Psychological Causes and Treatments for Premature Ejaculation

Treatments for Rapid Ejaculation

Visiting a psychologist.
Psychological Treatments for Premature Ejaculation. kristian sekulic / Getty Images

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.

Psychological Effects of Premature Ejaculation

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 others aren'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 for Premature Ejaculation

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 depression or performance anxiety.

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

Psychotherapy for Premature Ejaculation and Single Men

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 or hostility to women. 

Individual psychotherapy may be exploratory by examining the developmental underpinnings of reluctance to enter into relationships, and fear or 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.

Psychotherapy for Premature Ejaculation and Couples

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. This sits somewhat uncomfortably when compared with evidence-based medical research involving large, randomized controlled studies.

The high success rates of bigger sex studies conducted by Masters and Johnson (1970) have never been replicated in subsequent studies. All studies with long-term follow-up report a tendency for men to suffer some degree of relapse, by 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.

Sources
Althof, Stanley E. Psychological approaches to the treatment of rapid ejaculation. The Journal of Men's Health. June 2006. Vol 3 Issue 2:180-186.

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