Psychosexual therapy in idiosyncratic situational delayed ejaculation: a case study

Delayed ejaculation (DE) is a relatively uncommon male sexual dysfunction and remains insufficiently studied in clinical literature. This article reports on the psychosexual therapeutic approach employed in a rare case of primary, situational, and idiosyncratic DE. Clinical assessment revealed that the patient was only able to achieve ejaculation following arousal when he exited the bed and engaged in genital stimulation by rubbing his penis against the floor. A structured intervention grounded in psychosexual couples therapy was implemented. Across eight sessions, the couple was actively involved in therapeutic exercises. The therapeutic goal was to gradually transfer the conditions for ejaculation to the shared sexual setting. Initially, ejaculation was attempted on a hard slab placed on the bed, followed using a towel atop the slab to introduce new tactile stimuli, and subsequently by involving the partner’s hand positioned between the towel and the slab. Individually, the patient was instructed to engage in standing masturbation using the sink surface, followed by a transition to a latex vaginal simulator. Once successful ejaculation was achieved using the latex device in a standing position, the next step involved simulating coitus by masturbating while the partner was positioned in a receptive posture on a table, transitioning to vaginal penetration immediately prior to climax. The final phase of the intervention involved vaginal penetration in the missionary position, with concurrent anal vibrator stimulation provided by the partner. This graduated desensitization and reconditioning strategy ultimately enabled the patient to ejaculate intravaginally.