Men feel diminished by their PE. Some blame their partners (e.g., she’s too sexy, I can’t help it), others worry that their partners will have affairs, some try incessantly to please their partners via non-coital behaviors, only to be rejected in their attempts. Female partners are distressed that the man has been unable or unwilling to fix the problem and resent his preoccupation with his performance during lovemaking. Additionally, female partners dislike the abrupt cessation in emotional intimacy that occurs when the man ejaculates. He feels ashamed and turns away from her; she is left feeling abandoned and angry. As mentioned previously these issues continue to grow and snowball into more chronic contentious issues.
Therapists seek to help couples reclaim their sexual and emotional intimacy while decreasing the hostility and withdrawal from one another. Helping couples to surmount these obstacles, finding rational solutions to their conflicts and working constructively together to solve the issues are the primary goals of relationship therapy for PE.
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Psychotherapy outcome
The majority of psychotherapy outcome studies do not meet the standard for evidenced-based medicine. They tend to be uncontrolled (no wait list or sham intervention), employ small sample sizes without adequate follow-up, and because of definitional controversies are studying very different groups of PE men (e.g., in some PE groups the IELT is 2 minutes; in others, it is 6 or more minutes). Due to the inadequate quality of the research, meta-analytic studies include very few studies in their reviews. One meta-analytic review concluded that there is limited evidence that physical behavioral techniques improve IELT and other outcomes over waitlist controls (35); two other meta-analyses found that there was weak and inconsistent evidence for psychological interventions for PE (36,37). All three meta-analysis concluded that there is good evidence for the use of combination therapy (more efficacious than drug alone).
There are however, two psychotherapy studies of modest sample size that provide useful data. De Carufel and Trudel demonstrated an eightfold increase in IELT among men treated with psychological intervention (education on sensuality, movement of the body, speed of sexual activity, muscular tension and breathing, squeeze and stop/start techniques) compared with a wait-list control condition (38). Masters and Johnson reported the results of using the squeeze technique, sensate focus, individual and conjoint therapy as well as sexual skills and communication training (21). Their “failure rates” were 2.2% and 2.7% immediately post therapy and at a 5-year follow-up respectively (21). Clearly, more research employing better sampling, statistical and outcome methods needs to be conducted.
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Discussion
In general, psychological interventions offer promising treatment options for sexual dysfunctions. As regards PE, psychological therapies address both the rapidity of the ejaculatory response and the burden that the dysfunction has on the man, partner and couple. Combination pharmaco- and psychotherapy offers superior efficacy to drug alone. This is because men and couples learn sexual skills, address the intrapsychic, interpersonal and cognitive issues that precipitate and maintain the dysfunction.
Additionally, we now have improved outcome measures [Index of Premature Ejaculation, Premature (39) Ejaculation Profile (40) and Premature Ejaculation Diagnostic Tool (41)] that allow researchers to better examine the efficacy of their interventions on subjects. Likewise we also have agreement on who does and does not suffer from PE so moving forward there should be increased homogeneity of treatment groups.
Sexual skills training, couples, and cognitive therapy, are all helpful in alleviating the anguish of men, partners and couples who suffer from PE. Hopefully more studies will be conducted and included in future meta-analysis to better judge the quality of psychological interventions.
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