There have been mixed professional opinions over the last few decades as to what is the ideal treatment for male sexual disorders. The best treatment for DSM-5 premature (early) ejaculation disorder (previously referred to in the DSM-IV as simply, “premature ejaculation”) ultimately depends on the etiology, or “root cause,” of the problem.
If it is of a strictly medical nature one should consult with their primary care physician. Examples of medical causes are side effects of medication, cardiovascular problem, or metabolic dysfunction. In this case, one’s primary care physician can either diagnose or treat the patient themselves or refer the patient to a specialist. If it is caused by another medication the male is being prescribed, it is suggested that they contact the prescribing physician and discuss medication solutions to the problem; these are easily obtained in most instances.
Otherwise, if the patient or their doctor suspects a psychological issue as the source for their early ejaculation tendencies (for example, anxiety around performance or intimacy), a clinical psychologist who specializes in sexual disorders will be the optimal provider of treatment. There are various methods that may work better for some men. Some men benefit from self-help books on this subject alone, while others may benefit most from seeing a therapist with specific training in sexual disorders.
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Cognitive behavioral therapy (CBT) is the best evidence-based therapy for many psychological problems. CBT involves a three-pronged approach. When applied to early ejaculation, this includes: addressing unhelpful thoughts (cognitions) in the male that get in the way; establishment of a cooperative partner relationship; and teaching the patient behaviors for delaying ejaculation. These three interactive components form treatment linking body and mind.
1) Altering negative maladaptive cognitions is a cornerstone of CBT for any form of distress. In early ejaculation this generally involves the male’s facing thoughts of self-defeat or failure and, in turn, restructuring them so that the problem can eventually remit. Cognitive restructuring involves challenging the objective validity and importance behind holding onto thoughts that are self-defeating. This may also involve education around how unwanted-but-automatic thought patterns influence subsequent emotions and biological states. This approach can initially help the male patient to understand how changing your thoughts about the problem and towards yourself will actually help to improve the physiological reaction of early ejaculation.
2) Having a cooperative partner relationship is necessary in the context of therapy because mastering the skills taught take practice. The individual may be instructed to practice techniques alone first, but the problem ultimately involves performance during intimate contact. Thus, having a cooperative, compassionate, and understanding partner can optimize the effects of therapy for this disorder.
3) As stated above, unless this problem is caused by taking another medication that lists premature ejaculation as a side effect, the solution to delaying ejaculation will require behavioral practice. The most common behavioral component of treatment for this disorder is to become more familiar with the feelings and sensations surrounding the time leading up to ejaculation. By learning to become more familiar with these sensations, you can then slowly learn how to predict when the upcoming ejaculation will occur and gain more control over them.
Daily use of selective serotonin reuptake inhibitors (SSRI) medication is the first line of medication treatment for early ejaculation disorder. SSRIs are most commonly prescribed for anxiety and depression, while often carrying the negative sexual side effects of decreased libido and erectile dysfunction. In males with early ejaculation tendencies, however, SSRIs can help placate the problem through the mechanism of serotonin in the central nervous system.
As mentioned above, many men utilize self-help methods from a book to combat this problem. One popular method taught in self-help books (advocated for by the Sexual Advice Association; SAA) is the “stop and start” method. A person begins masturbating (alone or with a partner) and a moment or two before ejaculation, stops. Masturbating resumes when the person has come down from his closeness to ejaculation. Again, masturbation is stopped as the man approaches ejaculation. This is done repeatedly until gains are produced in the patient.
After doing this exercise a few times, the man will hopefully become more aware of the sensations leading up to ejaculation and be able to better control them through stopping intercourse for a few minutes. Of course sexual play doesn’t need to end at this time. Combining this method with taking one’s mind off of the “performance” aspect of sexual intercourse (and instead think about other, non-related activities) can lead to greater control over one’s ejaculation.
Some books condoned by the SAA encourage use of creams and other products to prolong orgasm. However, these products have not been scientifically studied. Ultimately, if you choose to consult a self-help book try to use advice coming from a reputable source. For example, authors of sexual self-help texts should have the educational and training status necessary for providing behavioral recommendations, such as appropriate health degrees and a number or years of experience in treating sexual disorders. For more on symptoms, please see symptoms of premature (early) ejaculation disorder.