The male is encouraged to lie flat on his back and the female to mount in a superior position, her knees placed approximately at his nipple line and parallel to his trunk.
The nearer the two individuals are to the same height, the nearer the woman's knees should be placed to the nipple line. If the wife has the shorter trunk, she should place herself somewhat below the nipple line. If the wife has the longer trunk, her knees should be just above the nipple line.
Leaning over her mate at a 45-degree angle, she is comfortably able to insert the penis and then to move back on, rather than sit down on the penile shaft.
The penis to full erection and employing the squeeze technique two or three times for his control orientation
The wife then should mount in this specifically described superior position. Once mounted, she should concentrate on retaining the penis intravaginally in a motionless manner, providing no further stimulation for her husband by thrusting pelvically.
Her physical restraint enables the husband to become acquainted with the sensation of intravaginal containment in a non demanding, therefore non threatening, and environment. No longer does he respond to the subconscious concept that his wife is ready to force his ejaculatory process to an unhappily rapid conclusion by overt physical expression of her own sexual desire.
For the established premature ejaculator the ultimate of sexual stimulation occurs with the mounting opportunity and during the first few seconds of intravaginal containment. If the man with inadequate control has not ejaculated prior to intravaginal penetration he will do so in short order, once penile containment has been accomplished, when there is any suggestion of active pelvic thrusting on his wife's part.
When his wife cooperates fully in the superior coital position and in the sexually non demanding fashion of penile containment described above, she enables her husband to concentrate on the concepts of ejaculatory control elicited by the squeeze technique and additionally to become accustomed to the stimulative effect of intravaginal containment.
During the husband's level of sexual excitation threatens to escape his still shaky control, he should immediately communicate this increased sexual tension to his wife. She then can elevate from the penile shaft, apply the squeeze technique in the previously practiced manner for 3 or 4 seconds, and reinsert the penis, again providing full vaginal containment without the added stimulus of pelvic thrusting.
The specifically described female-superior coital position makes pelvic elevation from the penile shaft physically easy for her so that the squeeze technique can be applied rapidly to the proper area of the penis, if threatened loss of ejaculatory control develops.
In subsequent days, with some degree of performance reliability established for penile containment in the female-superior position, the husband is encouraged to provide just sufficient pelvic thrusting to maintain his erection. Again the wife is requested to maintain the specifically fixed superior position without active pelvic thrusting.
If man and woman lie together with the penis in intravaginal containment without either partner providing some degree of pelvic thrusting, the man will tend to lose his erection after a short period of time, just as the woman will note marked reduction in the rate of lubrication production.
This physiological evidence of reduction in sexual tension is:
Due to the fact that both marital partners become distracted by any long continued state of sexual inactivity, losing focus on the sensate pleasure inherent in the principle of quiet vaginal containment.
It should be emphasized to the couple that success in ejaculatory control in the female superior position is but another psycho physiological step toward effective coital functioning in any desired coital positioning. It is an important psychological step in providing further relief for both husband's and wife's fears of performance.
With a "healthy skepticism" attitude encouraged by authority, both members of the couple develop insight into the fact that they are accomplishing their own "cure." Through their physical cooperation and increasingly effective verbal and nonverbal communication, ejaculatory control is developing.
Proof positive of improved control develops by the second or third day's exposure to the female-superior coital position in that 15 to 20 minutes of intravaginal containment without untoward ejaculatory demand is a relatively routine accomplishment.
Yet another important factor coming into focus at this stage in the development of the husband's voluntary ejaculatory control is the cooperative wife's level of sexual responsivity. Indeed many women married to premature ejaculators have never been orgasmic in the marriage, and most of those women that have been orgasmic in the marriage have obtained this release through manipulative or oral-genital techniques rather than coital opportunity.
Intercourse in married couples attention obviously has been focused upon the male partner for the first few days of the therapeutic program, yet the wife may have experienced an elevation of sexual tension far superior to levels she might have anticipated. There are many reasons for this sex tension increment, the most prominent of which should be considered in some detail.
During the sensate-focus phase of the therapy, there is mutual "pleasuring". Usually her levels of sexual responsivity elevate rapidly under these most advantageous conditions. There is physical closeness and holding, development or redevelopment of communication, and markedly increased warmth of understanding between husband and wife.
Many of the misconceptions, fallacies, or even the taboos relating to the couple's prior sexual interaction have been faced, examined, explained in depth, and, to a major degree, reversed or mutually accepted during daily interviews with the cotherapists. There is no environment more conducive to marked elevation in the levels of female sexual response than that occasioned by the concept that something is happening of a positive nature to reduce or eliminate the couple's sexual dysfunction.
As both husband and wife cooperate in the pleasuring opportunity, the increasing warmth of their interpersonal relationship is a hopeful support for the emotionally insecure woman that .the wife of a premature ejaculator usually becomes after years of sexual frustration.
During manipulative phase of the squeeze technique there concomitantly is further increase in the level of female sexual tension. When the wife provides controlled play for her husband and observes both the physical pleasure she provides and his obvious delight in progress toward ejaculatory control, these reactions are reflected as positive and highly stimulative biophysical and psychosocial influences. In short order the wife finds herself highly excited sexually and strongly motivated toward orgasmic release.
Although the wife is instructed to avoid pelvic thrusting, the initial period of intravaginal penile containment provides her with the simultaneous opportunity to feel and think sexually, not infrequently for the first time in her marriage. The sensate pleasures of non demanding penile containment have not been available to her in view of the couple's basic sexual dysfunction.
When there has been sufficient ejaculatory control to accomplish penetration, the actual act of physical connection usually has been followed immediately by the wife's straining demand for tension release. Alternatively, if past sexual patterning has forced her to lie quietly after penetration in the vain hope of avoiding forcing her husband to ejaculation, the entire psycho sexual experience of coital connection has been focused on his battle for ejaculatory control rather than on providing her with any expression of freedom to enjoy personal sexual responsivity.
Contending with a husband fighting a constant battle for ejaculatory control not only engenders severe sexual frustration for the wife but also over the years produces in her a distinctively negative attitude toward sexual expression.
When in the female-superior coital position with intravaginal containment of the penis and even with controlled restriction of pelvic movement, the wife has been directed simply to feel and think sexually and to enjoy the sensation of vaginal distention. Following these suggestions, the proprioceptive pressures created by intravaginal containment of the erect penis are subjectively anticipated and appreciated. The wife gains almost as much from this stage in the exercise of ejaculatory control as does her husband.
Thus, the combination of subjective relief of fear for her husband's inadequacy of sexual performance plus the opportunity to feel, think, and relate sexually are enormously stimulating to the female partner. As her partner's control increases, female pelvic thrusting can be encouraged, initially in a slow, non demanding manner, but soon with full freedom of expression. Once sexual tensions, built from both freedom for biophysical-system response and growing confidence in the psychosocial elements of the unit's interpersonal relationships, are released to be enjoyed at will, orgasmic expression becomes a natural potential.
In the voluntary development of ejaculatory control is entered as the couple is encouraged to convert the female-superior position to that of the lateral coital position. In the lateral coital position there is a maximum opportunity for male ejaculatory control. As the husband's sexual tensions elevate, he can withhold active pelvic thrusting yet provide a full controlled erection with which his wife can continue to express her own sexual demands and against which she can relieve her sexual tensions.
In the lateral coital position the woman uniquely has complete freedom of pelvic movement in any direction. There is no pelvic or chest pinning, or cramping of leg or arm muscles. She can respond to her own tension demands as she sees fit, confident that this coital position provides her husband not only with high levels of subjective sexual pleasure but also with the best possible physical opportunity for ejaculatory control.
After becoming secure in the multiple protection the position affords and in the anatomies of leg and arm arrangement, most couples employ lateral coital positioning by choice in at least 75 percent of their coital opportunities.