Teaching the Quiet Vagina Technique

The woman provides some stimulation with a lubricant to produce an erection. Once again, she is told to provide stimulation with the idea that should an erection occur they can proceed. An erection is never prescribed or assumed. She also pre-lubricates herself with ample lubrication in order to minimize friction to the penis thereby keeping stimulation during intercourse to a minimum. Once the man has an erection, she mounts from on top and does not move for the man to gradually become accustomed to intravaginal stimulation without ejaculation. If needed, there can be slight movement to help maintain the erection. For physiological reasons, most men can control ejaculation better when on bottom than when on top. We also instruct the man to relax the large muscles in the buttocks and thighs since these muscles appear to be orgasm triggers when tense. If the man places one hand below his thigh muscle, he will notice there are times when he begins to become tense.

The quiet vagina technique is repeated several times with slowly increasing stimulation or movement. The man must monitor his sensations carefully and let his partner know when to stop or slow down. During the initial phase of this exercise, penetration should be deep and the movement minimal. This type of thrusting pattern means the most sensitive part of the penis is in the posterior portion of the vagina where there aren’t muscles creating friction against the penis. Over the course of several exercises, the pace and length of stroking can be increased such that the glans penis is now moving over the pubococcygeus muscle, which supports the external third of the vagina and he experiences more friction. Once control is achieved using the female superior position, the man can try different positions. The next position is usually male on top, using plenty of lubrication. Once again, he should achieve full penetration and make only short thrusts, slowly increasing the rapidity of movement and length of stroke over time. He is to monitor his sensations and slow down or stop when needed in order to maintain ejaculatory control. Over time his control will improve. The therapist constantly monitors the couple’s progress, adjusting the exercises accordingly. The couple may need to slow down or proceed faster through these exercises. Always check to make sure the man is monitoring his sensations and telling his partner what he needs in order to delay ejaculation. Since the basic principles behind the exercises are described from the beginning, the couple can be good collaborators in setting up the next exercise or modifying the exercise at home without consulting the therapist.

Most of the techniques mentioned earlier can be modified for homosexual couples. Once ejaculatory control is obtained, it is usually stable. Should the man find it difficult to control ejaculation using the pacing method described above, he may practice some of the earlier exercises again. As more control is gained, the time between sessions may be increased, as they need more practice. It is important to increase the time between sessions but not to discontinue treatment. Instead, we recommend that the couple check in periodically, perhaps monthly, until the therapist is certain that ejaculatory control is learned. Follow-up sessions will help maintain his progress.

A man with PE is often pessimistic about ever obtaining ejaculatory control through talk therapy, communication, and homework exercises. When beginning treatment, the couple is told that there is a standard treatment that usually works and will improve ejaculatory control. If the man is told that it might be possible to gain complete ejaculatory control in 10-15 sessions over about 3 months, however, it is likely the therapist will not be perceived as credible. Once the couple has experienced some success, the therapist might discuss the possibility of complete control, but it is wise never to promise something so unpredictable.

Finally, it is obvious that the partner is fully involved in most, if not all these exercises, for him to learn ejaculatory control. The exercise is highly structured for the man with PE. To keep the therapy systemic, the partner should be allowed an equal amount of time they devote to the partner with PE for whatever they want except intercourse. The partner may wish to talk, some types of massage, sexual stimulation, etc. By keeping it systemic, the partner is not only fully involved in helping their partner, but each is also fully involved in giving the other something they desire.