Stop Premature Ejaculation Now!Comments from the sex advice forumsBack to home
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Psychological intervention for premature ejaculationIt's certainly true that psychological issues are present in most men who have premature ejaculation. The question is whether these psychological issues are the cause of premature ejaculation or an effect of this condition. Three scientists at the University of Sao Paulo have investigated studies to determine if there is evidence that psychosexual and behavioral treatments can lessen the severity of premature ejaculation. They found little solid evidence in formal studies that psychological interventions are effective in the treatment of PE. 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, with premature ejaculation occurring 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] there is certainly good reason to investigate any therapy that claims to have a high success rate. Let's start by defining premature ejaculation as a male sexual dysfunction in which emission of semen and the culmination of sexual climax occurs within about a minute or two of vaginal penetration. In some ways a formal definition is not necessary, because men who suffer from premature ejaculation know only too well that they are rapid ejaculators. They experience a condition that diminishes sexual pleasure for their partners and reduces their own sense of self-esteem and masculinity. 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 PE 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 history of premature ejaculation research contains many reports of the psychological aspects as a major factor in its etiology. The most common theory about the origin of PE is that it is a conditioned reflex, in which a pattern of rapid ejaculation has become habituated when masturbation, or perhaps the very act of sexual intercourse, has been conducted hastily because of fear about being seen or discovered or perhaps because of some other issue such as fear of pregnancy. In 1956 Semans was the first researcher to introduce a behavioral technique - the so-called stop-start technique - for the treatment of premature ejaculation. He reported high success rates with this: it's a method which involves repeatedly stimulating a man's penis until he has almost reached the point of ejaculatory inevitability, then pausing until his arousal has diminished, and then repeating the sequence until the man has learned to control his ejaculation voluntarily. However it appears that there is no supporting evidence of the claimed success rate, and nobody has been able to replicate the results of Semans. This work was followed up by Masters and Johnson in the 1970s; they also claimed a 97+% success rate in remission of premature ejaculation. They developed Semans' work into the squeeze technique and combined it with individual and couples therapy: the female partner was trained to squeeze the frenulum of her partner's penis when he was fully erect, aroused and on the verge of ejaculation. This squeeze was followed by a pause of about 30 seconds to allow the man's arousal to drop. This, it was claimed, soon enabled a man to control his ejaculation for up to 20 minutes. After the manual experience of learning to control ejaculation, a man and his partner would engage in sexual intercourse using the woman on top position, with the woman remaining motionless. With gradually increasing levels of stimulation, Masters and Johnson claimed that the vast majority of their clients were able to develop sufficient control over their ejaculation to ensure that the couple were enabled to engage in prolonged intercourse. Unfortunately, once again, other researchers have been unable to replicate these results. Yet, with some modification, these techniques represent the standard treatment of premature ejaculation to this day. The researchers referred to in this paper 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 treating premature ejaculation, the authors reported on heterosexual couples who were given a self-help course in sensate focusing (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 increase of 37 minutes in the duration of ejaculation control.
(Note that a control group who received formal
treatment only to to 18.6 minute increase in ejaculation control. It seems clear
therefore that when asking people to report on their experience of premature
ejaculation control, they they are prone to exaggerate the results.) 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. Normally any treatment for premature ejaculation would include providing a man with information on human sensuality and facts about the sexual responses of men and women. Table 1 in the article offers a comparison of the number of studies conducted by different researchers over a time span of 30 years. Tamara Melnik and her colleagues, who are the authors of this review paper, concluded that there was little evidence to demonstrate that psychological interventions were effective as a treatment for premature ejaculation. 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. To get the best out of psychotherapy, the authors of the research paper compared and contrasted a number of studies conducted over the years. In the study conducted by Golden, the effectiveness of sex therapy administered in either a group or couple setting was studied. The sessions consisted of information and practice of sensate focus and the squeeze and pause techniques. The techniques produced a significant improvement in premature ejaculation, whether they were administered in group or a couple setting.
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