Psychological Treatments for Premature Ejaculation

Premature ejaculation, sometimes known as rapid ejaculation, is the occurrence of ejaculation prior to the wishes of both sexual partners. The cause, or causes, are not fully understood. Explanations for premature ejaculation range from the purely biological to the purely psychological, with yet others suggesting a more complex relationship between biology and psychology. Psychological factors, however, are known to worsen or precipitate premature ejaculation which is why treatment may involve psychological therapies.

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Psychological Effects

Premature ejaculation can lower self-confidence, make men reluctant to start new relationships or lead to concerns that a partner may seek a relationship with another man. Within a relationship, men may feel misunderstood, that their partner isn't aware of the extent of frustration and humiliation they regularly experience. Their partners may suffer in silence for fear of upsetting their man further or may become frustrated at the apparent unwillingness of the man to address the problem.

Benefits of Psychotherapy

Stanley E. Althof, Ph.D., from the Center for Marital and Sexual Health of South Florida, has analyzed the strengths and limitations of different psychological interventions for premature ejaculation. He feels that psychotherapy alone is best for men or couples where the problem is clearly psychological—for example, caused by performance anxiety.

Approaches to psychotherapy emphasize control of ejaculation by learning new techniques, gaining confidence, lessening anxiety, and learning better communication.

Individual Psychotherapy

For single men not in relationships, individual psychotherapy may help to address men's reluctance to enter into relationships. For men in relationships, individual psychotherapy may help when the dysfunction appears to be rooted in childhood issues or excessive fear of or hostility toward women.

Individual psychotherapy may be exploratory, examining the developmental underpinnings of reluctance to enter into relationships, and fear of hostility toward women. It can also be behavioral, and specific techniques can be learned that help control ejaculation, improve attention to arousal, and manage anxiety.

Couples Psychotherapy

For couples, combined psychotherapy may help where both partners are motivated to seek treatment and where the various factors involved in premature ejaculation can be explored.

Couples therapy can be either exploratory, looking into issues in the relationship that contribute to sexual issues and premature ejaculation, or it may be behavioral, examining specific techniques around ejaculatory control and arousal that are worked on directly with the couple together (“sex therapy”).

Psychotherapy With Medication

Combining medications with psychological therapies may, according to Dr. Althof, offer the best of both worlds. The effect of certain medications to delay ejaculation can help to build confidence before psychological therapies are used. In time, the man can be taught not to fear his arousal and to attend to other sensations. Once achieved, many men can be weaned off medication completely.

Do Psychological Therapies Work?

Sex therapy studies tend to be small and uncontrolled. The high success rates reported by Masters and Johnson (1970) have never been replicated in subsequent studies. All studies with a long-term follow-up report a tendency for men to suffer some degree of relapse, at a rate as high as 75 percent, although sexual satisfaction overall appears relatively good.

On balance, Dr. Althof believes that psychological treatments have relevance for both men and couples, whether or not traditional psychotherapy is used alongside medicines. The results, he believes, point to an overall improvement in sexual and relationship satisfaction.

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By Jerry Kennard
 Jerry Kennard, PhD, is a psychologist and associate fellow of the British Psychological Society.