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Delaying Ejaculation Treatment - Psychological - Part 2Is Psychological Treatment Effective?Men who have adequate access to psychotherapy can use the stop-start and squeeze techniques perfectly well to extend the duration of sexual activity and the longer, lingering experience of sex which results from this increases partner satisfaction. In any event, what is abundantly clear is that men require close attention from a therapist whatever treatment method may be chosen. Indeed, sex therapists regard the following factors as being helpful in establishing greater control of ejaculation and extending a man's ability to delay ejaculation and last longer in bed:
A trusting relationship with the sex therapist and a motivated and supportive partner are also essential for effective progress in controlling speedy ejaculation. There are reasons why a couple might actually seek to maintain any sexual dysfunction as a dynamic within the relationship: for example, in situations where rapid ejaculation and any problem associated with it maintains a sexual equilibrium, no matter how dysfunctional -- for example when it covers up a woman's sexual dysfunction or when the man (or his partner, or both) have unrealistic expectations about what is possible in a sexual relationship. (Even simpler: a man might not wish to linger over sex because he dislikes intimacy.) This may also be true where major issues between the couple find expression inside the relationship, or when either the man or his partner are deceitful about what is their objective within the relationship or in therapy. As you would expect, couples who have high levels of disharmony within their relationship demonstrate the lowest success rates in sexual therapy. This is obviously because there are more fundamental issues that need to be dealt with in couples therapy before delaying ejaculation and other sexual dysfunctions can be tackled. The conclusion of the study is that more research is required before we can understand this whole area fully. Yet is drug (pharmacological) treatment the right way forward for this condition, since as yet none of the drugs which appear to be even moderately effective in controlling rapid ejaculation have been licensed for use in that way in the USA? The quality of research in the field of ejaculation control is not high; Bernard Althof in particular has indicated that both higher professional standards and more research are required into the efficacy of both psychological and pharmacological treatments. He has particularly pointed out that large sample sizes, control groups, and validated research methodology, plus long-term outcome assessment is required. He's also made the observation that it isn't enough to investigate the main effects of psychosexual treatment: research should also address interactions between the characteristics of each individual patient and treatment modality. In other words, any experiment conducted into controlling PE needs to be designed so that it measures other outcomes including the level of motivation and a man's readiness to change, his sexual confidence, his sexual satisfaction and that of his partner, their willingness to dawdle over sexual intimacy, and intimacy levels within the relationship, as well as sexual functioning and general quality of life.
There is also a need for a standardized method of assessing
and diagnosing
IELT. The desire to have a unified and
standardized treatment method may be unrealistic, but as with delayed
ejaculation, treatment varies by individual and an eclectic approach may
actually turn out to be the best way of dealing with any individual's
problems. One of these is whether or not there is any particular personality type which makes men more likely to suffer from speedy ejaculation than others. Conversely, there are some men who can last for a long time between penetration and ejaculation; what helps them loiter over their sexual activities? Psychological intervention for premature ejaculationThe treatment of choice for men with lifelong or acquired PE is couples' therapy during which both partners can understand the factors that have brought on the speedy ejaculation as well as those which are maintaining it. It's also important for the therapy to investigate the effect that this sexual dysfunction has both the man and his female partner so that mutual understanding is achieved and the appropriate treatment method aimed at producing a longer lasting form of intercourse for men and their partners can be established. Clearly, this is only likely to succeed where both partners are psychologically and emotionally healthy and have a high level of motivation to pursue the retarded nature of male orgasm. Following the interest in pharmacological treatment of deferred ejaculation, a combined therapy that involves both drugs and psychological interventions has been recommended by some authors. Drugs such as Dapoxetine do have an effect on the time between penetration and ejaculation and therefore serve to provide the man with sexual confidence if he has previously had no ability whatsoever to delay ejaculation. This is similar to the use of Viagra as a confidence boosting drug in the short term for men whose erectile dysfunction has its origin in performance anxiety. Using the drug in this way as a short-term aid to increase the man's ability to achieve delaying ejaculation gives the therapist, so it is said, an opportunity to teach the man to attend to his bodily sensations and pace himself during sexual activity rather than becoming anxious about the rapidity of his sexual response. I would question how able a man is to learn these things whilst he is taking medication; moreover, even the proponents of treatment readily acknowledge that not all men can give up the pharmaceutical remedy once it has helped them to last longer during intercourse. The final option is psychotherapy alone, in whatever form this may take. Most likely these days is psychotherapy will be a mixture of behavioral therapy, cognitive therapy, and psychodynamic approaches. Clearly however, the most important aspect of treatment is that the man should learn to control his ejaculation, and that he and his partner should: 1 recover
confidence in sexual activities To which I would add, for men, lasting longer in sex will also help increase sexual confidence and self-esteem. The psychodynamic orientation of therapy is useful in understanding that the premature ejaculation may be a metaphor for deeper issues that are of primary importance to each member of the couple. A skilful therapist will be able to unearth these so that behavior therapy can then work on the condition aspects of sexual dysfunction. How long this takes depends on the dedication and commitment of the couple to the work. This would typically involve homework exercises, exercises for men that enable them and their partners to establish qualities 1 - 7 listed above within their relationship. Many men think that if they pay attention to the level of sexual arousal or excitement they're feeling it will cause them to ejaculate more rapidly than before, so they try to dawdle their way through sex by paying attention to physical factors such as desensitization ointment, repeated masturbation before intercourse, avoiding stimulation from their sexual partner, using two condoms, or distracting themselves with irrelevant thoughts whilst making love. Unfortunately all of these strategies for lasting longer during sex and loitering over ejaculation take the focus away from awareness of physical arousal for men and make it even less likely that they will be able to control their ejaculatory responses. It's interesting to listen to men talk about their sexual experience because what they tend to describe is a rapid movement from a point where they do not feel sexually excited very suddenly to the point of ejaculatory inevitability. In other words the prima facie evidence suggests that they have a lack of awareness of their level of arousal between these points, or that they are perhaps unable to keep themselves in this mid-range of sexual arousal. Graduated exercises for men during sex allow them to become familiar with their bodily sensations, starting with masturbation and moving on to foreplay and full sexual intercourse. This gradual increase in levels of sexual arousal gives them the ability to stay in a mid range sexual arousal below the point of ejaculatory inevitability. It is also clear that anxiety plays a large part in the lack of retarded or delayed ejaculation, so relaxation and sensate focus are invaluable tools in this treatment methodology. But it is also necessary to teach men how they can resolve the relationship issues that may be supporting PE and the cognitive distortions which exist within the relationship in the interactions between the man and his partner. For example, Rosen et al listed eight forms of cognitive distortions that certainly interfere with the ability of a man to achieve normal sexual function:
Clearly there is an important role here for an educational process during therapy which will enable a man to reconstruct a framework within which he sees his sexual performance, and which will also enable a couple to rewrite their sexual script (that's the behavioral repertoire of the couple in the field of their sexual activities). Achieving retarded ejaculations during sex is not magic; it involves some work and some commitment of time and effort for men and for women. There's always resistance at some point during therapy. It is not easy, and it's often not comfortable, for a man or his partner, or both, to give up the status quo because it represents some point of reference within the relationship which maintains the behaviors even if they are maladaptive ones. skilful therapist will be able to break down these resistances using confrontation, interpretation, intervention, and perhaps a smattering of humor. A typical source of resistance would be the fact that rapid ejaculation and the disharmony that arises from it can maintain a sexual equilibrium within a relationship and disguise the female partner's concern about sexual activities. Psychotherapy outcome studies show dwindling speedThere is a regrettable lack of control and methodology in reported studies on the treatment of this sexual dysfunction. This led to a large amount of literature producing apparently compelling conclusions which are in fact mostly anecdotal. In the 1960s, however, Masters and Johnson reported on 186 men studied in their quasi-residential setting who received intensive treatment including the squeeze technique, sensate focus, both individual and couples therapy, as well as training in sexual skills and communication. Masters and Johnson's claimed success was extraordinarily high - they reported only 2 to 3% failure rate at five years after treatment. It has to be said that this level of effectiveness has never been achieved since. It seems that either the results were misreported or that to maintain the improvement in the time for which a man can last during sex, constant reinforcement is needed. For example, only 64% of men in Hawton et al.'s study and 80% of Kaplan's cohort appeared to be successful in overcoming their premature ejaculation, and that was immediately after therapy. Moreover almost all studies that have invested in long-term follow-up showed that men suffered from relapses, in as many as 75% of cases. Interestingly enough, 34% were not even bothered by this which strongly suggests that the treatment methodology they had received had improved the quality of their relationship and sexual satisfaction. This emphasizes that treating the couple as a unit can produce improvements in intimacy communication which may outweigh in importance the increase in intra-vaginal ejaculatory latency time. Nonetheless, modern therapists have begun to look at the question of preventing relapses. This can be done by scheduling regular sessions at regular intervals after the termination of main therapy. Knowing that there will be a six-month follow-up session motivates patients to keep up with the work involved in learning to last longer and gives them the opportunity to discuss any problems that have arisen. Combined treatment and coaching can produce delaysClearly there are major differences where treatment is a combination of pharmaceutical intervention and psychological approaches. For one thing, the psychological aspects of treatment have been referred to as coaching rather than therapy: they are more directive, the focus on giving advice and education and the improvement of ejaculatory delay technique. They also directly target behaviors that are maladaptive or unhelpful such as the avoidance of foreplay, inhibited sexual behavior, and destructive sexual patterns which are established with the relationship including the ability to communicate about problems. In summary, the objectives of such coaching are:
It's possible that the best focus of combined treatment is when pharmacological therapy has not proved effective. However that is a matter of opinion, and I would always go for psychological approaches before pharmaceutical solutions. Conclusion - the longer, the better - at least during intercourse!What can be said in a field so vexed by differing opinions? One thing is clearly that treatment needs to be tailored to the requirements of the man and his partner. Premature ejaculation is, or at least can be, a very distressing condition which affects the relationship between a man and his partner in every way. It is therefore arguable that every approach that can be brought to bear on the situation should be brought to bear to ensure that a couple achieves greater sexual satisfaction, emotional intimacy and a better relationship which is more harmonious and satisfying to them.
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