Squeeze Technique

Description of the Strategy

The squeeze technique was introduced as a modification of the earlier behavioral treatment for premature ejaculation, termed the pause, or stop-start procedure. With both, the partner of the patient is instructed to sit between his legs facing him, and to masturbate him. The patient monitors his arousal and when he feels he is about to ejaculate informs his partner. Unlike the stop-start procedure, when the partner then temporarily ceases stimulation, the partner carries out a penile squeeze. She or he places the first finger on the subject's glans penis, the second fingers just below it, and the thumb under it, and firmly but not painfully squeezes the glans. This inhibits ejaculation and usually results in some loss of erection. The partner then recommences masturbation. It can be helpful if a diagram is used to instruct the partner how to carry out the squeeze. When the patient is maintaining an erection for several minutes before being about to ejaculate, the couple proceeds to have coitus. This is commenced with the patient lying on his back and not thrusting while stimulated by the partner sitting on his penis. If the patient feels about to ejaculate prematurely, he informs his partner. The partner then ceases stimulation by raising herself or himself off the penis and, if necessary, uses the penile squeeze. Alternatively, the partner stops moving, and the patient squeezes the base of his penis. Both the stop-start and the squeeze technique have been reported to be used successfully with self-masturbation by men without partners who had anxieties about premature ejaculation.

Research Basis

There is no research demonstrating that the stop-start and squeeze techniques have effects beyond those of suggestion. A significant number of men report an immediate satisfactory response, but it is not established that this is specific rather than due to reduction in anxiety and reassurance equivalent to that which would follow placebo therapy. Also, the techniques are usually employed as part of a cognitive-behavioral approach to treatment of sexual dysfunctions, which includes improvement of the couple's communication about their sexual and emotional relationship. The evidence is substantial that the nature of a couple's communication is much more significant than the presence of sexual dysfunctions in determining sexual satisfaction. Improved communication could lead to the couple finding premature ejaculation no longer a problem. There is as yet no accepted operational definition for premature ejaculation and hence no certainty that subjects treated in research studies have comparable conditions. The DSM-IV-TR diagnosis involves persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration. The diagnostician has to take into account factors that could affect the duration of the excitement phase, and the patient must believe the condition causes marked distress or interpersonal difficulty. Premature ejaculation would not be diagnosed in men who report they experience it but do not consider it a problem for themselves or their partners. A representative United States population sample found that 28% of men aged 18 to 59 reported a period of several months or more in the previous year when they came to a climax too quickly. Three-year follow-up studies of men with premature ejaculation reported improvement in about 40% who were not treated and a high relapse rate in those who initially responded to treatment.

...