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Premature Ejaculation (PE) Treatment - Psychological 1Stanley E. Althof PhD has written extensively about PE, and these notes are based on his article in JMHG Vol. 3 No. 2, pp. 180- 186, June 2006. In this article he reviewed the psychological theories and various treatment approaches to developing delays in ejaculation. It also describes the potential negative psychological effect of PE on the man and his partner. As part of the article he provided some suggestions as to how a man might approach the issue of delaying treatment for fast or early ejaculation, and how his partner might take part in this. He also discussed the effects and usefulness of a treatment approach that combined drugs and psychotherapy: in doing so, he discussed the limits of psychotherapy, and assessed how successful psychological interventions designed at producing delays can be. His conclusions may have relevance for improving the quality of psychotherapy for a lot of men - in any event, there's no question that psychological interventions are a crucial aspect of encouraging men to learn how to delay orgasm. Althof observed that it's comparatively easy to increase the intravaginal ejaculatory latency time (IELT) by offering men SSRIs, even though they are not licensed for use as a treatment for PE. What is more difficult is restoring the depleted confidence of a man and establishing a satisfactory relationship between him and his partner when his sense of sexual prowess and confidence has been diminished by his consistent inability to control the timing of his ejaculation. Indeed, Althof claimed in the article that the administration of SSRIs is now the routine treatment of choice. But he also observes that, just as with the use of Viagra, the administration of drugs alone has proved to be a false dawn in the treatment of premature ejaculation. Why? Because developing a truly delayed ejaculation has a major psychological component. The point is, of course, that drugs in isolation cannot always overcome the psychological factors which may cause, or contribute to the cause of, sexual dysfunction. It's also quite obvious, especially to those couples where the experience of any delays has been a persistent difficulty, that administering drugs to the man may not have any influence on the psychological interplay with his partner. If, therefore, psychological factors play a part in either causing or worsening a man's premature ejaculation, it follows that psychotherapy of some kind is essential as an intervention in the treatment of both the man and his partner when a couple has experienced rapid ejaculation and it has affected their relationship. The question arises, which treatments are more effective in dealing with this pernicious condition? Perhaps the first step in establishing this information is to decide whether or not it's clear where the cause of a man's tendency to ejaculate quickly actually lies. Some therapists suggest PE is entirely psychological in origin; others say it's entirely physical in origin; and some think it's the result of a combination of many factors. Recent psychological thinking suggests that anxiety is one of the main factors which lies behind the lack of delays in ejaculating. Psychological Treatment OptionsPsychotherapy, or counseling, is clearly indicated where lack of delaying is clearly psychological in origin, or where major emotional factors are maintaining the problem. It is particularly indicated in couples where the man's quick ejaculation serves as a distraction from sexual dysfunction in the woman, such as lack of orgasm, or where the relationship is clearly in jeopardy because of other factors. It's also important to establish the partner's role in the man's lack of delayed sexual response: for example, if she is putting pressure on him to in "last 20 minutes because it takes me that long to have an orgasm" then at the very least she requires factual information about the nature of sexual relationships and the low possibility of a man being able to make a woman orgasm during sex alone. Psychodynamic psychotherapy can be helpful for single men not in relationships who are seeking treatment for premature ejaculation, since this allows the therapist to help them overcome the any reluctance to enter into new relationships at the same time. In addition, of course, psychotherapy can only proceed to a certain extent without a partner who can assist in the practical training exercises that help a man retard his orgasm and establish greater control. When a man is already in a relationship, psychotherapy is recommended when the issues that appear to support his tendency to come too soon are in the main psychological rather than interpersonal: in other words if a man was anxious about getting intimate or felt hostile towards women, solo therapy might be more appropriate than couples' therapy. If the relationship is in jeopardy or looks as though it has no future, then individual therapy may also be the appropriate treatment, but once again treatment options are limited when it comes to the practical aspect of training. Couples therapy is the treatment of choice where a couple is functional and a man and his partner are both emotionally healthy and dedicated to pursuing treatment with the objective of retarding his climax. With the full co-operation of the partner, hopefully the effect of PE on both the man and his partner can be explored, and a treatment strategy developed which involves them both. A Psychological Cure For Premature EjaculationIt's certainly true that psychological issues are present in most men who have no ejaculatory retardation. But are these psychological issues cause or effect? Three scientists at the University of Sao Paulo have investigated studies to determine if there is evidence that psychosexual and behavioral treatments can reduce premature ejaculation and extend sex. They found little solid evidence in formal studies that psychological interventions are effective in the treatment of premature ejaculation. One of the reasons for this is the fact that many studies are poorly conducted, with a lack of randomization, an absence of data about long-term follow-up, lack of reproducibility of the study findings, and small sample sizes. Nonetheless, premature ejaculation occurs in at least 25% of the population [and, of course, depending on how you define "premature" it may be a condition that affects as many as 75% of men] so there is certainly good reason to investigate any therapy that claims to have a high success rate. Many researchers have supported the role of psychological factors in the etiology of PE. For example, a common idea is that it is a learned behavior, a response to a meaningful event such as an episode of sexual anxiety. Others have attributed early ejaculation to physical conditions such as oversensitivity of the penile glans. Because of the significance of the effect of rapid climax on both men and their sexual relationships, with notable decreases in self-confidence, difficulties in establishing relationships, and distress about the lack of satisfaction that their partners achieve during sexual intercourse, there is certainly good reason to review the studies that have been conducted in this area. The literature on increasing the slowness of ejaculation and helping men to last longer during sex contains many reports of how psychology plays its part. Perhaps, for example, lack of delayed orgasm is a conditioned reflex, in which a pattern of rapid ejaculation has become habituated by furtive and swift masturbation or sex. This can be due to fear of being seen or discovered, or perhaps because of some other issue such as fear of pregnancy. The researchers compared studies of the effectiveness of psychotherapy with other psychological treatments, pharmacotherapy, behavioral therapy, or a combination of more than one treatment. In trying to determine whether psychosocial treatments are indeed a useful way of stopping premature ejaculation, the authors reported on heterosexual couples who were given a self-help course in sensate focus (a technique in which each partner is encouraged to focus on their own sensory experience, instead of thinking of orgasm as the only objective of sexual interaction with another person). Giving people the opportunity to train in the squeeze technique, and combining it with a variety of other therapeutic modalities, resulted in a self-reported improvement in delayed ejaculation of 37 minutes.
(Note that a control group only succeeded in
delaying ejaculating by 18.6 minutes.) Treatment intended to improve control over the moment at which a man ejaculates, in other words to give a man the opportunity to decide when he ejaculates, is based on simple underlying principles: the basic idea is that the man can assess his level of sexual excitement - which he can do by focusing on spatial, temporal, and energetic dimensions of his sexual movements - he can use his bodily muscles in a more relaxed way (since tension rapidly increases arousal and rushes a man towards the point of ejaculatory inevitability), he and his partner can use sex positions which induce less muscular tension, and he can learn to breathe deeply from his diaphragm during sex. All of these are realistic techniques to stop premature ejaculation and help a man last longer during sex. Normally any treatment would include providing a man with information on human sensuality and facts about the sexual responses of men and women. Tamara Melnik and her colleagues, co-authors of this review paper, concluded that there was little evidence to demonstrate that psychological interventions were effective as a treatment for PE. However, they do admit that effectively designed and controlled studies of psychotherapy are limited, and even those that do exist had a small number of participants. Continues here: psychology 2
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