Psychological Treatment for Premature Ejaculation

Premature ejaculation is something that many men are concerned about, though it’s actually unlikely in most cases that they are suffering from the clinical definition of premature ejaculation. While there is no completely agreed ‘cut off point’ for what doctors consider to be ‘premature ejaculation’, it is generally considered to be anything within 15 seconds of penetration. Some men with genuine PE will not even get to the point of penetration before they ‘finish’.

The normal ‘ejaculatory latency’ for men is actually anywhere between 3-4 minutes however and in many cases less than that. Thus men who actually have completely typical sexual stamina will often feel that they aren’t lasting as long as they should and may consider themselves to have a ‘mild’ form of premature ejaculation. The problem is that most women require at least 10 minutes and often up to 30 minutes of stimulation before they are able to reach orgasm. Normal healthy men might therefore be unable to bring their partners to climax and may be looking for treatment to improve their sex lives.

Whether you are someone who is genuinely suffering with premature ejaculation, or you just want to last a little longer in bed, there are a number of treatments available, many of which address the psychological aspect of the problem.

Therapy

There are many therapeutic treatments available for those struggling with premature ejaculation, several of which have a high success rate.

One form of therapy is CBT or ‘cognitive behavioral therapy’. This is a psychotherapeutic approach that involves teaching the patient to recognize the way that their negative thought patterns might be contributing to the problem of PE and then showing them how to combat these with positive affirmations and cognitive restructuring.

Essentially the goal is to get the patient to stop stressing about the prospect of premature ejaculation, which only makes the problem worse by drawing attention to it. By having sex while maintaining a calm attitude and focusing purely on your partner’s satisfaction, it’s possible to ‘get out of your own way’ often leading to the results you may be looking for.

Another form of therapy is psychotherapy. This is a type of therapy that follows the teachings of Freud and psychodynamic theory and which is considerably less successful than CBT in treating the problem. Here, it is believed that those suffering from premature ejaculation may in fact have an ‘unconscious hostility’ towards women and that their PE is an attempt to frustrate the partners they’re with while still getting their own satisfaction. The science, evidence and common sense fail to back this up, though some people still choose this form of therapy.

Finally, sex therapy combines a CBT-type approach with practical advice. Sex therapists teach men to identify the signs that they’re about to climax and then recommend using a ‘stop and start’ approach where they stop moving during sex to help them relax. This method has been shown to be successful, but it is worth remembering that women need continual stimulation in order to orgasm so this could be a counter-productive strategy. Sex therapists also recommend the use of desensitizing agents which numb sensation for the men and of exercises to strengthen the pubococcygeus muscle which can be used to control ejaculation.

Generally though, using cognitive behavioral therapy or just self-help to try and remove the anxiety associated with premature ejaculation is the best strategy. And one of the best ways to do that is to remove some of the pressure by focusing more on foreplay and trying techniques like tantric massage where orgasm is no longer the focus or the ‘goal’ of sex.

Antidepressants for Premature Ejaculation

Medication can also be used to treat premature ejaculation which takes the form of SSRIs. SSRIs are medications that are also used as antidepressants and which act as ‘serotonin reuptake inhibitors’. This means that they work by preventing the brain from ‘recycling’ unused serotonin, thus increasing the amount available.

Serotonin is a ‘feel good’ neurotransmitter which is associated with feelings of elation and euphoria as well as pain relief and several other positive effects. Thus users who take SSRIs will often feel happy and carefree and may experience reduced physical pain. These medications have been shown to be very effective in treating premature ejaculation in studies (1) but they do carry potential side effects and the potential for addiction and abuse. For these reasons they should generally be reserved for cases that have proven unresponsive to other types of treatment rather than used as the first line of defense.

Other Approaches – Is Therapy Enough?

For those who are really struggling there are even surgical options available that work by freezing the dorsal penile nerve via an injection into the navel. This appears to be effective and it’s only an outpatient procedure, but it’s also nevertheless expensive and you might require multiple visits – so it’s hard to wholeheartedly recommend.

What this does suggest though, is that premature ejaculation isn’t solely ‘in the head’. If changes to the penile nerve are what it takes to treat a case of PE, then using CBT or sex therapy may not be enough. Likewise, it also appears that there is a familial link that can predict PE. In other words, if a male in your family had the issue, then you are more likely to as well. While this doesn’t necessary preclude a psychological element, it does suggest that something more physical may be at play and as such it may again be beyond the scope of a purely ‘talking’ cure. The paragigantocellularis region of the brain is one that is associated with the regulation of ejaculation, so physical damage here could even be the cause.

Conclusions

So with all that in mind, how do you best go about treating a case of premature ejaculation? That’s going to depend specifically on your symptoms and the severity of your problem. Sex therapy and CBT however can be highly effective at treating many cases of PE and more importantly can help you to manage the problem and to take some of the pressure off of sex. When you use something like tantric massage in order to enjoy erotic experiences with your partner that don’t revolve around penetration then you can find that this removes the focus from helping her to reach orgasm and that you both have a better experience as a result.

If that’s not enough and you’re still highly frustrated though then therapy and management may not go as far as you need them to. SSRIs might be helpful but if you can afford and if you can find somewhere that offers it, then surgery to freeze the penile nerve will have fewer potential side effects.

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