← Rena Malik, MD Podcast
Rena Malik, MD Podcast
Moment: The 5-Step Method to Last Longer in Bed | Premature Ejaculation Treatment ft. Keeley Rankin
00:17:41
In this episode, Dr. Rena Malik, MD and Keeley Rankin break down a five-step method to help men overcome premature ejaculation. They share actionable techniques focused on mindful breathing, managing anxiety, and expanding pleasure, offering practical guidance for enhancing sexual control and intimacy.
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- [01:01]
D
Step method to help men sort of overcome premature ejaculation. Can you talk a little bit about that?
- [01:08]
B
Yeah, I would love to. Yes. So the first step is breath. So it's learning how to use breath as a tool to help connect with your body and notice what's happening inside of your body. Breath is the most important tool and it's something that you'll never fully master. It's something you always will return back to to. And I normally say like you want to be breathing slowly and fully through your mouth and you're breathing into between a count of five to seven and out to a count of five to seven. And this just really helps you drop in and feel what's happening.
- [01:39]
D
And this is during arousal or just in general?
- [01:42]
B
Yes, during arousal, specifically during arousal. And when I talk about how people learn this five step method, I really recommend that we start with solo practice. So with masturbation. So you can try and apply this with a partner. And depending sort of where you are in the severity of early ejaculation, it might be helpful. But in general, the most important place is to start with self pleasure so you can start to learn this practice inside of your body. The second step is the anal breath. So it's actually learning how to breathe into your asshole, which is if we were going into the pelvic floor specialist place, there's whole different language for this, but the language that I use when I talk with my clients about it is like the back part of the pelvis. So if you were bearing down to go to the bathroom like Pushing out to go to the bathroom. You want just the slightest energy going into the asshole on the inhale. And that is actually so almost like.
- [02:37]
D
You'Re having a bowel movement. Like you're pushing in that area.
- [02:41]
B
Yes.
- [02:41]
D
While you inhale.
- [02:42]
B
Yes. So you're inhaling and you're pushing out just a tiny bit, and then you're exhaling and letting everything release. So we're doing nothing on the exhale. So the first one is just breathing into the body. The second one is learning the anal breath. And what the anal breath does is allow you to come down the arousal curve. And also when we think about what happens during ejaculation, the pelvic floor tightens, has these involuntary contractions. So a lot of times men who struggle with early ejaculation are already over tightening in that area, which we talked about earlier. And so learning how to soften that area is incredibly important in terms of how we start to relate with our arousal. So the next step, which is step three, is learning how to separate your arousal curve and your anxiety curve and learning how to be in your arousal curve.
- [03:27]
D
That is so difficult, right?
- [03:29]
B
Can be very, very difficult, yes.
- [03:32]
D
Because I feel like it is. So especially so. I think there's. Just to be clear, there's multiple different types of premature ejaculators, but we typically define them as acquired, meaning that something new versus lifelong. And then within acquired, you could talk about sometimes it happens, sometimes it doesn't, variable things like that. But when you're talking about someone who's acquired it newly, it becomes a huge source of anxiety for them. And then people who've had it lifelong, I mean, some of them learn acceptance, but a lot of them have this anxiety for years around premature ejaculation.
- [04:01]
B
Yeah, absolutely. Yeah. What I always started. Well, what I noticed with my clients is that as arousal would build, their anxiety would build. So it's almost like their anxiety and their arousal was married together. So if we think of arousal on a scale from 1 to 10, one being like, I'd be interested in sexual, like, we could see where this goes, 9 being the point of a return and 10 being orgasm. And if we think about that as also an anxiety curve, once you cross over the five on the arousal curve, if you cross over the five on the anxiety curve, now our system is in a full fight or flight response. It's very difficult to feel pleasure. It's very difficult to relax. And so the nervous system sort of goes into a panic. And then ejaculation just happens right after. And for many men who struggle with that, it's not even a pleasurable experience. I think sometimes there's this idea that, oh, he's coming quick, he doesn't care about me. And a lot of times the men I've worked with, there is a deep, deep shame around how quickly this is happening. And oftentimes there can be even a turning away from sex and a pulling back from ever wanting to be intimate at all because it brings up so much shame and discomfort and embarrassment for them.
- [05:17]
D
Yeah.
- [05:18]
B
So if we go back into the step three, though, and we talk about separating this arousal curve from the anxiety curve, and we talk about how to breathe and stay connected to your body and relaxing your asshole, being able to cruise up and down, which is step four, which is surfing the sweet spot. Moving up and down your arousal curve in a relaxed way allows for that possibility that you're not just going to jump right into that nine point of no return and the orgasm. So the surfing of the sweet spot goes back into a little confusing, but goes back into step two, which is that anal breath. So as you're going up your arousal curve, if you notice, oh, I'm starting to feel a little anxious here, I might jump into my orgasm. You actually change what you're doing, how you're just normally breathing into the anal breath, and that drops you back down the arousal curve. And when I talk with clients about mastery, mastery looks like you can continue to engage in whatever sex act is happening. Penetration, blow jobs, hand jobs, and you just change your breath. And within three full breaths, your arousal has dropped to two levels. Now, that is like PhD level control of your body. What it looks like when we start is sometimes men have never actually even come down their arousal curve before. They've only ever gone up. And so learning how to actively come down, and there's oftentimes a lot of fear in coming down. Like, if I come down, I'll fly down the arousal curve and I'll never get hard again. And so learning to trust the body and to trust their pleasure and learning how to use that anal breath to drop back down is really, really is a huge part of that.
- [06:54]
D
Yeah. I think that the hard part that I can imagine is that if your body is so used to going from. From 1 to 10. Right. So quickly that you may not even get to the point where you're even like. Like figuring out where 5 is might be so fast or so sudden. So how do they work towards, like, one, recognizing that, especially if they're, like, ejaculating within A minute, let's say, or less than a minute. Right. And if they are really anxious, how do they sort of like, so they're like in the moment, they're really excited. Like how do they kind of manage all this? Obviously you said start with masturbation, but like how do they sort of regulate that? Like, I feel like that's like a huge mountain. Like step three is a huge mountain to overcome.
- [07:33]
B
It's huge. It is, it. It truly is. Yeah. So I have a course online for people to work through this. And what I say in the course is do not move on to the next module until you can check the list that I have at the bottom that says I can do these things. And so for some men, if they're struggling with severe early ejaculation and they are coming really, really quickly, it can take a really long time. We can be talking like six months, nine months, a year before they feel like they can really separate the arousal curve and enter into arousal where they're relaxed and their bodies are relaxed. It just takes time depending upon like what has gone on in their lives and how they treat sex and how they feel about it and often how patient they are. Like, psychologically, I find folks who struggle with early ejaculation are very, very empty, impatient. They're go getters. They get a lot of things done in their life like that anxiety is sort of just like threaded throughout their whole nervous system. And so learning this can be very, very, very difficult.
- [08:37]
D
They actually looked, there was a, I think it was a Chinese study where they looked at personality characteristics and association with men who had premature ejaculation. They found that they were less risk takers, they were more anxious. And so like, it may be that there is sort of a personality trait that lends itself to, you know, who knows, chicken or egg that comes first. But maybe it lends itself to being a more rapid ejaculator.
- [09:01]
B
Right, right. Feeling more anxious, feeling more nervous, feeling like it matters how I perform, like all of those things contribute. And again, I often say that too with my clients. It's like we talk about what has led to this point, but it's also like now we're here and it's sort of this self fulfilling prophecy of like it just, it just builds on itself and builds on itself and builds on itself and to circle back real quick. So step five is one that I think often gets overlooked, but it's all about spreading the energy from the cock, which is the pleasure center of the body, through the rest of the body. So it's not this over focus just on genitals. It's allowing the pleasure to move through the whole system. So we move into an experience. Experience that's not just focused on, like, how hard am I and how long do I last, but actually pleasure centered. And I found that that shift for men, when I say, like, this isn't just about lasting longer so that you don't feel shame or that your partner is satisfied. Like, this is truly about your pleasure, owning your pleasure and being able to relax and connect with it. And that makes a really, really big difference in the framework, I think, that we come into this challenge with.
- [10:07]
D
So let's go back to. Sorry, I'm going back to step three because I think it's still so difficult to overcome. What are some actionable tools that you'll give patients to help them sort of understand and, like, understand their curves and really, like, get in their headspace with those?
- [10:21]
B
Yeah, absolutely. So mindfulness is a huge component to this. So if nobody, if I'm working with someone and they've never had a meditation practice, they don't know what mindfulness is. They don't know what a body scan is. We start there. Going back into, like, what does it mean to enter into your body and to feel your body? Like, if you were to close your eyes, can you feel your big finger? Can you feel your big toe on the left side? Like, being able to actually go in and notice what's happening in the body has a lot to do with, like, how are you going to respond in these moments where you're feeling really anxious and really nervous.
- [10:57]
D
Yeah.
- [10:57]
B
So that's where that breath comes. Comes in and becomes so important is like, how do we actually feel into the actual physical body here that we're exploring. Exploring pleasure with.
- [11:07]
D
And so sort of, I guess in my head, I'm thinking you're delineating. This is what I. And then when you learn that you can, then when you're feeling aroused, sort of like, this is what my body feels like when I'm aroused. I'm, you know, sort of very focused. My, like, my senses are heightened. You know, I'm like, whatever I feel, my, you know, my erection, I feel blood flow, whatever it is. And then you can separate that from anxious. Like your. Your. Your shoulders tense up, you feel a little bit like on edge. Like, you know, those sorts of feelings that you might experience. So you can sort of separate those two.
- [11:39]
B
Right, right. The first part is like, learning how to relax, then building in arousal and seeing how the system Is like tightening as arousal enters. Because like we talked about before, a lot of men will tighten to get hard. The pressure to either stop ejaculation or feeling like they need to get hard really quickly can have a lot to do with it. And so it's like, how do you actually learn how to relax the body, take a breath, feel what's going on, and then you can start to assess kind of like where things are at. And there is a really big learning process. And everybody's arousal curve looks really different. Like, I might say, for instance, I was in the room and I was watching. I might say, you look like you're here or. But it might feel different for the person on the inside. And so everybody has to learn. Every man would have to learn for themselves. Like, where are they on the inside? Like, where are they on their arousal curve? And I think that's part of the fun of this journey is like, you're learning so much about your body and so much about what's possible with pleasure.
- [12:39]
D
Yeah. And then I think that the one challenge also is that your body, your brain doesn't really delineate arousal. Different types of arousal. And so sometimes, sometimes anxiety. Some of the feelings that you get with anxiety, like your heart racing, you feeling maybe your blood pressure going up, those are also signs that you're aroused. And so it may be also differentiating. Like, you know that you can still feel aroused while feeling calm, while calming your body.
- [13:07]
B
Yes. That's a huge component, I feel like, for people who struggle with early ejaculation is that it feels like as the arousal builds there, the panic sets in. That's what I often talk to my clients about. It's like there is a feeling of panic, like something's gonna go wrong. Either it could be, you know, rooted in more historical trauma, like, I'm gonna get in trouble, or I was caught masturbating at some point as a kid, or somebody said something mean to me during a sexual experience or, you know, there's all sorts of different reasons why people might feel like they're gonna get and something bad is going to happen to them. But it. It really is about being able to separate those two things.
- [13:44]
D
So step five is another one where I'm sort of like, okay, so you. I think that sounds to most men like, very like, woo, woo. So let's talk a little bit about, like, what that means. Like, actually, like, what does that. Actually, how does. How does one do that?
- [13:59]
B
So sometimes I'll. Yes, most people will say that that's woo. Woo. And it's funny because I'm like the least woo of the community that I'm in, so it's funny, but I can understand how that sometimes sounds. Woo. So if you were to imagine like your pleasure, so your pleasures, the pleasure center of your body are your genitals. And although your whole body can carry pleasure, that center carries lots and lots of pleasure. The nerves, all, everything that's down there. But if you were to imagine almost like in a river or a lake, that there's some dye that goes into the water and it spreads out, that's what we want to think about in terms of what's going on in the arousal. So when the next time someone's in their arousal and women can do this as well, it's like as you're feeling your pleasure, as you're feeling like, wow, this is feeling really, really good, imagine that. It's almost like a drop of dye goes in and it just moves through the whole system and we want it moving through the inside of the system. So it's like it moves out down your legs, down your knees, into your feet, feet, up your belly, down your arms, into your hands. So it's this idea of like you're consciously putting your attention into the rest of your body and it's, it's almost like an invitation to the rest of your body to like, hey, come join us here. Like this is a pleasurable experience because when full body orgasm comes in and women are tend to be a lot better at finding this on, on their own, men sometimes need a little bit of help into the full body orgasm. It's like they. You see when the orgasm happens, the undulation of the whole entire body versus what we often see with men where it's just like, just the ejaculation comes out and not that full orgasm.
- [15:44]
D
Yeah. I think, I mean, I wonder. I think part of it, I mean, I suspect part of it is because men are like from a young age sort of groomed into this idea that like orgasm is the most important thing. So they rush to get it and they don't actually like spend time enjoying pleasure. Right. As much they feel like that's the only source of pleasure.
- [16:06]
B
Right. And I think there's also a lot of pressure on men. Like in heterosexual dynamics. It's like you have to get hard under a certain period of time. And often it's like there's a pressure like I should be hard before she reaches for me, which is an incredible amount of pressure, especially as men age. Because what turns you on changes. And oftentimes you do need more stimulation. And so you're not going to actually be hard until there's a touch that feels good as well as you're now supposed to stay hard for a certain period of time. But don't stay hard and not come for too long because now you're venturing into the delayed orgasm place, which can cause even more struggles in a relationship. So there is also just so much pressure on performance for most men and there can be this kind of like confusion. Like there's not really room for my pleasure here because I'm supposed to act out all of these scripts and perform all of these things and get it all right at the same time.
- [17:06]
D
Yeah, it's a lot of pressure. If you like that clip with Keeley Rankin, make sure to check out the full episode right here.
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