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Supporting research

Behavioural training for early ejaculation has been studied since the 1950s and is still the first-line non-drug option. Here is the record, by author, with what each actually reported. The figures are theirs, about their patients.

James Semans, urologist

The stop-start method is described

In 1956 a Duke University urologist published a short paper proposing that early ejaculation was driven by what he called a rapid reflex mechanism, and that the reflex could be trained to run more slowly.

His method was the one every program since has borrowed: stimulate until ejaculation feels imminent, stop until the feeling subsides, resume, and repeat, until stimulation can be tolerated for as long as the man wants. Holdline's steps 1 to 5 are structured versions of exactly this.

All eight men in the original series reported improved control.
Semans JH. Premature ejaculation: a new approach. Southern Medical Journal. 1956;49(4):353–358.
William Masters and Virginia Johnson

The squeeze technique, and the first large series

Masters and Johnson treated early ejaculation within a structured, graded program that moved from manual stimulation, to motionless intercourse, to full intercourse, advancing only when the man was ready. They added a firm squeeze of the glans at the edge as a faster way to bring arousal down.

The graded structure is the part most later programs quietly dropped and the part Holdline keeps: six steps, each closer to real intercourse, each held for two weeks before the next.

They reported a failure rate of about 2 percent among the men treated for early ejaculation in their program.
Masters WH, Johnson VE. Human Sexual Inadequacy. Boston: Little, Brown; 1970.
Helen Singer Kaplan, psychiatrist and sex therapist

Early ejaculation as a lack of learned control

Kaplan founded the first sexual-disorders clinic at a US medical school and reframed early ejaculation as a failure to have learned voluntary control over a reflex, rather than a disease. That reframing is why the condition responds to training at all, and it is the idea behind the word recalibration.

She wrote that more than 90 percent of men could gain control, with treatment averaging about fourteen weeks.
Kaplan HS. The New Sex Therapy. New York: Brunner/Mazel; 1974. Kaplan HS. PE: How to Overcome Premature Ejaculation. New York: Brunner/Mazel; 1989.
François de Carufel and Gilles Trudel, clinical psychologists

Behavioural training tested against a newer approach

A randomised trial at the Université du Québec à Montréal compared traditional behavioural treatment, stop-start and squeeze, with a newer functional-sexological approach. Both produced large gains in intercourse duration and in both partners' satisfaction, and the behavioural arm held its own.

The authors reported intercourse duration rising several-fold in both groups, with corresponding gains in partner satisfaction.
de Carufel F, Trudel G. Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex & Marital Therapy. 2006;32(2):97–114.
Cochrane Collaboration review

The systematic review

A Cochrane review pooled the randomised trials of psychological and behavioural treatments. It found improvements in ejaculatory latency and satisfaction compared with waiting-list controls, and it was candid that the trials were few and small. That candour is why Holdline publishes its own measured outcomes rather than leaning on the review alone.

Behavioural therapy improved latency against waiting-list controls; the evidence base was rated as limited by trial size.
Melnik T, Althof S, Atallah AN, Puga MEDS, Glina S, Riera R. Psychosocial interventions for premature ejaculation. Cochrane Database of Systematic Reviews. 2011;(8):CD008195.
International Society for Sexual Medicine

Current guidelines

The ISSM guideline lists behavioural techniques among first-line options for early ejaculation, on their own or alongside medication, and recommends them particularly where the man prefers to avoid drugs.

Behavioural therapy is a recognised first-line option in current international guidance.
Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation. Sexual Medicine. 2014;2(2):60–90.

What we measure ourselves

The studies above describe other people’s patients. We will publish Holdline’s own success rate only once enough members have completed eight sessions, computed from their timers using the same bar the refund guarantee uses. Until then this space stays honest and empty, and the guarantee stands in for the number. What you can expect.