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. In another study administered by Zeiss 20 heterosexual couples were studied under three conditions: treatment self-administered with no therapist present or available; self-administered treatment with a little therapist communication; and treatment administered by a therapist. The results were assessed between 15 and 20 weeks after the start of treatment: Zeiss reviewed the man's tendency to ejaculate quickly and the level of sexual satisfaction before and after treatment. Treatment in this case consisted of providing the man with a manual describing the causes of premature ejaculation and descriptions of the various techniques that can be used to treat it, including sensate focus and the stop and squeeze technique. There was also a lesson every week in sexual communication between members of the couple, which was designed to promote intimacy and communication. The group who received therapist contact had one hour of tuition from the therapist for a period of between 12 and 20 weeks. The outcome of this research was very clear: not a single couple within the group who had no contact with a therapist achieved an increase in IELT of more than three minutes, nor did any of the men manage to last for more than five minutes before reaching orgasm during sexual intercourse. By contrast, five of the six couples who had minimal contact with the therapist achieved these goals, as did all six couples in the group that was administered by therapist. And the results of therapist contact were impressive: intravaginal ejaculatory latency time increased from just under 2 minutes to 10 minutes for the group who had minimal therapist contact, and from just under 2 minutes to nearly 11 minutes for the therapist administered group. The research also clearly demonstrated that contact with a therapist, whether in person or by telephone, produced a significant increase in sexual satisfaction compared to those who receive no contact. Of course another research approach to premature declaration is to consider the effect of psychological therapy administered together with pharmacological therapy. There are many pages on this website which describe the effectiveness of pharmacological interventions, but few controlled studies have been conducted to discover whether psychotherapy and medication act in complementary fashion. However, there is actually some evidence that combination therapy of this kind results in a higher rate of completion of therapy, as well as increased satisfaction with the outcome.
Tang et
al conducted an investigation in which they administered Sildenafil citrate
(Viagra) in combination with behavioral therapy to 60 men experiencing rapid
ejaculation. The measure of success of the treatment was the intravaginal
ejaculatory latency time (IELT) and satisfaction with sex of both partners
before and after the combined treatment. Li conducted a study with 90 patients using the same basic research parameters as above but substituting Clomipramine for Viagra. The scores for control of ejaculatory reflex, sexual satisfaction and self-esteem around sex did show significant increases in a combined therapy and drug treatment group when compared with a control group who received only behavioral therapy. Similar results have been obtained with SSRIs. Abdel-Hamid conducted similar research with clomipramine, sertraline, paroxetine and sildenafil. In this case the drugs were administered on an "as-needed" basis 3 to 5 hours before sexual intercourse was expected. A control group was instructed to use the pause and squeeze technique. Results showed that the pause and squeeze technique was associated with the lowest success rate both in terms of extending sexual intercourse and increased partner satisfaction. The improvements achieved from clomipramine, paroxetine and sertraline were similar.
The investigators drew the conclusion that paroxetine was
superior to the squeeze and pause technique in controlling premature
ejaculation: however, we do know that men who have adequate access to
psychotherapy can use the pause and squeeze technique perfectly well to extend
the duration of sexual activity and there is a concomitant Indeed, sex therapists regard the following factors as being helpful in establishing greater control of ejaculation:
A stop trusting relationship with the sex therapist and a motivated and supportive partner are also essential for effective progress in controlling quick ejaculation. There are reasons why a couple might actually seek to maintain premature ejaculation 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. 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 the premature ejaculation and other sexual disorders can be tackled. The conclusion of the study is that more research is required before we can understand more completely the role of psychotherapy in the treatment and resolution of rapid ejaculation. It is probably a mistake to believe that pharmacological treatment is 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. The quality of research in the field of premature ejaculation 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 premature ejaculation control 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, intimacy levels within the relationship, sexual functioning and general quality of life.
There is also a need for a standardized method of assessing
and diagnosing premature ejaculation. 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. Another aspect of treatment that has not yet been adequately explored is the optimum dose of medication and the optimum amount and duration of psychological treatments from therapists.
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