The Sex Therapist Perspectiveby PEhomepage.com Editorial Team
The emphasis on treating PE, a common male disorder, may have swung from almost strictly behavioral and psychological to strictly medical – at least that is the opinion of Perelman. The author asserts that by ignoring that PE encompasses both physiological and psychological components, men who suffer from the condition may not receive the treatment they need to alleviate it. Recent studies suggest that PE manifests itself along a continuum similar to other human characteristics. There are biological components to PE, yet many men note anxiety, depression, and relationship concerns at the same time.
Since the condition is undiagnosed in many men due to embarrassment or a lack of understanding that treatment is available, it is difficult to determine precisely how prevalent the condition is. Some studies point to prevalence rates as high as 16 to 23 percent. Sex therapy can alleviate the condition in many men, yet it cannot fully treat all of those who are affected. In addition, sex therapy can be expensive and time-consuming, thus further limiting the number of men who are willing to engage in it.
The Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, text revision (DSM-IV-TR) explains PE as “persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The condition must also cause marked distress or interpersonal difficulty, and cannot be due exclusively to the direct effects of a substance.” This definition encompasses both physical realms and the psychological distress that accompanies PE. There are other organizations which also define PE, and each of them also contains diagnostic criteria related to the associated anxiety or stress of the condition.
As far as etiology or origin of PE, there are differing opinions. One theory is that men with PE fail to recognize there are separate stages to ejaculation, comprised of emission and expulsion. These stages may be close in time to one another, with emission being the stage where seminal fluid is deposited into the posterior urethra. During expulsion ejaculation is imminent, usually seconds away. Perelman states, “Men with PE frequently are unable to identify and/or do not or cannot respond quickly enough to these early warning signals to delay their ejaculatory process consciously.” In other words, by teaching men who have PE to understand the separate and distinct processes which underlie ejaculation, treatment can be more effective. Perelman advocates a model of the “Sexual Tipping Point™” whereby it is easy to understand the interaction between physical and psychological factors involved in ejaculation.
During the evaluation process for PE, physicians should gather information about the patient’s sexual history, nature and length of previous sexual encounters, and how the person reacts to their own sexual performance. Using this information to assist with the treatment process is critical. There are numerous methods of physiological treatment including medication, ointments, herbal remedies or other alternative treatment, as well as psychological or psychosocial therapy. The earliest treatments of PE were strictly psychosocial in nature with approaches such as the squeeze technique and the start-stop technique dominating thinking of the period. While some of these treatments showed great promise, they require a great deal of commitment from the male and his female partner. In addition, these treatments are expensive over time. Finally, follow-up studies indicate that relapse rates are unacceptably high with approaches that do not include a physiological/medical component included in the treatment regimen. There are drawbacks, however, to the physiological treatments available on the market today. Topical anesthetic ointments are messy, could cause problems with burning or numbing in both male and female partners, and are disruptive to the intimacy of the moment since they must be applied prior to intercourse and then washed off the penis. Antidepressant oral medications (tablets), while showing more promise than ointments, need to be taken on a chronic, daily basis in order to provide the best results. Antidepressants have side effects such as nausea and decreased sexual interest or libido. In addition, PE returns when the patient stops taking the medication.
For men with severe PE, a combination approach that uses both medication to increase intravaginal ejaculatory latency time (IELT – the time measured from the beginning of vaginal penetration to the moment of ejaculation) and sex therapy to identify the sensations leading up to ejaculation would be optimal. Treatment with an antidepressant could lengthen the sexual experience giving the patient longer to discover the sensations that eventually trigger ejaculation. Training himself to relax and feel in control of his ejaculation, the male could then begin to wean himself off of medication while still achieving a satisfactory ejaculation response rate. By creating a balance between psychological and medical treatment interventions, the patient is able to recover at a faster rate and maintain his rate of recovery.
Source: Perelman MA. "A New Combination Treatment for Premature Ejaculation: A Sex Therapist`s Perspective". Journal of Sexual Medicine. 2006;3:1004-1012.
Back to Articles 
Articles Archive 
E-mail a Friend
