
index finger “masturbate” as how male do
Erection of clitoris can be felt
Check the vagina for lubrication
CONTINUE THE SAME PROCESS of FIRST
METHOD
36. if the lubrication is present
Male partner can penetrate the
finger inside and
GO FOR
TO AND FRO MOVEMENTS
37. Finger insertion to vagina can be done at
the end of this stage if the vagina is wet
Go for clitoral stimulation
38. Penetrate on demand
If sexual arousal and sexual desire
is achieved female partner
will demand for penetration
39. By all this methods we can reduce the
time for attaining sexual orgasm in
female.
Thus paradoxical premature ejaculation
can be treated.
40. Secondary PME
IF PREMATURE EJACUTION OCCURS TO
NORMAL EJACULATING MALE
1 ) IT MAY BE INTIAL STAGE OF DEVELOPING
ED( CAN BE DIAGNOSED BY
ADMINISTRATION OF PDE5 INHIBITORS
2)PROSTATE PATHOLOGY
(By proper investigation ,Usg ,PSA )