Sex therapy usually begins with a few days of sensate focus, when the man should not have an ejaculation by masturbation or partner interaction. If his partner desires orgasm, this can be accomplished in whatever fashion is comfortable for both partners. The next step is for the man to stimulate himself to orgasm with his partner present. Once both partners feel comfortable with the man masturbating, the couple can move on to the next phase, where the partner attempts to bring him to orgasm with whatever stimulation is most arousing. It may take several sessions before the partner’s stimulation produces an ejaculation, and it is important for the man not to ejaculate by masturbation during this period. Most therapists agree that once he can reach orgasm by his partner’s touch, an important step has been accomplished.
When the man is ejaculating consistently in response to partner stimulation, the couple can move on to the final phase of treatment, in which ejaculation takes place during penetration. After building arousal by other means, the couple tries penetration. If he does not ejaculate shortly after penetration, he should withdraw and resume other stimulation until he is about to ejaculate, at which point the couple resumes penetration. Once the man experiences a few ejaculations during penetration, the mental block that is usually associated with ejaculatory disorder often disappears. In addition, psychotherapy to understand and resolve deeper personal or couple problems may be necessary to resolve male orgasmic disorder.