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Hello, and welcome to the Intimacy Institute's course for erectile dysfunction. My name is Daniel Leibowitz and I am the co-director of the Intimacy Institute. I have provided this curriculum to hundreds of men who have benefited from a building awareness of their body, how to regulate their anxiety and tension and increase their sexual functioning through a few easy adjustments so walk through this step-by-step process with me as I helped, you understand how to be in better control of your nervous system and your overall sexual functioning working with erectile dysfunction. I have heard the many, many, many stories of frustration, and disappointment and embarrassment that men have dealt with regarding times when their erections disappeared or didn't show up at all, in a sexual experience and it is incredibly frustrating and hard to hear and experience, until you have a better understanding of what's happening and then what to do about it, A struggle to get an erection is often times the result of your body not responding in the way you want it to, when you are in a sexual situation. Now, I always offer the disclaimer specific to erectile functioning that it is worthwhile to go and see your doctor and discuss any physical changes. Any health changes that you've experienced because sometimes erectile functioning can be related to other health issues that are worth investigating and making sure that your health is taken care of. For many other men erectile functioning is a result of fizzy of physiological, responses to psychological conditions. Meaning your mind is feeling anxious, pressured, and worried. And your body is having a response as a result and all of that is tied to your central nervous system. Your central nervous system is the fight or flight response that you are experiencing or or encountering. So, for example, if your body is experiencing that central nervous system activation it thinks that it is fighting for or running away for its life. And so it is trying to help you but what happens during that process of central nervous system activation, is that a number of physiological changes start to take place, specific to erectile functioning. Here's a few of the pieces that play out in the puzzle. One, your breathing starts to change. Usually when you're nervous or anxious or worried, you're going to start taking short shallow breaths up in the chest. And as a result of that, your mind is going to start, realizing your brain is going to start realizing that you have more CO2 built up. And as a result, your brain is going to start worrying about the CO2 build-up. The more you start worrying about the CO2 build-up, you're going to worry about what's wrong The more you worry about what's wrong, the faster, your breathing because the more anxious and concerned you are the more anxious and concerned you are the more CO2 gets built up and it Creating a feedback loop. The downside of this feedback loop is that your body can't activate the parasympathetic nervous system, which is the rest and digest or feed and breed system. I'll get more on to the parasympathetic nervous system and a moment. But just understand that when you are breathing short, shallow breaths up in the chest, that is the result of increased anxiety, worry, stress and tension. The next physiological change to understand is that when your body gets stressed or anxious, or that central nervous system activation takes place. What starts to happen is that your body is going to start to pull all the blood to your most essential organs to keep you alive. So that it's your heart, your brain and your lungs. And in those moments, guess what, your body doesn't consider. Are an essential part of your body to keep blood flow going to your erection. So when your body is pulling all that blood and the intent of that is if you happen to be eaten by a sabor tooth tiger, if it's biting your arm, you're not going to bleed out so it's a beneficial mechanism from an evolutionary standpoint but it's not serving you in the here and now because that nervous anxious energy is activating your nervous system and And as a result, your erection is struggling. So that's another component of how your erection is impacted by your central nervous system activation. Another thing that also tends to happen for men is in increased tension in your muscles. So the tension increasing in your muscles is your body's way of engaging your armor. If you think of your muscles, especially your stomach, your stomach is it So is exposing lots of vital organs, but when you clench your stomach, it's protected by a layer of muscle. So your body is thinking that it is protecting you from the threat that your mind is acknowledging which is that anxiety and worry. The downside of this is that one you are trapping blood flow in the muscle. So when you flex a muscle, you're actually restricting the blood flow. And this happens in particular, in the pelvic floor, which is the group of muscles that if you were to cut urination in the middle of the stream, your pelvic floor is going to be clenched. So it's going to restrict blood flow to your erection thinking that it's helping you. And also because all these other muscle groups are clenched, you're going to be dealing with less blood flow overall. So as a result, blood flow being needed for an erection, you're going to deal with some setbacks there. So that's another way that your nervous system in being engaged and overactivated isn't serving. You one way I like to explain nervous system activation to men. Is that pretty much every single man when they first went through puberty experienced probably involuntary uncontrollable erections, right? So when you first hit puberty, you would notice you'd be bored in math class, kind of sleepy little tired wanting to just doze off and you would get an erection and be spontaneous. It wouldn't even have to be connected to a sexual thought at all. That's because your parasympathetic nervous system, which is the rest and digest system was starting to be activated. What that means is that your body was saying, there's a Comfortable environment, I'm kind of bored. There isn't any environmental threat that I have to deal with. Therefore this is a time to be off duty and that rest and digest or feed and breed system kicks off. I'm also willing to bet that if you've ever done any exercise or played a sport or even just taking a test in math, class during that test, you didn't get an erection because your body experience, a level of stress and anxiety. And as a result, it shifted gears from rest and digest into fight or flight. So that's an easy way to understand that your body. Is responding to lots of different environmental factors, making it feel safe enough to get an erection or creating enough of a setback. That getting an erection can be very challenging. One of the ways I also like to explain this is to think of your penis as a lightning rod in today's society, we talk a lot about thinking with the other head which is sort of implying you're not thinking at all, you're just mindlessly being attracted to whatever you're attracted to. To the truth is, your body is actually going to pick up on all sorts of cues and signals with regards to your comfort, or discomfort your partner's Comfort, or discomfort things on your mind work stress, whether there's an issue in the relationship, you're not dealing with whatever. The case might be your body is going to pick up on the amount of stress and tension. You're carrying long before you might be able to consciously recognize it. And That is going to have a direct impact on your ability, to get an erection. And so you have to figure out how to retrain your body so that your nervous system regulation, isn't running the show and instead, you're able to actively engage your parasympathetic nervous system. I want to focus next on how to begin to engage your parasympathetic nervous system. So again, these are great evolutionary mechanisms that have kept us alive for thousands of years, right? So the benefit of your nervous system being activated and therefore, not allowing you to get an erection is that we didn't get eaten by saber-toothed tigers. The downside is that your brain can't recognize the difference between a modern-day stressful, anxious situation around how sex is going to go with a new partner. or whether or not things will go well in the bedroom with your partner of many years, your brain interprets that as the same level of stress, as if you were about to be attacked by a saber tooth tiger tiger, so we have to be able to separate that and help you learn how To reclaim control of your nervous system. And there's a number of specific things, we're going to walk through around reclaiming, your parasympathetic nervous system as I said before your parasympathetic nervous system is the rest and digest system, which means that salivation starts your body can digest food your body, can fall asleep. It's that sleepy feeling right before you go to bed. And that is also known as the feed and breed system which is basically your body is saying, this is a safe enough environment that I can be distracted and have sex without ignoring other environmental factors that might otherwise be a risk to my well-being. So we want to engage the parasympathetic nervous system as much as possible and deactivate the central nervous system as much as possible to be able to allow your erections to come online. The first place, we're going to focus on is with regards to breath. So as I said, the starting point to begin to hijack and retrain, your central nervous system to engage that rest and digest or feed and breed parasympathetic nervous system is through breath. Now, you can't do this too much. It's something that if you practice this all day, you would probably be better at work at home life. Pretty much across the board. But for now we're just focusing on sexual situations. So, what I want you to do is you're going to sit here. And I like to track right where my rib cage ends, right at the top of my stomach, which is right where my diaphragm is. And when we're taking full diaphragmatic or belly breaths, what happens is that it's next to impossible to have a panic attack in those moments. When you're breathing fully with your belly, couple reasons, one, you're releasing tension in your stomach so you're not Jing, the armor of your muscles and instead you're saying it's safe to relax and let your body unwind. Another part is also that you can get a much Fuller breath and a much Fuller, exhalation through a belly breath, which again, exhales all of those toxins and and CO2 that otherwise would accumulate if you're taking short, shallow breaths up and up in your chest. If you ever watched how a baby breathes, they'll naturally breathe with their whole diaphragm, as opposed to, as you shift. How you breathe the older, you get it tends to shift more up towards your chest. So we're going to retrain, how you breathe. What I want you to do is I want you to put your hand right on that spot where your rib cage, ends and highlight right where that diaphragm is, I like to close my eyes. So I just focus on that. So, I'm going to close my eyes. I'm going to breathe in through my nose and out through my mouth. I'm going to see how full of a breath. I can take that will allow my hand to As far as possible and then I'm going to breathe out and see how far I can let my hand fall. I'm not going to actually be able to touch my spine but I like to imagine breathing out. So completely that my hand is going to touch my spine and my belly is just in the way. What that will do is just make sure that you can get that full exhalation and really begin to regulate your nervous system. So it looks like this I'm just going to demonstrate about maybe three of them. Oh, so you have an idea of what this looks like. I'm going to add another detail which is one that at the beginning men oftentimes find a little strange but I'll say makes a big difference to really double check that you're getting a full exhalation and also that each time you breathe out you're releasing as much tension as possible in your body. What I want you to do is you're going to actually vocalize that breath out and let the sound of your voice reverberate through your body and just sort of melt any tension, you might be experiencing What that looks like is this. It always a movement, or a way of breathing that can make men feel a little uncomfortable or self-conscious, but it goes a long way. There's usually a few things that people notice. So first, when you are getting that full exhalation, you'll notice how much more are you can push out and that allows for that full exhalation and really then allows for a full expansion of breathing in and taking in fresh clean air. That makes a huge difference. The reverberations also help because as As you get that full exhalation you can tell if you have a little bit more air and really push it out. One way, you can tell that this is Shifting you out of central nervous system activation and instead into the parasympathetic nervous system or that feed and breed system is by. When you open your eyes, you'll notice that everything in the room, looks a little foggier you might feel the desire to yawn, you might feel a little sleepy, everything just sort of softens and when everything softens. Your parasympathetic nervous system kicking in. It's the feeling you get right before you fall asleep. Often times. And again, that's your body's way of saying, I feel safe enough that I can be off-duty. That's really what we're going for because we want you to be off duty while also really being able to enjoy the excitement of the moment because it's a safe enough environment. One of the benefits of using your hand to track the breath and making sure you're taking that full deep belly breath. Is that you always have your hand with you another way to track this. If it's hard to sort of get the feel of it in the beginning or just you want to practice it a little bit more fully, is if you lie down on your couch and you put a pillow on the top of your belly, you can take those deep belly breaths. And you'll watch how much A pillow moves rather than your hand and being able to see the pillow. Sometimes, indicates how much movement there is rather than just relying on your hand as the visualization for that. So now that we focused on breath, as the starting point, for regulating, your nervous system which is going to allow your body to feel safe in sexual situations. The next thing we want to do is add to that sense of reassurance and relaxation that you can offer to your body. What we're going to do is something called progressive muscle relaxation. Basically, we're going to start just with our toes. We're going to tent, just our toes, and hold the Tension in our toes for three seconds, and I'll count you down and then you're going to release that tension. And then you're going to tend to your feet and your toes for 3 seconds. And then release, we're going to keep adding more and more body parts to the exercise. Until eventually you're tensing, your whole body and holding that tension. For 3 seconds, one of the areas that I want you to focus on specifically as We are going through this exercise is each time you release. I want you to release tension in your whole body but I really want you to track your pelvic floor. Your pelvic floor, is the group of muscles that. Which is down in your groin. And it's a group of muscles that if you were to stop urinating in the middle of the stream, you would clinch that muscle group or if you're trying to squeeze in a fart. So that muscle group that you contract is your pelvic floor. This is also something that men don't always realize, but involuntarily contracts meaning. You don't even think about it, whenever you feel level of surprise or worse. Worry, for example, if you've ever been driving, which pretty much everybody has had this situation at some point, if you ever been driving and all the sudden you have to slam on the brakes, your body's going to have a startle response and that startled response is going to clench your pelvic floor. So if you are just sit here and pull the sudden try to slam your foot on the ground, you might notice your pelvic floor Contracting. We're going to try to relax your pelvic floor as much as possible because the more relaxed it is the more it can regulate arousal and let blood flow in and out as is appropriate for the situation. The benefit of this exercise is that muscles are like bungee cords. Sometimes you have to stretch them out a little bit to be able to unhook the hook and then let it go slack and that's really what we're doing with your muscles. The more your body can relax your muscles and just Lower your armor. If you think of your armor as your muscles in your body, your way, body's way of trying to protect you. What you're going to do is just release that tension as much as possible for your body. To say, this is a safe environment that I can get lost in this activity and really enjoy it. So how do we begin progressive muscle relaxation as an exercise? What I like to do is I like to close my eyes and I start with just again a few full deep belly The breaths. And each time I relax, I feel myself melting into the chair. Letting my whole body goes slack, and releasing any tension that I'm able to track. So And you can see my whole body, just sort of collapses. I feel that state of rest, that I'm inviting my body into, I'm going to start just with my toes. And I'm going to tense, three, two, one, and release the tension in my toes. Next, I'm going to tense to my feet and my toes and tense. Three, two, one. And release that tension letting my body go Slack. Next, I'm going to tense my calves. and my shins, my ankles and my feet and my toes and tense. Three, two, one. And release. Next, I'm going to tense my hips. I'm going to tense my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release the tension melting into the chair or the couch, or the whatever environment you're in. Just letting your body go Slack. Next, I'm going to tense my pelvic floor, that group of muscles, that we talked about, just a moment ago, my hips, my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release letting that tension go as much as possible. Next, I'm going to tense to my stomach and my lower back, my pelvic floor, my hips, my glutes, my hamstrings, my quads, my ankles shins, calves toes feet, everything from basically, the rib line down and tense, three. Two one and release that tension letting everything go slack. Next, I'm going to have you tense your chest in your shoulder blades, your back, your stomach, your hips, the pelvic floor, your legs, your ankles your feet and your toes and tense. Three, two, one, and release, letting all that tension go. Remembering to take full belly, breaths in between the moments of tension. Next, we're going to tense our hands, and our forearms, our arms, and our shoulders, our chest, our back, our stomach, our hips, the pelvic floor, our legs our feet, and our toes. Everything from the neck down and tense, three, two, one and release. Letting that tension, go melting into whatever chair or bed you're sitting on. As a final one, I'm going to have you. Bring your shoulders up to your ears. You're going to scrunch up your face and your forehead, your scalp, your neck, your arms, your hands, your shoulders, your chest, your back, your stomach, the pelvic floor, your hips, your legs, and your feet, and your toes, your whole body. And we're going to tense, 3, 2, 1, and just release all of the tension that your body might be holding. Take a few breaths before opening your eyes view Full Belly breaths. And just track this feeling in your body. This is the feeling we're trying to replicate when you're interacting in a sexual experience so that your body is relaxed and comfortable and feeling safe. Usually, when people open their eyes from this exercise, they begin to notice it again. Everything's a little bit foggier they might feel the desire to yawn, everything just sort of softens and quiets a little bit as a result, that is your body. Just saying I'm safe and comfortable. We're trying to A that feeling as much as possible with sexual situations which we're going to start moving into in a moment and how to integrate these exercises into improving sexual functioning. For men who are practicing the masturbation segment of this exercise. One thing that I tend to recommend, if one of the moments that erections tend to get lost, is the moment when you're putting on a condom is to masturbate and put on a condom and continue to masturbate. Get your body used to that pause and the interruption of stimulation with a condom on and then get used to the stimulation through a condom so that your body can get used to that on your own and then it isn't as much of a jarring leap to experience that with a partner and expect a smooth transition. One thing that will make a big difference as you're masturbating is to practice losing your erection, and then stimulating yourself back to the point of a full erection. One of the things that men tend to find is that in the moment if they lose their erection. There's a lot of anxiety that pops up and the erection tends to go away in a sexual situation because they feel pressure to make it happen and they don't know if they can make it happen. If you've practiced over and over letting Your erection Wax and Wane meaning sometimes it'll be stronger, sometimes it won't be as firm and continuing to stimulate masturbate, yourself through that, then as that happens during a typical intercourse experience, you don't worry about a, an erection that isn't as firm because you're able to trust that it will become firm again as you continue. There's a lot of different information out there. One thing that a lot of people ask about is does it ever make sense to not masturbate what I think of masturbation as is really training for sexual experiences and it's also your own Relationship to your body. So building up that awareness is incredibly beneficial but the other thing is also that the more you are masturbating, the more likely you are to increase. The number of erections you're getting and the strength of erections because sex is a use-it-or-lose-it skill. If your body is not used to sexual experiences on your own or with a partner. What's going to happen is it's not going to know how to respond. As efficiently or effectively. As if it is very familiar with erections and ejaculation and arousal and by being familiar with that, you know, how to adjust the situation to accommodate the outcome you want. Now, that you have an idea of how we're going to make changes around masturbation. We're going to start to add in some of the mental adjustment to you're going to make so that you can relax and enjoy the experience as much as possible. And when pleasure is present, it's a lot harder to be stressed and anxious about the sexual situation. One analogy, I like to use to make sense of this is Imagine You have the best steak in the world. If you don't like steak. Imagine that it's any other food that you absolutely love. But let's use steak for now. So, you have the best steak in the world, it is world class, and it's right in front of you, but I'm going to make a number of rules around how you eat that steak first, you have to eat that steak and exactly one minute and 38 seconds and you're going to have to chew 232 times per bite of steak and the whole time you're chewing. You have to look to the right, but when you're not chewing, you have to look to the left. And you also can't look at the steak after you've put the bike in your mouth. If I made all those rules, I'm willing to bet you wouldn't even be able to taste the steak as you're trying to track all of the different things you have to pay attention to. That's a pretty good analogy for what happens for men with regards to sexual functioning, when they're trying to have sex because they're tracking all sorts of different situations. They're wondering if their Tanner's having a good time, they're wondering if they're hard enough, they're wondering if their partner likes their body, they're wondering if premature ejaculation is going to happen. They're stressed and worried about the situation. And when you're stressed and worried about the situation, you can't relax and enjoy the experience. So what we're trying to do mentally is instead shift to enjoying that steak as much as possible. So how would you enjoy that steak as much as possible? You would slow down. And focus on all of the different sensations that you can engage in all of the different parts of that experience. So, with the steak, if you were to cut it first, you're going to take a look at it. You're going to notice visually what you see, you're going to notice the marbling you're going to notice how well it's seared, you're going to notice the steam Rising off of it, all the little details that make your mouth water. Just thinking about it and as you move it, closer, You're going to start to smell the steak. You're going to notice all of the smells that start to fill your nose. You're going to immerse yourself in that part of the experience. And then, once you put it in your mouth, you begin to taste. You begin to feel the temperature of the steak you're going to notice all of your taste buds engaged and then you're going to chew it. And you're going to notice all the flavor that begins to take place and you're going to just notice all of those different parts of the equation. You otherwise wouldn't track or pay attention to, if you're rushing through the experience, hoping to avoid something going wrong. Instead what we're going to do is we're going to try to slow it down as much as possible and soak up as much pleasure as possible because that's one of the ways, your body is going to relax unwind and say I'm here to enjoy this rather than I'm here to get through this. So, during this next exercise, there's a number of times where I'm going to intentionally slow down and mention the different senses that I'm engaging, as a way of relaxing my body, This exercise that we're moving into. Next is a guided imagery exercise or a visualization exercise. We're actually borrowing from sports psychology here. What we're doing is we're looking at some of the studies that have taken place around the power of visualization used in sports. So one very well-known study was that they took three groups of basketball players, one group of basketball players Just free throws for two weeks, every single day for two hours a day, another group of basketball players, didn't practice free throws at all for those two weeks. A last group, the third group, sat in a classroom and visualized, real successful, free throws, and if they imagined missing, they imagined getting the ball again. And instead making the next one, what? I found was that the group that practiced the free throws for two weeks improved, which makes sense practice makes perfect. Right? The group that didn't practice didn't get any better, which also makes sense if you don't actually try it, something you're not going to improve on it. The part that we're going to really emphasize for the sake of this guided imagery exercise, is that the group that sat in a classroom and visualized successful, free throws got 90% of the benefit of the basketball players who practiced the successful free throws. So, if by going through a guided imagery or visualization exercise, with regards to sex, we can get 90% of the benefit of having a relaxed and positive. Give and pleasurable, sexual experience. I think that's fantastic. And we're going to really try to add some details to make that as positive and of an experience as possible for you and the more you can visualize it the easier it is to access it when you're interacting with a partner. And if we pair the visualization exercise with the masturbation exercise that we just described what you can do is get the physical sensations of a relaxed and positive. To experience and add the visualization component and we're getting even more benefit as a result. And the more you can build up positive and relaxed and enjoyable, sexual experiences, it serves as a counterbalance to the worry and the stress that oftentimes builds up for men, as a result of having had difficult or disappointing sexual experiences. So now that we've identified that visualization or guided imagery can be incredibly beneficial. I'm going to describe exactly how I want to utilize it to serve you as much as possible. So first, what we're going to do is we're going to describe and I'll have you come up with your own version. But I'm going to give you an example of one. So you have an idea of what this looks like. What I'm going to have you do is describe a relaxed and comfortable and positive sexual situation. We're going to start ideally coming home from dinner or some Sort of beginning to the narrative that is long before sex is actually happening. Because whenever tension or anxiety is present around sexual situations for men, that stress, that worried that tension, oftentimes begins to present itself long before sex is even actually started. So, we're going to visualize walking in through the door to a comfortable relaxed. Setting what I want you to do as you are walking through this narrative and it actually helps to say it out loud. Even if you're entirely alone because just hearing it yourself. Actually activates different parts of your brain and your able to access the information in a totally different way. So I want you to tell yourself this story out loud as you are going about the visualization exercise. I want you to make clear affirmative statements. That are direct and our action items that you are involved in rather than passive or anxious or uncertain statements. An example of that would be next. I reach up and I unclasp her bra which is very different than next. I think about seeing if she's comfortable with me trying to reach up and unhook her bra. Obviously the first statement was simple, clear and direct. Then other statement introduced a lot more doubt and uncertainty and that's going to produce more anxiety. So firm clear statements. Another thing we're going to focus on is slowing it down at specific moment, where anxiety might be present and we're going to track any tension that pops up and if there's tension, we're going to see if we can release the muscle that tends to tense up. And we're going to invite that deep belly breathing back in so you can regulate your nervous system and we might just slow down and get lost in. The sensations of what's happening in a particular moment and that's going to allow us to really get present and not be thinking about what might happen and instead be focused on how enjoyable the things that are happening really are, as you're lost in the experience as you're going through the visualization exercise. A really useful thing to pay attention to is what are the hiccup points? What are the moments where you notice that anxiety starts to build in the narrative? Usually, those are the same moments that happened during sexual situation. So for example, with men who are struggling with erectile functioning, putting on a condom tends to be a spot where most men notice a level of anxiety and that tends to be an area of stress and When men begin to lose their erections or if you are struggling with premature ejaculation, a moment where that pops up for a lot of men is right at the point of entry, that's a moment where there's a lot of anxiety. And worry with the first times of feeling the sensations of being inside your partner and noticing the amount of physiological response. You have your body tenses up and in that stress and worry, there isn't the ability to relax. and regulate your nervous system. So now I'm going to run through an example of the guided imagery exercise so that you have an idea of what it looks like. So I like to have men close their eyes. It's an easier way to be able to really get lost in the story. And again, I am encouraging you to tell yourself the story out loud so that you're able to access it as much as possible. Ideally you're pairing this with masturbation. Using lubrication lying down in bed. So that we're approximating the experience, we're making the experience as close as possible to a real-life interaction with a partner. I walk over to my partner's car door and I open the door and let them out. And I grabbed her hand and I walk in through the front door. and, I just take a moment and I look around noticing that now we're in a relaxed private setting, and as I help my partner take off her coat. She looks at me and I look at her and I get lost in that moment of her, looking at me with an inviting smile and I smile back. And I leaned over and I begin to kiss her on the lips. As she wraps her hands around me. And then it turns into a bit of a hug does. We just take a moment and sort of settled into the space. And then I lead her over to the couch and sit down on the couch. And she sits down next to me and we're cuddling and I move her legs onto mine. We're just looking at each other having a conversation, making some physical contact. My hand is on her shoulder. And then I began to kiss her with more passion. Making out. Just noticing the smell of her hair. Noticing the feel of her lips noticing her hand on my back, getting lost in the sensations of that moment without expectation or worried about where it's going. And I'm just going to really soak up all of the moments of that experience, being really present. And then things are going to begin to increase in terms of intensity. I'm going to begin to. Unbutton her shirt and she's going to begin. Looking at me and giving me a bit of a knowing smile about what's coming next. And she's going to begin to pull my shirt off of my back. has I'm describing this example, if you notice each action is clear and direct about who is doing it when and how And also I'm focused on the earlier steps, rather than rushing towards sex itself. I'm taking my time. I'm letting my body settle in and enjoy the experience early on Really thinking of allowing that experience to be drawn out and as settled as possible. so, What I'm going to do now is I'm going to invite you to continue describing each step moving from the couch to walking to the bedroom and undressing but I'm going to speak to a few specific moments in ways to work through specific hiccups around sex itself. So, for example, an area that a lot of men get stuck in is putting on a condom if erectile functioning is an issue. So, I begin to notice myself feeling hard and we're naked in bed and she reaches down, and puts her hand on my penis and I feel myself, get harder. And I noticed that thought in the back of my mind, present itself, that you're going to have to put a condom on you, start getting worried, and if that worry starts to present itself, What I would encourage you to think about is slowing it down and instead focusing on the sensations of her touching you. And I would also invite you to direct your focus to looking at her noticing her body, noticing your body being touched. What Sensations, do you feel? What do you hear? What do you see? The more you can get lost in the sensations or less, it becomes about. what's happening next in terms of the condom and instead allows you to focus on the experience at hand, So specific to premature ejaculation an area of particular anxiety. For a lot of men is the moment of penetration and so what we're going to do is describe ways of inviting that relaxation into that moment. So as I feel my erection strong, I'm going to begin to move towards my partner and I feel myself enter my partner and I'm just going to slow down and notice how tight my partner feels I'm going to notice this sensation is I'm going to notice the look on their face and the look on my face that they're watching me and I'm watching them when I get lost in that moment rather than Worrying about what it means or how long I'm going to last. I'm going to redirect my focus to everything that's positive and enjoyable that I'm experiencing. Another very important moment to add as you are walking through. This visualization is feeling your body during intercourse, relaxed, and having fun. I want you to have a moment where you notice, You are lost in the sensations of having sex. You are just feeling your body relaxed and enjoying the experience as much as possible. You feel all of the tension in your body in terms of that muscle tension relax you're feeling your breathing coming online and your body is just lost in the pleasure and enjoyment of the moment. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit. More is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment, what you can focus on instead, are your senses? What do you see? What do you hear? What Do you feel by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information. That is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in the short term. Your central nervous system is the fight or flight response that you are experiencing or or encountering. So, for example, if your body is experiencing that central nervous system activation it thinks that it is fighting for or running away for its life. And so it is trying to help you but what happens during that process of central nervous system activation, is that a number of physiological changes start to take place, specific to erectile functioning. Here's a few of the pieces that play out in the puzzle. One, your breathing starts to change. Usually when you're nervous or anxious or worried, you're going to start taking short shallow breaths up in the chest. And as a result of that, your mind is going to start, realizing your brain is going to start realizing that you have more CO2 built up. And as a result, your brain is going to start worrying about the CO2 build-up. The more you start worrying about the CO2 build-up, you're going to worry about what's wrong The more you worry about what's wrong, the faster, your breathing because the more anxious and concerned you are the more anxious and concerned you are the more CO2 gets built up and it Creating a feedback loop. The downside of this feedback loop is that your body can't activate the parasympathetic nervous system, which is the rest and digest or feed and breed system. I'll get more on to the parasympathetic nervous system and a moment. But just understand that when you are breathing short, shallow breaths up in the chest, that is the result of increased anxiety, worry, stress and tension. The next physiological change to understand is that when your body gets stressed or anxious, or that central nervous system activation takes place. What starts to happen is that your body is going to start to pull all the blood to your most essential organs to keep you alive. So that it's your heart, your brain and your lungs. And in those moments, guess what, your body doesn't consider. Are an essential part of your body to keep blood flow going to your erection. So when your body is pulling all that blood and the intent of that is if you happen to be eaten by a sabor tooth tiger, if it's biting your arm, you're not going to bleed out so it's a beneficial mechanism from an evolutionary standpoint but it's not serving you in the here and now because that nervous anxious energy is activating your nervous system and And as a result, your erection is struggling. So that's another component of how your erection is impacted by your central nervous system activation. Another thing that also tends to happen for men is in increased tension in your muscles. So the tension increasing in your muscles is your body's way of engaging your armor. If you think of your muscles, especially your stomach, your stomach is it So is exposing lots of vital organs, but when you clench your stomach, it's protected by a layer of muscle. So your body is thinking that it is protecting you from the threat that your mind is acknowledging which is that anxiety and worry. The downside of this is that one you are trapping blood flow in the muscle. So when you flex a muscle, you're actually restricting the blood flow. And this happens in particular, in the pelvic floor, which is the group of muscles that if you were to cut urination in the middle of the stream, your pelvic floor is going to be clenched. So it's going to restrict blood flow to your erection thinking that it's helping you. And also because all these other muscle groups are clenched, you're going to be dealing with less blood flow overall. So as a result, blood flow being needed for an erection, you're going to deal with some setbacks there. So that's another way that your nervous system in being engaged and overactivated isn't serving. You one way I like to explain nervous system activation to men. Is that pretty much every single man when they first went through puberty experienced probably involuntary uncontrollable erections, right? So when you first hit puberty, you would notice you'd be bored in math class, kind of sleepy little tired wanting to just doze off and you would get an erection and be spontaneous. It wouldn't even have to be connected to a sexual thought at all. That's because your parasympathetic nervous system, which is the rest and digest system was starting to be activated. What that means is that your body was saying, there's a Comfortable environment, I'm kind of bored. There isn't any environmental threat that I have to deal with. Therefore this is a time to be off duty and that rest and digest or feed and breed system kicks off. I'm also willing to bet that if you've ever done any exercise or played a sport or even just taking a test in math, class during that test, you didn't get an erection because your body experience, a level of stress and anxiety. And as a result, it shifted gears from rest and digest into fight or flight. So that's an easy way to understand that your body. Is responding to lots of different environmental factors, making it feel safe enough to get an erection or creating enough of a setback. That getting an erection can be very challenging. One of the ways I also like to explain this is to think of your penis as a lightning rod in today's society, we talk a lot about thinking with the other head which is sort of implying you're not thinking at all, you're just mindlessly being attracted to whatever you're attracted to. To the truth is, your body is actually going to pick up on all sorts of cues and signals with regards to your comfort, or discomfort your partner's Comfort, or discomfort things on your mind work stress, whether there's an issue in the relationship, you're not dealing with whatever. The case might be your body is going to pick up on the amount of stress and tension you're carrying long before you might be able to consciously recognize it And That is going to have a direct impact on your ability, to get an erection. And so you have to figure out how to retrain your body so that your nervous system regulation, isn't running the show and instead, you're able to actively engage your parasympathetic nervous system. I want to focus next on how to begin to engage your parasympathetic nervous system. So again, these are great evolutionary mechanisms that have kept us alive for thousands of years, right? So the benefit of your nervous system being activated and therefore, not allowing you to get an erection is that we didn't get eaten by saber-toothed tigers. The downside is that your brain can't recognize the difference between a modern-day stressful, anxious situation around how sex is going to go with a new partner. or whether or not things will go well in the bedroom with your partner of many years, your brain interprets that as the same level of stress, as if you were about to be attacked by a saber tooth tiger tiger, so we have to be able to separate that and help you learn how how to reclaim control of your nervous system. And there's a number of specific things, we're going to walk through around reclaiming, your parasympathetic nervous system as I said before your parasympathetic nervous system is the rest and digest system, which means that salivation starts your body can digest food your body, can fall asleep. It's that sleepy feeling right before you go to bed. And that is also known as the feed and breed system which is basically your body is saying, this is a safe enough environment that I can be distracted and have sex without ignoring other environmental factors that might otherwise be a risk to my well-being. So we want to engage the parasympathetic nervous system as much as possible and deactivate the central nervous system as much as possible to be able to allow your erections to come online. The first place, we're going to focus on is with regards to breath. So as I said, the starting point to begin to hijack and retrain, your central nervous system to engage that rest and digest or feed and breed parasympathetic nervous system is through breath. Now, you can't do this too much. It's something that if you practice this all day, you would probably be better at work at home life. Pretty much across the board. But for now we're just focusing on sexual situations. So, what I want you to do is you're going to sit here. And I like to track right where my rib cage ends, right at the top of my stomach, which is right where my diaphragm is. And when we're taking full diaphragmatic or belly breaths, what happens is that it's next to impossible to have a panic attack in those moments. When you're breathing fully with your belly, couple reasons, one, you're releasing tension in your stomach so you're not Jing, the armor of your muscles and instead you're saying it's safe to relax and let your body unwind. Another part is also that you can get a much Fuller breath and a much Fuller, exhalation through a belly breath, which again, exhales all of those toxins and and CO2 that otherwise would accumulate if you're taking short, shallow breaths up and up in your chest. If you ever watched how a baby breathes, they'll naturally breathe with their whole diaphragm, as opposed to, as you shift. How you breathe the older, you get it tends to shift more up towards your chest. So we're going to retrain, how you breathe. What I want you to do is I want you to put your hand right on that spot where your rib cage, ends and highlight right where that diaphragm is, I like to close my eyes. So I just focus on that. So, I'm going to close my eyes. I'm going to breathe in through my nose and out through my mouth. I'm going to see how full of a breath. I can take that will allow my hand to As far as possible and then I'm going to breathe out and see how far I can let my hand fall. I'm not going to actually be able to touch my spine but I like to imagine breathing out. So completely that my hand is going to touch my spine and my belly is just in the way. What that will do is just make sure that you can get that full exhalation and really begin to regulate your nervous system. So it looks like this I'm just going to demonstrate about maybe three of them. Oh, so you have an idea of what this looks like. I'm going to add another detail which is one that at the beginning men oftentimes find a little strange but I'll say makes a big difference to really double check that you're getting a full exhalation and also that each time you breathe out you're releasing as much tension as possible in your body. What I want you to do is you're going to actually vocalize that breath out and let the sound of your voice reverberate through your body and just sort of melt any tension, you might be experiencing What that looks like is this. It always a movement, or a way of breathing that can make men feel a little uncomfortable or self-conscious, but it goes a long way. There's usually a few things that people notice. So first, when you are getting that full exhalation, you'll notice how much more are you can push out and that allows for that full exhalation and really then allows for a full expansion of breathing in and taking in fresh clean air. That makes a huge difference. The reverberations also help because as As you get that full exhalation you can tell if you have a little bit more air and really push it out. One way, you can tell that this is Shifting you out of central nervous system activation and instead into the parasympathetic nervous system or that feed and breed system is by. When you open your eyes, you'll notice that everything in the room, looks a little foggier you might feel the desire to yawn, you might feel a little sleepy, everything just sort of softens and when everything softens. Your parasympathetic nervous system kicking in. It's the feeling you get right before you fall asleep. Often times. And again, that's your body's way of saying, I feel safe enough that I can be off-duty. That's really what we're going for because we want you to be off duty while also really being able to enjoy the excitement of the moment because it's a safe enough environment. One of the benefits of using your hand to track the breath and making sure you're taking that full deep belly breath. Is that you always have your hand with you another way to track this. If it's hard to sort of get the feel of it in the beginning or just you want to practice it a little bit more fully, is if you lie down on your couch and you put a pillow on the top of your belly, you can take those deep belly breaths. And you'll watch how much A pillow moves rather than your hand and being able to see the pillow. Sometimes, indicates how much movement there is rather than just relying on your hand as the visualization for that. So now that we focused on breath, as the starting point, for regulating, your nervous system which is going to allow your body to feel safe in sexual situations. The next thing we want to do is add to that sense of reassurance and relaxation that you can offer to your body. What we're going to do is something called progressive muscle relaxation. Basically, we're going to start just with our toes. We're going to tent, just our toes, and hold the Tension in our toes for three seconds, and I'll count you down and then you're going to release that tension. And then you're going to tend to your feet and your toes for 3 seconds. And then release, we're going to keep adding more and more body parts to the exercise. Until eventually you're tensing, your whole body and holding that tension. For 3 seconds, one of the areas that I want you to focus on specifically as We are going through this exercise is each time you release. I want you to release tension in your whole body but I really want you to track your pelvic floor. Your pelvic floor, is the group of muscles that. Which is down in your groin. And it's a group of muscles that if you were to stop urinating in the middle of the stream, you would clinch that muscle group or if you're trying to squeeze in a fart. So that muscle group that you contract is your pelvic floor. This is also something that men don't always realize, but involuntarily contracts meaning. You don't even think about it, whenever you feel level of surprise or worse. Worry, for example, if you've ever been driving, which pretty much everybody has had this situation at some point, if you ever been driving and all the sudden you have to slam on the brakes, your body's going to have a startle response and that startled response is going to clench your pelvic floor. So if you are just sit here and pull the sudden try to slam your foot on the ground, you might notice your pelvic floor Contracting. We're going to try to relax your pelvic floor as much as possible because the more relaxed it is the more it can regulate arousal and let blood flow in and out as is appropriate for the situation. The benefit of this exercise is that muscles are like bungee cords. Sometimes you have to stretch them out a little bit to be able to unhook the hook and then let it go slack and that's really what we're doing with your muscles. The more your body can relax your muscles and just Lower your armor. If you think of your armor as your muscles in your body, your way, body's way of trying to protect you. What you're going to do is just release that tension as much as possible for your body. To say, this is a safe environment that I can get lost in this activity and really enjoy it. So how do we begin progressive muscle relaxation as an exercise? What I like to do is I like to close my eyes and I start with just again a few full deep belly The breaths. And each time I relax, I feel myself melting into the chair. Letting my whole body goes slack, and releasing any tension that I'm able to track. So And you can see my whole body, just sort of collapses. I feel that state of rest, that I'm inviting my body into, I'm going to start just with my toes. And I'm going to tense, three, two, one, and release the tension in my toes. Next, I'm going to tense to my feet and my toes and tense. Three, two, one. And release that tension letting my body go Slack. Next, I'm going to tense my calves. and my shins, my ankles and my feet and my toes and tense. Three, two, one. And release. Next, I'm going to tense my hips. I'm going to tense my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release the tension melting into the chair or the couch, or the whatever environment you're in. Just letting your body go Slack. Next, I'm going to tense my pelvic floor, that group of muscles, that we talked about, just a moment ago, my hips, my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release letting that tension go as much as possible. Next, I'm going to tense to my stomach and my lower back, my pelvic floor, my hips, my glutes, my hamstrings, my quads, my ankles shins, calves toes feet, everything from basically, the rib line down and tense, three. Two one and release that tension letting everything go slack. Next, I'm going to have you tense your chest in your shoulder blades, your back, your stomach, your hips, the pelvic floor, your legs, your ankles your feet and your toes and tense. Three, two, one, and release, letting all that tension go. Remembering to take full belly, breaths in between the moments of tension. Next, we're going to tense our hands, and our forearms, our arms, and our shoulders, our chest, our back, our stomach, our hips, the pelvic floor, our legs our feet, and our toes. Everything from the neck down and tense, three, two, one and release. Letting that tension, go melting into whatever chair or bed you're sitting on. As a final one, I'm going to have you. Bring your shoulders up to your ears. You're going to scrunch up your face and your forehead, your scalp, your neck, your arms, your hands, your shoulders, your chest, your back, your stomach, the pelvic floor, your hips, your legs, and your feet, and your toes, your whole body. And we're going to tense, 3, 2, 1, and just release all of the tension that your body might be holding. Take a few breaths before opening your eyes view Full Belly breaths. And just track this feeling in your body. This is the feeling we're trying to replicate when you're interacting in a sexual experience so that your body is relaxed and comfortable and feeling safe. Usually, when people open their eyes from this exercise, they begin to notice it again. Everything's a little bit foggier they might feel the desire to yawn, everything just sort of softens and quiets a little bit as a result, that is your body. Just saying I'm safe and comfortable. We're trying to A that feeling as much as possible with sexual situations which we're going to start moving into in a moment and how to integrate these exercises into improving sexual functioning. For men who are practicing the masturbation segment of this exercise. One thing that I tend to recommend, if one of the moments that erections tend to get lost, is the moment when you're putting on a condom is to masturbate and put on a condom and continue to masturbate. Get your body used to that pause and the interruption of stimulation with a condom on and then get used to the stimulation through a condom so that your body can get used to that on your own and then it isn't as much of a jarring leap to experience that with a partner and expect a smooth transition. One thing that will make a big difference as you're masturbating is to practice losing your erection, and then stimulating yourself back to the point of a full erection. One of the things that men tend to find is that in the moment if they lose their erection. There's a lot of anxiety that pops up and the erection tends to go away in a sexual situation because they feel pressure to make it happen and they don't know if they can make it happen. If you've practiced over and over letting Your erection Wax and Wane meaning sometimes it'll be stronger, sometimes it won't be as firm and continuing to stimulate masturbate, yourself through that, then as that happens during a typical intercourse experience, you don't worry about a, an erection that isn't as firm because you're able to trust that it will become firm again as you continue. There's a lot of different information out there. One thing that a lot of people ask about is does it ever make sense to not masturbate what I think of masturbation as is really training for sexual experiences and it's also your own Relationship to your body. So building up that awareness is incredibly beneficial but the other thing is also that the more you are masturbating, the more likely you are to increase. The number of erections you're getting and the strength of erections because sex is a use-it-or-lose-it skill. If your body is not used to sexual experiences on your own or with a partner. What's going to happen is it's not going to know how to respond. As efficiently or effectively. As if it is very familiar with erections and ejaculation and arousal and by being familiar with that, you know, how to adjust the situation to accommodate the outcome you want. Now, that you have an idea of how we're going to make changes around masturbation. We're going to start to add in some of the mental adjustment to you're going to make so that you can relax and enjoy the experience as much as possible. And when pleasure is present, it's a lot harder to be stressed and anxious about the sexual situation. One analogy, I like to use to make sense of this is Imagine You have the best steak in the world. If you don't like steak. Imagine that it's any other food that you absolutely love. But let's use steak for now. So, you have the best steak in the world, it is world class, and it's right in front of you, but I'm going to make a number of rules around how you eat that steak first, you have to eat that steak and exactly one minute and 38 seconds and you're going to have to chew 232 times per bite of steak and the whole time you're chewing. You have to look to the right, but when you're not chewing, you have to look to the left. And you also can't look at the steak after you've put the bike in your mouth. If I made all those rules, I'm willing to bet you wouldn't even be able to taste the steak as you're trying to track all of the different things you have to pay attention to. That's a pretty good analogy for what happens for men with regards to sexual functioning, when they're trying to have sex because they're tracking all sorts of different situations. They're wondering if their Tanner's having a good time, they're wondering if they're hard enough, they're wondering if their partner likes their body, they're wondering if premature ejaculation is going to happen. They're stressed and worried about the situation. And when you're stressed and worried about the situation, you can't relax and enjoy the experience. So what we're trying to do mentally is instead shift to enjoying that steak as much as possible. So how would you enjoy that steak as much as possible? You would slow down. And focus on all of the different sensations that you can engage in all of the different parts of that experience. So, with the steak, if you were to cut it first, you're going to take a look at it. You're going to notice visually what you see, you're going to notice the marbling you're going to notice how well it's seared, you're going to notice the steam Rising off of it, all the little details that make your mouth water. Just thinking about it and as you move it, closer, You're going to start to smell the steak. You're going to notice all of the smells that start to fill your nose. You're going to immerse yourself in that part of the experience. And then, once you put it in your mouth, you begin to taste. You begin to feel the temperature of the steak you're going to notice all of your taste buds engaged and then you're going to chew it. And you're going to notice all the flavor that begins to take place and you're going to just notice all of those different parts of the equation. You otherwise wouldn't track or pay attention to, if you're rushing through the experience, hoping to avoid something going wrong. Instead what we're going to do is we're going to try to slow it down as much as possible and soak up as much pleasure as possible because that's one of the ways, your body is going to relax unwind and say I'm here to enjoy this rather than I'm here to get through this. So, during this next exercise, there's a number of times where I'm going to intentionally slow down and mention the different senses that I'm engaging, as a way of relaxing my body, This exercise that we're moving into. Next is a guided imagery exercise or a visualization exercise. We're actually borrowing from sports psychology here. What we're doing is we're looking at some of the studies that have taken place around the power of visualization used in sports. So one very well-known study was that they took three groups of basketball players, one group of basketball players Just free throws for two weeks, every single day for two hours a day, another group of basketball players, didn't practice free throws at all for those two weeks. A last group, the third group, sat in a classroom and visualized, real successful, free throws, and if they imagined missing, they imagined getting the ball again. And instead making the next one, what? I found was that the group that practiced the free throws for two weeks improved, which makes sense practice makes perfect. Right? The group that didn't practice didn't get any better, which also makes sense if you don't actually try it, something you're not going to improve on it. The part that we're going to really emphasize for the sake of this guided imagery exercise, is that the group that sat in a classroom and visualized successful, free throws got 90% of the benefit of the basketball players who practiced the successful free throws. So, if by going through a guided imagery or visualization exercise, with regards to sex, we can get 90% of the benefit of having a relaxed and positive. Give and pleasurable, sexual experience. I think that's fantastic. And we're going to really try to add some details to make that as positive and of an experience as possible for you and the more you can visualize it the easier it is to access it when you're interacting with a partner. And if we pair the visualization exercise with the masturbation exercise that we just described what you can do is get the physical sensations of a relaxed and positive. To experience and add the visualization component and we're getting even more benefit as a result. And the more you can build up positive and relaxed and enjoyable, sexual experiences, it serves as a counterbalance to the worry and the stress that oftentimes builds up for men, as a result of having had difficult or disappointing sexual experiences. So now that we've identified that visualization or guided imagery can be incredibly beneficial. I'm going to describe exactly how I want to utilize it to serve you as much as possible. So first, what we're going to do is we're going to describe and I'll have you come up with your own version. But I'm going to give you an example of one. So you have an idea of what this looks like. What I'm going to have you do is describe a relaxed and comfortable and positive sexual situation. We're going to start ideally coming home from dinner or some Sort of beginning to the narrative that is long before sex is actually happening. Because whenever tension or anxiety is present around sexual situations for men, that stress, that worried that tension, oftentimes begins to present itself long before sex is even actually started. So, we're going to visualize walking in through the door to a comfortable relaxed. Setting what I want you to do as you are walking through this narrative and it actually helps to say it out loud. Even if you're entirely alone because just hearing it yourself. Actually activates different parts of your brain and your able to access the information in a totally different way. So I want you to tell yourself this story out loud as you are going about the visualization exercise. I want you to make clear affirmative statements. That are direct and our action items that you are involved in rather than passive or anxious or uncertain statements. An example of that would be next. I reach up and I unclasp her bra which is very different than next. I think about seeing if she's comfortable with me trying to reach up and unhook her bra. Obviously the first statement was simple, clear and direct. Then other statement introduced a lot more doubt and uncertainty and that's going to produce more anxiety. So firm clear statements. Another thing we're going to focus on is slowing it down at specific moment, where anxiety might be present and we're going to track any tension that pops up and if there's tension, we're going to see if we can release the muscle that tends to tense up. And we're going to invite that deep belly breathing back in so you can regulate your nervous system and we might just slow down and get lost in. The sensations of what's happening in a particular moment and that's going to allow us to really get present and not be thinking about what might happen and instead be focused on how enjoyable the things that are happening really are, as you're lost in the experience as you're going through the visualization exercise. A really useful thing to pay attention to is what are the hiccup points? What are the moments where you notice that anxiety starts to build in the narrative? Usually, those are the same moments that happened during sexual situation. So for example, with men who are struggling with erectile functioning, putting on a condom tends to be a spot where most men notice a level of anxiety and that tends to be an area of stress and When men begin to lose their erections or if you are struggling with premature ejaculation, a moment where that pops up for a lot of men is right at the point of entry, that's a moment where there's a lot of anxiety. And worry with the first times of feeling the sensations of being inside your partner and noticing the amount of physiological response. You have your body tenses up and in that stress and worry, there isn't the ability to relax. and regulate your nervous system. So now I'm going to run through an example of the guided imagery exercise so that you have an idea of what it looks like. So I like to have men close their eyes. It's an easier way to be able to really get lost in the story. And again, I am encouraging you to tell yourself the story out loud so that you're able to access it as much as possible. Ideally you're pairing this with masturbation. Using lubrication lying down in bed. So that we're approximating the experience, we're making the experience as close as possible to a real-life interaction with a partner. I walk over to my partner's car door and I open the door and let them out. And I grabbed her hand and I walk in through the front door. and, I just take a moment and I look around noticing that now we're in a relaxed private setting, and as I help my partner take off her coat. She looks at me and I look at her and I get lost in that moment of her, looking at me with an inviting smile and I smile back. And I leaned over and I begin to kiss her on the lips. As she wraps her hands around me. And then it turns into a bit of a hug does. We just take a moment and sort of settled into the space. And then I lead her over to the couch and sit down on the couch. And she sits down next to me and we're cuddling and I move her legs onto mine. We're just looking at each other having a conversation, making some physical contact. My hand is on her shoulder. And then I began to kiss her with more passion. Making out. Just noticing the smell of her hair. Noticing the feel of her lips noticing her hand on my back, getting lost in the sensations of that moment without expectation or worried about where it's going. And I'm just going to really soak up all of the moments of that experience, being really present. And then things are going to begin to increase in terms of intensity. I'm going to begin to. Unbutton her shirt and she's going to begin. Looking at me and giving me a bit of a knowing smile about what's coming next. And she's going to begin to pull my shirt off of my back. has I'm describing this example, if you notice each action is clear and direct about who is doing it when and how And also I'm focused on the earlier steps, rather than rushing towards sex itself. I'm taking my time. I'm letting my body settle in and enjoy the experience early on Really thinking of allowing that experience to be drawn out and as settled as possible. so, What I'm going to do now is I'm going to invite you to continue describing each step moving from the couch to walking to the bedroom and undressing but I'm going to speak to a few specific moments in ways to work through specific hiccups around sex itself. So, for example, an area that a lot of men get stuck in is putting on a condom if erectile functioning is an issue. So, I begin to notice myself feeling hard and we're naked in bed and she reaches down, and puts her hand on my penis and I feel myself, get harder. And I noticed that thought in the back of my mind, present itself, that you're going to have to put a condom on you, start getting worried, and if that worry starts to present itself, What I would encourage you to think about is slowing it down and instead focusing on the sensations of her touching you. And I would also invite you to direct your focus to looking at her noticing her body, noticing your body being touched. What Sensations, do you feel? What do you hear? What do you see? The more you can get lost in the sensations or less, it becomes about. what's happening next in terms of the condom and instead allows you to focus on the experience at hand, So specific to premature ejaculation an area of particular anxiety. For a lot of men is the moment of penetration and so what we're going to do is describe ways of inviting that relaxation into that moment. So as I feel my erection strong, I'm going to begin to move towards my partner and I feel myself enter my partner and I'm just going to slow down and notice how tight my partner feels I'm going to notice this sensation is I'm going to notice the look on their face and the look on my face that they're watching me and I'm watching them when I get lost in that moment rather than Worrying about what it means or how long I'm going to last. I'm going to redirect my focus to everything that's positive and enjoyable that I'm experiencing. Another very important moment to add as you are walking through. This visualization is feeling your body during intercourse, relaxed, and having fun. I want you to have a moment where you notice, You are lost in the sensations of having sex. You are just feeling your body relaxed and enjoying the experience as much as possible. You feel all of the tension in your body in terms of that muscle tension relax you're feeling your breathing coming online and your body is just lost in the pleasure and enjoyment of the moment. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit. More is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment, what you can focus on instead, are your senses? What do you see? What do you hear? What Do you feel by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information. That is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in So as I said, the starting point to begin to hijack and retrain, your central nervous system to engage that rest and digest or feed and breed parasympathetic nervous system is through breath. Now, you can't do this too much. It's something that if you practice this all day, you would probably be better at work at home life. Pretty much across the board. But for now we're just focusing on sexual situations. So, what I want you to do is you're going to sit here. And I like to track right where my rib cage ends right at the top of my stomach, which is right where my diaphragm is. And when we're taking full diaphragmatic or belly breaths, what happens is that it's next to impossible to have a panic attack in those moments. When you're breathing fully with your belly, couple reasons, one, you're releasing tension in your stomach so you're not Jing, the armor of your muscles and instead you're saying it's safe to relax and let your body unwind. Another part is also that you can get a much Fuller breath and a much Fuller, exhalation through a belly breath, which again, exhales all of those toxins and and CO2 that otherwise would accumulate if you're taking short, shallow breaths up and up in your chest. If you ever watched how a baby breathes, they'll naturally breathe with their whole diaphragm, as opposed to, as you shift. How you breathe the older, you get it tends to shift more up towards your chest. So we're going to retrain, how you breathe. What I want you to do is I want you to put your hand right on that spot where your rib cage, ends and highlight right where that diaphragm is, I like to close my eyes. So I just focus on that. So, I'm going to close my eyes. I'm going to breathe in through my nose and out through my mouth. I'm going to see how full of a breath. I can take that will allow my hand to As far as possible and then I'm going to breathe out and see how far I can let my hand fall. I'm not going to actually be able to touch my spine but I like to imagine breathing out. So completely that my hand is going to touch my spine and my belly is just in the way. What that will do is just make sure that you can get that full exhalation and really begin to regulate your nervous system. So it looks like this I'm just going to demonstrate about maybe three of them. Oh, so you have an idea of what this looks like. I'm going to add another detail which is one that at the beginning men oftentimes find a little strange but I'll say makes a big difference to really double check that you're getting a full exhalation and also that each time you breathe out you're releasing as much tension as possible in your body. What I want you to do is you're going to actually vocalize that breath out and let the sound of your voice reverberate through your body and just sort of melt any tension, you might be experiencing What that looks like is this. It always a movement, or a way of breathing that can make men feel a little uncomfortable or self-conscious, but it goes a long way. There's usually a few things that people notice. So first, when you are getting that full exhalation, you'll notice how much more are you can push out and that allows for that full exhalation and really then allows for a full expansion of breathing in and taking in fresh clean air. That makes a huge difference. The reverberations also help because as As you get that full exhalation you can tell if you have a little bit more air and really push it out. One way, you can tell that this is Shifting you out of central nervous system activation and instead into the parasympathetic nervous system or that feed and breed system is by. When you open your eyes, you'll notice that everything in the room, looks a little foggier you might feel the desire to yawn, you might feel a little sleepy, everything just sort of softens and when everything softens. Your parasympathetic nervous system kicking in. It's the feeling you get right before you fall asleep. Often times. And again, that's your body's way of saying, I feel safe enough that I can be off-duty. That's really what we're going for because we want you to be off duty while also really being able to enjoy the excitement of the moment because it's a safe enough environment. One of the benefits of using your hand to track the breath and making sure you're taking that full deep belly breath. Is that you always have your hand with you another way to track this. If it's hard to sort of get the feel of it in the beginning or just you want to practice it a little bit more fully, is if you lie down on your couch and you put a pillow on the top of your belly, you can take those deep belly breaths. And you'll watch how much A pillow moves rather than your hand and being able to see the pillow. Sometimes, indicates how much movement there is rather than just relying on your hand as the visualization for that. So now that we focused on breath, as the starting point, for regulating, your nervous system which is going to allow your body to feel safe in sexual situations. The next thing we want to do is add to that sense of reassurance and relaxation that you can offer to your body. What we're going to do is something called progressive muscle relaxation. Basically, we're going to start just with our toes. We're going to tent, just our toes, and hold the Tension in our toes for three seconds, and I'll count you down and then you're going to release that tension. And then you're going to tend to your feet and your toes for 3 seconds. And then release, we're going to keep adding more and more body parts to the exercise. Until eventually you're tensing, your whole body and holding that tension. For 3 seconds, one of the areas that I want you to focus on specifically as We are going through this exercise is each time you release. I want you to release tension in your whole body but I really want you to track your pelvic floor. Your pelvic floor, is the group of muscles that. Which is down in your groin. And it's a group of muscles that if you were to stop urinating in the middle of the stream, you would clinch that muscle group or if you're trying to squeeze in a fart. So that muscle group that you contract is your pelvic floor. This is also something that men don't always realize, but involuntarily contracts meaning. You don't even think about it, whenever you feel level of surprise or worse. Worry, for example, if you've ever been driving, which pretty much everybody has had this situation at some point, if you ever been driving and all the sudden you have to slam on the brakes, your body's going to have a startle response and that startled response is going to clench your pelvic floor. So if you are just sit here and pull the sudden try to slam your foot on the ground, you might notice your pelvic floor Contracting. We're going to try to relax your pelvic floor as much as possible because the more relaxed it is the more it can regulate arousal and let blood flow in and out as is appropriate for the situation. The benefit of this exercise is that muscles are like bungee cords. Sometimes you have to stretch them out a little bit to be able to unhook the hook and then let it go slack and that's really what we're doing with your muscles. The more your body can relax your muscles and just Lower your armor. If you think of your armor as your muscles in your body, your way, body's way of trying to protect you. What you're going to do is just release that tension as much as possible for your body. To say, this is a safe environment that I can get lost in this activity and really enjoy it. So how do we begin progressive muscle relaxation as an exercise? What I like to do is I like to close my eyes and I start with just again a few full deep belly The breaths. And each time I relax, I feel myself melting into the chair. Letting my whole body goes slack, and releasing any tension that I'm able to track. So And you can see my whole body, just sort of collapses. I feel that state of rest, that I'm inviting my body into, I'm going to start just with my toes. And I'm going to tense, three, two, one, and release the tension in my toes. Next, I'm going to tense to my feet and my toes and tense. Three, two, one. And release that tension letting my body go Slack. Next, I'm going to tense my calves. and my shins, my ankles and my feet and my toes and tense. Three, two, one. And release. Next, I'm going to tense my hips. I'm going to tense my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release the tension melting into the chair or the couch, or the whatever environment you're in. Just letting your body go Slack. Next, I'm going to tense my pelvic floor, that group of muscles, that we talked about, just a moment ago, my hips, my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release letting that tension go as much as possible. Next, I'm going to tense to my stomach and my lower back, my pelvic floor, my hips, my glutes, my hamstrings, my quads, my ankles shins, calves toes feet, everything from basically, the rib line down and tense, three. Two one and release that tension letting everything go slack. Next, I'm going to have you tense your chest in your shoulder blades, your back, your stomach, your hips, the pelvic floor, your legs, your ankles your feet and your toes and tense. Three, two, one, and release, letting all that tension go. Remembering to take full belly, breaths in between the moments of tension. Next, we're going to tense our hands, and our forearms, our arms, and our shoulders, our chest, our back, our stomach, our hips, the pelvic floor, our legs our feet, and our toes. Everything from the neck down and tense, three, two, one and release. Letting that tension, go melting into whatever chair or bed you're sitting on. As a final one, I'm going to have you. Bring your shoulders up to your ears. You're going to scrunch up your face and your forehead, your scalp, your neck, your arms, your hands, your shoulders, your chest, your back, your stomach, the pelvic floor, your hips, your legs, and your feet, and your toes, your whole body. And we're going to tense, 3, 2, 1, and just release all of the tension that your body might be holding. Take a few breaths before opening your eyes view Full Belly breaths. And just track this feeling in your body. This is the feeling we're trying to replicate when you're interacting in a sexual experience so that your body is relaxed and comfortable and feeling safe. Usually, when people open their eyes from this exercise, they begin to notice it again. Everything's a little bit foggier they might feel the desire to yawn, everything just sort of softens and quiets a little bit as a result, that is your body. Just saying I'm safe and comfortable. We're trying to A that feeling as much as possible with sexual situations which we're going to start moving into in a moment and how to integrate these exercises into improving sexual functioning. For men who are practicing the masturbation segment of this exercise. One thing that I tend to recommend, if one of the moments that erections tend to get lost, is the moment when you're putting on a condom is to masturbate and put on a condom and continue to masturbate. Get your body used to that pause and the interruption of stimulation with a condom on and then get used to the stimulation through a condom so that your body can get used to that on your own and then it isn't as much of a jarring leap to experience that with a partner and expect a smooth transition. One thing that will make a big difference as you're masturbating is to practice losing your erection, and then stimulating yourself back to the point of a full erection. One of the things that men tend to find is that in the moment if they lose their erection. There's a lot of anxiety that pops up and the erection tends to go away in a sexual situation because they feel pressure to make it happen and they don't know if they can make it happen. If you've practiced over and over letting Your erection Wax and Wane meaning sometimes it'll be stronger, sometimes it won't be as firm and continuing to stimulate masturbate, yourself through that, then as that happens during a typical intercourse experience, you don't worry about a, an erection that isn't as firm because you're able to trust that it will become firm again as you continue. There's a lot of different information out there. One thing that a lot of people ask about is does it ever make sense to not masturbate what I think of masturbation as is really training for sexual experiences and it's also your own Relationship to your body. So building up that awareness is incredibly beneficial but the other thing is also that the more you are masturbating, the more likely you are to increase. The number of erections you're getting and the strength of erections because sex is a use-it-or-lose-it skill. If your body is not used to sexual experiences on your own or with a partner. What's going to happen is it's not going to know how to respond. As efficiently or effectively. As if it is very familiar with erections and ejaculation and arousal and by being familiar with that, you know, how to adjust the situation to accommodate the outcome you want. Now, that you have an idea of how we're going to make changes around masturbation. We're going to start to add in some of the mental adjustment to you're going to make so that you can relax and enjoy the experience as much as possible. And when pleasure is present, it's a lot harder to be stressed and anxious about the sexual situation. One analogy, I like to use to make sense of this is Imagine You have the best steak in the world. If you don't like steak. Imagine that it's any other food that you absolutely love. But let's use steak for now. So, you have the best steak in the world, it is world class, and it's right in front of you, but I'm going to make a number of rules around how you eat that steak first, you have to eat that steak and exactly one minute and 38 seconds and you're going to have to chew 232 times per bite of steak and the whole time you're chewing. You have to look to the right, but when you're not chewing, you have to look to the left. And you also can't look at the steak after you've put the bike in your mouth. If I made all those rules, I'm willing to bet you wouldn't even be able to taste the steak as you're trying to track all of the different things you have to pay attention to. That's a pretty good analogy for what happens for men with regards to sexual functioning, when they're trying to have sex because they're tracking all sorts of different situations. They're wondering if their Tanner's having a good time, they're wondering if they're hard enough, they're wondering if their partner likes their body, they're wondering if premature ejaculation is going to happen. They're stressed and worried about the situation. And when you're stressed and worried about the situation, you can't relax and enjoy the experience. So what we're trying to do mentally is instead shift to enjoying that steak as much as possible. So how would you enjoy that steak as much as possible? You would slow down. And focus on all of the different sensations that you can engage in all of the different parts of that experience. So, with the steak, if you were to cut it first, you're going to take a look at it. You're going to notice visually what you see, you're going to notice the marbling you're going to notice how well it's seared, you're going to notice the steam Rising off of it, all the little details that make your mouth water. Just thinking about it and as you move it, closer, You're going to start to smell the steak. You're going to notice all of the smells that start to fill your nose. You're going to immerse yourself in that part of the experience. And then, once you put it in your mouth, you begin to taste. You begin to feel the temperature of the steak you're going to notice all of your taste buds engaged and then you're going to chew it. And you're going to notice all the flavor that begins to take place and you're going to just notice all of those different parts of the equation. You otherwise wouldn't track or pay attention to, if you're rushing through the experience, hoping to avoid something going wrong. Instead what we're going to do is we're going to try to slow it down as much as possible and soak up as much pleasure as possible because that's one of the ways, your body is going to relax unwind and say I'm here to enjoy this rather than I'm here to get through this. So, during this next exercise, there's a number of times where I'm going to intentionally slow down and mention the different senses that I'm engaging, as a way of relaxing my body, This exercise that we're moving into. Next is a guided imagery exercise or a visualization exercise. We're actually borrowing from sports psychology here. What we're doing is we're looking at some of the studies that have taken place around the power of visualization used in sports. So one very well-known study was that they took three groups of basketball players, one group of basketball players Just free throws for two weeks, every single day for two hours a day, another group of basketball players, didn't practice free throws at all for those two weeks. A last group, the third group, sat in a classroom and visualized, real successful, free throws, and if they imagined missing, they imagined getting the ball again. And instead making the next one, what? I found was that the group that practiced the free throws for two weeks improved, which makes sense practice makes perfect. Right? The group that didn't practice didn't get any better, which also makes sense if you don't actually try it, something you're not going to improve on it. The part that we're going to really emphasize for the sake of this guided imagery exercise, is that the group that sat in a classroom and visualized successful, free throws got 90% of the benefit of the basketball players who practiced the successful free throws. So, if by going through a guided imagery or visualization exercise, with regards to sex, we can get 90% of the benefit of having a relaxed and positive. Give and pleasurable, sexual experience. I think that's fantastic. And we're going to really try to add some details to make that as positive and of an experience as possible for you and the more you can visualize it the easier it is to access it when you're interacting with a partner. And if we pair the visualization exercise with the masturbation exercise that we just described what you can do is get the physical sensations of a relaxed and positive. To experience and add the visualization component and we're getting even more benefit as a result. And the more you can build up positive and relaxed and enjoyable, sexual experiences, it serves as a counterbalance to the worry and the stress that oftentimes builds up for men, as a result of having had difficult or disappointing sexual experiences. So now that we've identified that visualization or guided imagery can be incredibly beneficial. I'm going to describe exactly how I want to utilize it to serve you as much as possible. So first, what we're going to do is we're going to describe and I'll have you come up with your own version. But I'm going to give you an example of one. So you have an idea of what this looks like. What I'm going to have you do is describe a relaxed and comfortable and positive sexual situation. We're going to start ideally coming home from dinner or some Sort of beginning to the narrative that is long before sex is actually happening. Because whenever tension or anxiety is present around sexual situations for men, that stress, that worried that tension, oftentimes begins to present itself long before sex is even actually started. So, we're going to visualize walking in through the door to a comfortable relaxed. Setting what I want you to do as you are walking through this narrative and it actually helps to say it out loud. Even if you're entirely alone because just hearing it yourself. Actually activates different parts of your brain and your able to access the information in a totally different way. So I want you to tell yourself this story out loud as you are going about the visualization exercise. I want you to make clear affirmative statements. That are direct and our action items that you are involved in rather than passive or anxious or uncertain statements. An example of that would be next. I reach up and I unclasp her bra which is very different than next. I think about seeing if she's comfortable with me trying to reach up and unhook her bra. Obviously the first statement was simple, clear and direct. Then other statement introduced a lot more doubt and uncertainty and that's going to produce more anxiety. So firm clear statements. Another thing we're going to focus on is slowing it down at specific moment, where anxiety might be present and we're going to track any tension that pops up and if there's tension, we're going to see if we can release the muscle that tends to tense up. And we're going to invite that deep belly breathing back in so you can regulate your nervous system and we might just slow down and get lost in. The sensations of what's happening in a particular moment and that's going to allow us to really get present and not be thinking about what might happen and instead be focused on how enjoyable the things that are happening really are, as you're lost in the experience as you're going through the visualization exercise. A really useful thing to pay attention to is what are the hiccup points? What are the moments where you notice that anxiety starts to build in the narrative? Usually, those are the same moments that happened during sexual situation. So for example, with men who are struggling with erectile functioning, putting on a condom tends to be a spot where most men notice a level of anxiety and that tends to be an area of stress and When men begin to lose their erections or if you are struggling with premature ejaculation, a moment where that pops up for a lot of men is right at the point of entry, that's a moment where there's a lot of anxiety. And worry with the first times of feeling the sensations of being inside your partner and noticing the amount of physiological response. You have your body tenses up and in that stress and worry, there isn't the ability to relax. and regulate your nervous system. So now I'm going to run through an example of the guided imagery exercise so that you have an idea of what it looks like. So I like to have men close their eyes. It's an easier way to be able to really get lost in the story. And again, I am encouraging you to tell yourself the story out loud so that you're able to access it as much as possible. Ideally you're pairing this with masturbation. Using lubrication lying down in bed. So that we're approximating the experience, we're making the experience as close as possible to a real-life interaction with a partner. I walk over to my partner's car door and I open the door and let them out. And I grabbed her hand and I walk in through the front door. and, I just take a moment and I look around noticing that now we're in a relaxed private setting, and as I help my partner take off her coat. She looks at me and I look at her and I get lost in that moment of her, looking at me with an inviting smile and I smile back. And I leaned over and I begin to kiss her on the lips. As she wraps her hands around me. And then it turns into a bit of a hug does. We just take a moment and sort of settled into the space. And then I lead her over to the couch and sit down on the couch. And she sits down next to me and we're cuddling and I move her legs onto mine. We're just looking at each other having a conversation, making some physical contact. My hand is on her shoulder. And then I began to kiss her with more passion. Making out. Just noticing the smell of her hair. Noticing the feel of her lips noticing her hand on my back, getting lost in the sensations of that moment without expectation or worried about where it's going. And I'm just going to really soak up all of the moments of that experience, being really present. And then things are going to begin to increase in terms of intensity. I'm going to begin to. Unbutton her shirt and she's going to begin. Looking at me and giving me a bit of a knowing smile about what's coming next. And she's going to begin to pull my shirt off of my back. has I'm describing this example, if you notice each action is clear and direct about who is doing it when and how And also I'm focused on the earlier steps, rather than rushing towards sex itself. I'm taking my time. I'm letting my body settle in and enjoy the experience early on Really thinking of allowing that experience to be drawn out and as settled as possible. so, What I'm going to do now is I'm going to invite you to continue describing each step moving from the couch to walking to the bedroom and undressing but I'm going to speak to a few specific moments in ways to work through specific hiccups around sex itself. So, for example, an area that a lot of men get stuck in is putting on a condom if erectile functioning is an issue. So, I begin to notice myself feeling hard and we're naked in bed and she reaches down, and puts her hand on my penis and I feel myself, get harder. And I noticed that thought in the back of my mind, present itself, that you're going to have to put a condom on you, start getting worried, and if that worry starts to present itself, What I would encourage you to think about is slowing it down and instead focusing on the sensations of her touching you. And I would also invite you to direct your focus to looking at her noticing her body, noticing your body being touched. What Sensations, do you feel? What do you hear? What do you see? The more you can get lost in the sensations or less, it becomes about. what's happening next in terms of the condom and instead allows you to focus on the experience at hand, So specific to premature ejaculation an area of particular anxiety. For a lot of men is the moment of penetration and so what we're going to do is describe ways of inviting that relaxation into that moment. So as I feel my erection strong, I'm going to begin to move towards my partner and I feel myself enter my partner and I'm just going to slow down and notice how tight my partner feels I'm going to notice this sensation is I'm going to notice the look on their face and the look on my face that they're watching me and I'm watching them when I get lost in that moment rather than Worrying about what it means or how long I'm going to last. I'm going to redirect my focus to everything that's positive and enjoyable that I'm experiencing. Another very important moment to add as you are walking through. This visualization is feeling your body during intercourse, relaxed, and having fun. I want you to have a moment where you notice, You are lost in the sensations of having sex. You are just feeling your body relaxed and enjoying the experience as much as possible. You feel all of the tension in your body in terms of that muscle tension relax you're feeling your breathing coming online and your body is just lost in the pleasure and enjoyment of the moment. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit. More is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment, what you can focus on instead, are your senses? What do you see? What do you hear? What Do you feel by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information. That is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in the short term. So now that we focused on breath, as the starting point, for regulating, your nervous system which is going to allow your body to feel safe in sexual situations. The next thing we want to do is add to that sense of reassurance and relaxation that you can offer to your body. What we're going to do is something called progressive muscle relaxation. Basically, we're going to start just with our toes. We're going to tent, just our toes, and hold the Tension in our toes for three seconds, and I'll count you down and then you're going to release that tension. And then you're going to tend to your feet and your toes for 3 seconds. And then release, we're going to keep adding more and more body parts to the exercise. Until eventually you're tensing, your whole body and holding that tension. For 3 seconds, one of the areas that I want you to focus on specifically as We are going through this exercise is each time you release. I want you to release tension in your whole body but I really want you to track your pelvic floor. Your pelvic floor, is the group of muscles that clenches down in your groin. And it's a group of muscles that if you were to stop urinating in the middle of the stream, you would clinch that muscle group or if you're trying to squeeze in a fart. So that muscle group that you contract is your pelvic floor. This is also something that men don't always realize, but involuntarily contracts meaning. You don't even think about it, whenever you feel level of surprise or worry. For example, if you've ever been driving, which pretty much everybody has had this situation at some point, if you ever been driving and all the sudden you have to slam on the brakes, your body's going to have a startle response and that startled response is going to clench your pelvic floor. So if you are just sit here and pull the sudden try to slam your foot on the ground, you might notice your pelvic floor Contracting. We're going to try to relax your pelvic floor as much as possible because the more relaxed it is the more it can regulate arousal and let blood flow in and out as is appropriate for the situation. The benefit of this exercise is that muscles are like bungee cords. Sometimes you have to stretch them out a little bit to be able to unhook the hook and then let it go slack and that's really what we're doing with your muscles. The more your body can relax your muscles and just Lower your armor. If you think of your armor as your muscles in your body, your way, body's way of trying to protect you. What you're going to do is just release that tension as much as possible for your body. To say, this is a safe environment that I can get lost in this activity and really enjoy it. So how do we begin progressive muscle relaxation as an exercise? What I like to do is I like to close my eyes and I start with just again a few full deep belly The breaths. And each time I relax, I feel myself melting into the chair. Letting my whole body goes slack, and releasing any tension that I'm able to track. So And you can see my whole body, just sort of collapses. I feel that state of rest, that I'm inviting my body into, I'm going to start just with my toes. And I'm going to tense, three, two, one, and release the tension in my toes. Next, I'm going to tense to my feet and my toes and tense. Three, two, one. And release that tension letting my body go Slack. Next, I'm going to tense my calves. and my shins, my ankles and my feet and my toes and tense. Three, two, one. And release. Next, I'm going to tense my hips. I'm going to tense my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release the tension melting into the chair or the couch, or the whatever environment you're in. Just letting your body go Slack. Next, I'm going to tense my pelvic floor, that group of muscles, that we talked about, just a moment ago, my hips, my glutes, my hamstrings, my quads, my calves, my shins, my ankles, my feet, and my toes and tense. Three, two, one and release letting that tension go as much as possible. Next, I'm going to tense to my stomach and my lower back, my pelvic floor, my hips, my glutes, my hamstrings, my quads, my ankles shins, calves toes feet, everything from basically, the rib line down and tense, three. Two one and release that tension letting everything go slack. Next, I'm going to have you tense your chest in your shoulder blades, your back, your stomach, your hips, the pelvic floor, your legs, your ankles your feet and your toes and tense. Three, two, one, and release, letting all that tension go. Remembering to take full belly, breaths in between the moments of tension. Next, we're going to tense our hands, and our forearms, our arms, and our shoulders, our chest, our back, our stomach, our hips, the pelvic floor, our legs our feet, and our toes. Everything from the neck down and tense, three, two, one and release. Letting that tension, go melting into whatever chair or bed you're sitting on. As a final one, I'm going to have you. Bring your shoulders up to your ears. You're going to scrunch up your face and your forehead, your scalp, your neck, your arms, your hands, your shoulders, your chest, your back, your stomach, the pelvic floor, your hips, your legs, and your feet, and your toes, your whole body. And we're going to tense, 3, 2, 1, and just release all of the tension that your body might be holding. Take a few breaths before opening your eyes view Full Belly breaths. And just track this feeling in your body. This is the feeling we're trying to replicate when you're interacting in a sexual experience so that your body is relaxed and comfortable and feeling safe. Usually, when people open their eyes from this exercise, they begin to notice it again. Everything's a little bit foggier they might feel the desire to yawn, everything just sort of softens and quiets a little bit as a result, that is your body. Just saying I'm safe and comfortable. We're trying to A that feeling as much as possible with sexual situations which we're going to start moving into in a moment and how to integrate these exercises into improving sexual functioning. For men who are practicing the masturbation segment of this exercise. One thing that I tend to recommend, if one of the moments that erections tend to get lost, is the moment when you're putting on a condom is to masturbate and put on a condom and continue to masturbate. Get your body used to that pause and the interruption of stimulation with a condom on and then get used to the stimulation through a condom so that your body can get used to that on your own and then it isn't as much of a jarring leap to experience that with a partner and expect a smooth transition. One thing that will make a big difference as you're masturbating is to practice losing your erection, and then stimulating yourself back to the point of a full erection. One of the things that men tend to find is that in the moment if they lose their erection. There's a lot of anxiety that pops up and the erection tends to go away in a sexual situation because they feel pressure to make it happen and they don't know if they can make it happen. If you've practiced over and over letting Your erection Wax and Wane meaning sometimes it'll be stronger, sometimes it won't be as firm and continuing to stimulate masturbate, yourself through that, then as that happens during a typical intercourse experience, you don't worry about a, an erection that isn't as firm because you're able to trust that it will become firm again as you continue. There's a lot of different information out there. One thing that a lot of people ask about is does it ever make sense to not masturbate what I think of masturbation as is really training for sexual experiences and it's also your own relationship to your body. So building up that awareness is incredibly beneficial but the other thing is also that the more you are masturbating, the more likely you are to increase the number of erections you're getting and the strength of erections because sex is a use-it-or-lose-it skill. If your body is not used to sexual experiences on your own or with a partner. What's going to happen is it's not going to know how to respond. As efficiently or effectively. As if it is very familiar with erections and ejaculation and arousal and by being familiar with that, you know, how to adjust the situation to accommodate the outcome you want. Now, that you have an idea of how we're going to make changes around masturbation. We're going to start to add in some of the mental adjustment to you're going to make so that you can relax and enjoy the experience as much as possible. And when pleasure is present, it's a lot harder to be stressed and anxious about the sexual situation. One analogy, I like to use to make sense of this is Imagine You have the best steak in the world. If you don't like steak. Imagine that it's any other food that you absolutely love. But let's use steak for now. So, you have the best steak in the world, it is world class, and it's right in front of you, but I'm going to make a number of rules around how you eat that steak first, you have to eat that steak and exactly one minute and 38 seconds and you're going to have to chew 232 times per bite of steak and the whole time you're chewing. You have to look to the right, but when you're not chewing, you have to look to the left. And you also can't look at the steak after you've put the bike in your mouth. If I made all those rules, I'm willing to bet you wouldn't even be able to taste the steak as you're trying to track all of the different things you have to pay attention to. That's a pretty good analogy for what happens for men with regards to sexual functioning, when they're trying to have sex because they're tracking all sorts of different situations. They're wondering if their Tanner's having a good time, they're wondering if they're hard enough, they're wondering if their partner likes their body, they're wondering if premature ejaculation is going to happen. They're stressed and worried about the situation. And when you're stressed and worried about the situation, you can't relax and enjoy the experience. So what we're trying to do mentally is instead shift to enjoying that steak as much as possible. So how would you enjoy that steak as much as possible? You would slow down. And focus on all of the different sensations that you can engage in all of the different parts of that experience. So, with the steak, if you were to cut it first, you're going to take a look at it. You're going to notice visually what you see, you're going to notice the marbling you're going to notice how well it's seared, you're going to notice the steam Rising off of it, all the little details that make your mouth water. Just thinking about it and as you move it, closer, You're going to start to smell the steak. You're going to notice all of the smells that start to fill your nose. You're going to immerse yourself in that part of the experience. And then, once you put it in your mouth, you begin to taste. You begin to feel the temperature of the steak you're going to notice all of your taste buds engaged and then you're going to chew it. And you're going to notice all the flavor that begins to take place and you're going to just notice all of those different parts of the equation. You otherwise wouldn't track or pay attention to, if you're rushing through the experience, hoping to avoid something going wrong. Instead what we're going to do is we're going to try to slow it down as much as possible and soak up as much pleasure as possible because that's one of the ways, your body is going to relax unwind and say I'm here to enjoy this rather than I'm here to get through this. So, during this next exercise, there's a number of times where I'm going to intentionally slow down and mention the different senses that I'm engaging, as a way of relaxing my body, This exercise that we're moving into. Next is a guided imagery exercise or a visualization exercise. We're actually borrowing from sports psychology here. What we're doing is we're looking at some of the studies that have taken place around the power of visualization used in sports. So one very well-known study was that they took three groups of basketball players, one group of basketball players Just free throws for two weeks, every single day for two hours a day, another group of basketball players, didn't practice free throws at all for those two weeks. A last group, the third group, sat in a classroom and visualized, real successful, free throws, and if they imagined missing, they imagined getting the ball again. And instead making the next one, what? I found was that the group that practiced the free throws for two weeks improved, which makes sense practice makes perfect. Right? The group that didn't practice didn't get any better, which also makes sense if you don't actually try it, something you're not going to improve on it. The part that we're going to really emphasize for the sake of this guided imagery exercise, is that the group that sat in a classroom and visualized successful, free throws got 90% of the benefit of the basketball players who practiced the successful free throws. So, if by going through a guided imagery or visualization exercise, with regards to sex, we can get 90% of the benefit of having a relaxed and positive. Give and pleasurable, sexual experience. I think that's fantastic. And we're going to really try to add some details to make that as positive and of an experience as possible for you and the more you can visualize it the easier it is to access it when you're interacting with a partner. And if we pair the visualization exercise with the masturbation exercise that we just described what you can do is get the physical sensations of a relaxed and positive. To experience and add the visualization component and we're getting even more benefit as a result. And the more you can build up positive and relaxed and enjoyable, sexual experiences, it serves as a counterbalance to the worry and the stress that oftentimes builds up for men, as a result of having had difficult or disappointing sexual experiences. So now that we've identified that visualization or guided imagery can be incredibly beneficial. I'm going to describe exactly how I want to utilize it to serve you as much as possible. So first, what we're going to do is we're going to describe and I'll have you come up with your own version. But I'm going to give you an example of one. So you have an idea of what this looks like. What I'm going to have you do is describe a relaxed and comfortable and positive sexual situation. We're going to start ideally coming home from dinner or some Sort of beginning to the narrative that is long before sex is actually happening. Because whenever tension or anxiety is present around sexual situations for men, that stress, that worried that tension, oftentimes begins to present itself long before sex is even actually started. So, we're going to visualize walking in through the door to a comfortable relaxed. Setting what I want you to do as you are walking through this narrative and it actually helps to say it out loud. Even if you're entirely alone because just hearing it yourself. Actually activates different parts of your brain and your able to access the information in a totally different way. So I want you to tell yourself this story out loud as you are going about the visualization exercise. I want you to make clear affirmative statements. That are direct and our action items that you are involved in rather than passive or anxious or uncertain statements. An example of that would be next. I reach up and I unclasp her bra which is very different than next. I think about seeing if she's comfortable with me trying to reach up and unhook her bra. Obviously the first statement was simple, clear and direct. Then other statement introduced a lot more doubt and uncertainty and that's going to produce more anxiety. So firm clear statements. Another thing we're going to focus on is slowing it down at specific moment, where anxiety might be present and we're going to track any tension that pops up and if there's tension, we're going to see if we can release the muscle that tends to tense up. And we're going to invite that deep belly breathing back in so you can regulate your nervous system and we might just slow down and get lost in. The sensations of what's happening in a particular moment and that's going to allow us to really get present and not be thinking about what might happen and instead be focused on how enjoyable the things that are happening really are, as you're lost in the experience as you're going through the visualization exercise. A really useful thing to pay attention to is what are the hiccup points? What are the moments where you notice that anxiety starts to build in the narrative? Usually, those are the same moments that happened during sexual situation. So for example, with men who are struggling with erectile functioning, putting on a condom tends to be a spot where most men notice a level of anxiety and that tends to be an area of stress and When men begin to lose their erections or if you are struggling with premature ejaculation, a moment where that pops up for a lot of men is right at the point of entry, that's a moment where there's a lot of anxiety. And worry with the first times of feeling the sensations of being inside your partner and noticing the amount of physiological response. You have your body tenses up and in that stress and worry, there isn't the ability to relax. and regulate your nervous system. So now I'm going to run through an example of the guided imagery exercise so that you have an idea of what it looks like. So I like to have men close their eyes. It's an easier way to be able to really get lost in the story. And again, I am encouraging you to tell yourself the story out loud so that you're able to access it as much as possible. Ideally you're pairing this with masturbation. Using lubrication lying down in bed. So that we're approximating the experience, we're making the experience as close as possible to a real-life interaction with a partner. I walk over to my partner's car door and I open the door and let them out. And I grabbed her hand and I walk in through the front door. and, I just take a moment and I look around noticing that now we're in a relaxed private setting, and as I help my partner take off her coat. She looks at me and I look at her and I get lost in that moment of her, looking at me with an inviting smile and I smile back. And I leaned over and I begin to kiss her on the lips. As she wraps her hands around me. And then it turns into a bit of a hug does. We just take a moment and sort of settled into the space. And then I lead her over to the couch and sit down on the couch. And she sits down next to me and we're cuddling and I move her legs onto mine. We're just looking at each other having a conversation, making some physical contact. My hand is on her shoulder. And then I began to kiss her with more passion. Making out. Just noticing the smell of her hair. Noticing the feel of her lips noticing her hand on my back, getting lost in the sensations of that moment without expectation or worried about where it's going. And I'm just going to really soak up all of the moments of that experience, being really present. And then things are going to begin to increase in terms of intensity. I'm going to begin to. Unbutton her shirt and she's going to begin. Looking at me and giving me a bit of a knowing smile about what's coming next. And she's going to begin to pull my shirt off of my back. has I'm describing this example, if you notice each action is clear and direct about who is doing it when and how And also I'm focused on the earlier steps, rather than rushing towards sex itself. I'm taking my time. I'm letting my body settle in and enjoy the experience early on Really thinking of allowing that experience to be drawn out and as settled as possible. so, What I'm going to do now is I'm going to invite you to continue describing each step moving from the couch to walking to the bedroom and undressing but I'm going to speak to a few specific moments in ways to work through specific hiccups around sex itself. So, for example, an area that a lot of men get stuck in is putting on a condom if erectile functioning is an issue. So, I begin to notice myself feeling hard and we're naked in bed and she reaches down, and puts her hand on my penis and I feel myself, get harder. And I noticed that thought in the back of my mind, present itself, that you're going to have to put a condom on you, start getting worried, and if that worry starts to present itself, What I would encourage you to think about is slowing it down and instead focusing on the sensations of her touching you. And I would also invite you to direct your focus to looking at her noticing her body, noticing your body being touched. What Sensations, do you feel? What do you hear? What do you see? The more you can get lost in the sensations or less, it becomes about. what's happening next in terms of the condom and instead allows you to focus on the experience at hand, So specific to premature ejaculation an area of particular anxiety. For a lot of men is the moment of penetration and so what we're going to do is describe ways of inviting that relaxation into that moment. So as I feel my erection strong, I'm going to begin to move towards my partner and I feel myself enter my partner and I'm just going to slow down and notice how tight my partner feels I'm going to notice this sensation is I'm going to notice the look on their face and the look on my face that they're watching me and I'm watching them when I get lost in that moment rather than Worrying about what it means or how long I'm going to last. I'm going to redirect my focus to everything that's positive and enjoyable that I'm experiencing. Another very important moment to add as you are walking through. This visualization is feeling your body during intercourse, relaxed, and having fun. I want you to have a moment where you notice, You are lost in the sensations of having sex. You are just feeling your body relaxed and enjoying the experience as much as possible. You feel all of the tension in your body in terms of that muscle tension relax you're feeling your breathing coming online and your body is just lost in the pleasure and enjoyment of the moment. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit. More is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment, what you can focus on instead, are your senses? What do you see? What do you hear? What Do you feel by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information. That is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in the short term. Now, that you have an idea of how we're going to make changes around masturbation. We're going to start to add in some of the mental adjustment to you're going to make so that you can relax and enjoy the experience as much as possible. And when pleasure is present, it's a lot harder to be stressed and anxious about the sexual situation. One analogy, I like to use to make sense of this is Imagine You have the best steak in the world. If you don't like steak. Imagine that it's any other food that you absolutely love. But let's use steak for now. So, you have the best steak in the world, it is world class, and it's right in front of you, but I'm going to make a number of rules around how you eat that steak first, you have to eat that steak and exactly one minute and 38 seconds and you're going to have to chew 232 times per bite of steak and the whole time you're chewing. You have to look to the right, but when you're not chewing, you have to look to the left. And you also can't look at the steak after you've put the bite in your mouth. If I made all those rules, I'm willing to bet you wouldn't even be able to taste the steak as you're trying to track all of the different things you have to pay attention to. That's a pretty good analogy for what happens for men with regards to sexual functioning, when they're trying to have sex because they're tracking all sorts of different situations. They're wondering if their Tanner's having a good time, they're wondering if they're hard enough, they're wondering if their partner likes their body, they're wondering if premature ejaculation is going to happen. They're stressed and worried about the situation. And when you're stressed and worried about the situation, you can't relax and enjoy the experience. So what we're trying to do mentally is instead shift to enjoying that steak as much as possible. So how would you enjoy that steak as much as possible? You would slow down. And focus on all of the different sensations that you can engage in all of the different parts of that experience. So, with the steak, if you were to cut it first, you're going to take a look at it. You're going to notice visually what you see, you're going to notice the marbling you're going to notice how well it's seared, you're going to notice the steam Rising off of it, all the little details that make your mouth water. Just thinking about it and as you move it, closer, You're going to start to smell the steak. You're going to notice all of the smells that start to fill your nose. You're going to immerse yourself in that part of the experience. And then, once you put it in your mouth, you begin to taste. You begin to feel the temperature of the steak you're going to notice all of your taste buds engaged and then you're going to chew it. And you're going to notice all the flavor that begins to take place and you're going to just notice all of those different parts of the equation. You otherwise wouldn't track or pay attention to, if you're rushing through the experience, hoping to avoid something going wrong. Instead what we're going to do is we're going to try to slow it down as much as possible and soak up as much pleasure as possible because that's one of the ways, your body is going to relax unwind and say I'm here to enjoy this rather than I'm here to get through this. So, during this next exercise, there's a number of times where I'm going to intentionally slow down and mention the different senses that I'm engaging, as a way of relaxing my body, This exercise that we're moving into. Next is a guided imagery exercise or a visualization exercise. We're actually borrowing from sports psychology here. What we're doing is we're looking at some of the studies that have taken place around the power of visualization used in sports. So one very well-known study was that they took three groups of basketball players, one group of basketball players Just free throws for two weeks, every single day for two hours a day, another group of basketball players, didn't practice free throws at all for those two weeks. A last group, the third group, sat in a classroom and visualized, real successful, free throws, and if they imagined missing, they imagined getting the ball again. And instead making the next one, what? I found was that the group that practiced the free throws for two weeks improved, which makes sense practice makes perfect. Right? The group that didn't practice didn't get any better, which also makes sense if you don't actually try it, something you're not going to improve on it. The part that we're going to really emphasize for the sake of this guided imagery exercise, is that the group that sat in a classroom and visualized successful, free throws got 90% of the benefit of the basketball players who practiced the successful free throws. So, if by going through a guided imagery or visualization exercise, with regards to sex, we can get 90% of the benefit of having a relaxed and positive and pleasurable, sexual experience. I think that's fantastic. And we're going to really try to add some details to make that as positive and of an experience as possible for you and the more you can visualize it the easier it is to access it when you're interacting with a partner. And if we pair the visualization exercise with the masturbation exercise that we just described what you can do is get the physical sensations of a relaxed and positive. To experience and add the visualization component and we're getting even more benefit as a result. And the more you can build up positive and relaxed and enjoyable, sexual experiences, it serves as a counterbalance to the worry and the stress that oftentimes builds up for men, as a result of having had difficult or disappointing sexual experiences. So now that we've identified that visualization or guided imagery can be incredibly beneficial. I'm going to describe exactly how I want to utilize it to serve you as much as possible. So first, what we're going to do is we're going to describe and I'll have you come up with your own version. But I'm going to give you an example of one. So you have an idea of what this looks like. What I'm going to have you do is describe a relaxed and comfortable and positive sexual situation. We're going to start ideally coming home from dinner or some Sort of beginning to the narrative that is long before sex is actually happening. Because whenever tension or anxiety is present around sexual situations for men, that stress, that worried that tension, oftentimes begins to present itself long before sex is even actually started. So, we're going to visualize walking in through the door to a comfortable relaxed private setting. What I want you to do as you are walking through this narrative and it actually helps to say it out loud. Even if you're entirely alone because just hearing it yourself. Actually activates different parts of your brain and your able to access the information in a totally different way. So I want you to tell yourself this story out loud as you are going about the visualization exercise. I want you to make clear affirmative statements. That are direct and our action items that you are involved in rather than passive or anxious or uncertain statements. An example of that would be next. I reach up and I unclasp her bra which is very different than next. I think about seeing if she's comfortable with me trying to reach up and unhook her bra. Obviously the first statement was simple, clear and direct. Then other statement introduced a lot more doubt and uncertainty and that's going to produce more anxiety. So firm clear statements. Another thing we're going to focus on is slowing it down at specific moment, where anxiety might be present and we're going to track any tension that pops up and if there's tension, we're going to see if we can release the muscle that tends to tense up. And we're going to invite that deep belly breathing back in so you can regulate your nervous system and we might just slow down and get lost in. The sensations of what's happening in a particular moment and that's going to allow us to really get present and not be thinking about what might happen and instead be focused on how enjoyable the things that are happening really are, as you're lost in the experience as you're going through the visualization exercise. A really useful thing to pay attention to is what are the hiccup points? What are the moments where you notice that anxiety starts to build in the narrative? Usually, those are the same moments that happened during sexual situation. So for example, with men who are struggling with erectile functioning, putting on a condom tends to be a spot where most men notice a level of anxiety and that tends to be an area of stress and When men begin to lose their erections or if you are struggling with premature ejaculation, a moment where that pops up for a lot of men is right at the point of entry, that's a moment where there's a lot of anxiety. And worry with the first times of feeling the sensations of being inside your partner and noticing the amount of physiological response. You have your body tenses up and in that stress and worry, there isn't the ability to relax. and regulate your nervous system. So now I'm going to run through an example of the guided imagery exercise so that you have an idea of what it looks like. So I like to have men close their eyes. It's an easier way to be able to really get lost in the story. And again, I am encouraging you to tell yourself the story out loud so that you're able to access it as much as possible. Ideally you're pairing this with masturbation. Using lubrication lying down in bed. So that we're approximating the experience, we're making the experience as close as possible to a real-life interaction with a partner. I walk over to my partner's car door and I open the door and let them out. And I grabbed her hand and I walk in through the front door. and, I just take a moment and I look around noticing that now we're in a relaxed private setting, and as I help my partner take off her coat. She looks at me and I look at her and I get lost in that moment of her, looking at me with an inviting smile and I smile back. And I leaned over and I begin to kiss her on the lips. As she wraps her hands around me. And then it turns into a bit of a hug does. We just take a moment and sort of settled into the space. And then I lead her over to the couch and sit down on the couch. And she sits down next to me and we're cuddling and I move her legs onto mine. We're just looking at each other having a conversation, making some physical contact. My hand is on her shoulder. And then I began to kiss her with more passion. Making out. Just noticing the smell of her hair. Noticing the feel of her lips noticing her hand on my back, getting lost in the sensations of that moment without expectation or worried about where it's going. And I'm just going to really soak up all of the moments of that experience, being really present. And then things are going to begin to increase in terms of intensity. I'm going to begin to. Unbutton her shirt and she's going to begin. Looking at me and giving me a bit of a knowing smile about what's coming next. And she's going to begin to pull my shirt off of my back. has I'm describing this example, if you notice each action is clear and direct about who is doing it when and how And also I'm focused on the earlier steps, rather than rushing towards sex itself. I'm taking my time. I'm letting my body settle in and enjoy the experience early on Really thinking of allowing that experience to be drawn out and as settled as possible. so, What I'm going to do now is I'm going to invite you to continue describing each step moving from the couch to walking to the bedroom and undressing but I'm going to speak to a few specific moments in ways to work through specific hiccups around sex itself. So, for example, an area that a lot of men get stuck in is putting on a condom if erectile functioning is an issue. So, I begin to notice myself feeling hard and we're naked in bed and she reaches down, and puts her hand on my penis and I feel myself, get harder. And I noticed that thought in the back of my mind, present itself, that you're going to have to put a condom on you, start getting worried, and if that worry starts to present itself, What I would encourage you to think about is slowing it down and instead focusing on the sensations of her touching you. And I would also invite you to direct your focus to looking at her noticing her body, noticing your body being touched. What Sensations, do you feel? What do you hear? What do you see? The more you can get lost in the sensations or less, it becomes about. what's happening next in terms of the condom and instead allows you to focus on the experience at hand, So specific to premature ejaculation an area of particular anxiety. For a lot of men is the moment of penetration and so what we're going to do is describe ways of inviting that relaxation into that moment. So as I feel my erection strong, I'm going to begin to move towards my partner and I feel myself enter my partner and I'm just going to slow down and notice how tight my partner feels I'm going to notice this sensation is I'm going to notice the look on their face and the look on my face that they're watching me and I'm watching them when I get lost in that moment rather than Worrying about what it means or how long I'm going to last. I'm going to redirect my focus to everything that's positive and enjoyable that I'm experiencing. Another very important moment to add as you are walking through. This visualization is feeling your body during intercourse, relaxed, and having fun. I want you to have a moment where you notice, You are lost in the sensations of having sex. You are just feeling your body relaxed and enjoying the experience as much as possible. You feel all of the tension in your body in terms of that muscle tension relax you're feeling your breathing coming online and your body is just lost in the pleasure and enjoyment of the moment. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit. More is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment, what you can focus on instead, are your senses? What do you see? What do you hear? What Do you feel by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information. That is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in the short term. One technique that makes a big difference for men when there's anxiety or worry about getting an erection and they have a partner to interact with is a technique that is called the paint brush technique. What you're going to do is just brush along the outside of your partner's, vulva with the head of your penis. Many men notice that they begin to get somewhat of an erection great. If that happens. Fantastic. If not, that's totally fine, the intention of the exercise is not to get an erection, the exercise is intended. To just get your penis familiar with your partner's, genitals, what your body will begin to notice is that as you get more and more comfortable erections, do tend to come online with that kind of stimulation. And if it leads to penetration great and then if you lose your erection go back to the paint brush technique. You and continue with that until your erection comes back online. It's a different flow to sex, but what it tends to lead to the lot less pressure and expectation. That sex is going to look very specific and very linear and instead allows you to be in the moment and by being in the moment and that pressure and expectation is off of you. You are able to end up with firmer erections because your body is relaxed. One area, I keep referring to, but is probably where a spelling out a little bit more is tracking your own body often times when people are struggling with sexual functioning, when men have premature ejaculation or erectile dysfunction, what is happening, is, they're worried about their Partners, expectations of them, they're worried about how they're going to appear to their partner and it ends up being a bit of a self-fulfilling prophecy. What I suggest is Shifting to your own experience and when you shift to tracking and being aware of your own experience, your able to be more present for your partner but also less trying to mind-read and by less mind-reading, you're able to focus more on. Do you have any body parts that are tense? Do you have any specific thoughts that you need to address and the more you're able to track your own experience Your identifying what's within your own control If you are trying to guess what your partner is thinking, then you're likely to be wrong unless you are a genuine mind reader, which good on you but most of us aren't and so guessing is only going to arrive at answers that are probably wrong. And also are going to distract you from what's playing out in the moment. What you can focus on instead, are your senses, what do you see, what do you hear, what Do you feel. by tracking your senses, you're going to bring yourself back into your body and you're going to be more able to regulate your nervous system because you're not trying to access information that is not accessible just by guessing. An added benefit of your partner being involved in the Hands-On exercises or the exercise. I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in the short term. An added benefit of your partner being involved in the Hands-On exercises or the exercise I just described specific to intercourse is that you get familiar and used to communicating your needs and what you're experiencing during an uncertain situation. One of the common patterns that I tend to notice for a lot of men who struggle with sexual functioning is that it's difficult articulating. Your own experience and what your own needs are. And obviously there's a much larger subject, but one thing I will say that tends to go really long way. Is practicing communicating your needs or Desires in non-sexual situations. So for example, I encourage men to notice when they tend to ask questions or track their partner and instead re-direct the focus towards themselves, it's around day-to-day decisions. So an example of this is, what do you feel like for dinner is really different than I feel like sushi tonight. How does that work for you? If you are clear about what you want, your introducing less uncertainty and ambiguity into the situation. And you also are getting used to using your voice, to let your partner know where you're at. Because if you can say that around, Good when we then translate that to sex, you're able to say slow down a little bit. I'm I'm at that higher level of arousal, okay? I'm feeling good again. Alright. Now we can get back to moving faster. Let's let's slow down a little bit. I'm feeling a little bit too much arousal. Okay, I'm feeling really good. Let's have fun the ability to let your partner know where you're at. Is something that helps you and your partner know how to engage with the situation as positively as possible. Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take, Or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point. Where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via Dora. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than Outsourcing that confidence to a pill. Because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so learning how to retrain. Your body is the best long-term solution but it can serve a purpose in Another common question is what about the role of alcohol? If I have a drink, will it take the edge off and alcohol is a bit of a double-edged sword? It can take the edge off and sort of distract you a little bit or take your mind off of worrying about what may or may not happen. The downside is that it also will decrease the strength of an erection if you have too much. So if a drink is something that helps you feel relaxed and positive great, But it could be too much of a good thing and rather than just taking the edge off, you end up sloppy and that doesn't end up serving you. Another very common question. I get is what about the role of Viagra or Cialis or other PDE5 Inhibitors? They again, serve a role they can be useful for taking the edge off and helping add a level of confidence or reassurance that may be useful to allow you to relax enough to be able to have a positive sexual experience. However, I'm always cautious of anything that can become a crutch if I don't take viagra or if I don't take Cialis then I won't be able to get an erection is a belief that doesn't serve you rather than learning how to retrain your nervous system and calm your body to be able to arrive at a point where it feels safe enough to have an erection on your own. So in the short term, it what I recommend is that for men who have a prescription if they want to use it when with a partner while practicing and training on their own without via viagra. I find that that can be a useful combination. But I would also highly encourage you to walk through the step by step process and build up your own self-confidence with it rather than outsourcing that confidence to a pill, because the truth is for many men, even if you have Viagra or Cialis in your system, your mind and your body can still block the ability to get an erection. So, even with that, you can Still hit interruptions or hiccups, so, learning how to retrain your body is the best long-term solution but it can serve a purpose in the short term.