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Premature Ejaculation: Treatment

 
Medical Encyclopedia: Premature Ejaculation: Treatment
 

In 1966, William H. Masters and Virginia E. Johnson published Human Sexual Response, in which they broke the first ground in approaching this topic from a new perspective. Their method was devised by Dr. James Seman and has been modified subsequently by Dr. Helen Singer Kaplan and others.

A competent and orthodox sex therapist will spend much more time focusing on the personal than the sexual relationship between the two people who come for treatment. Without emotional intimacy, sexual relations are superficial and sexual problems such as premature ejaculation are not always overcome.

With that foremost in mind, a careful plan is outlined that requires dedication, patience, and commitment by both partners. It necessarily begins by prohibiting intercourse for an extended period of time—at least a week, often a month. This is very important to the man because "performance anxiety" is the greatest enemy of performance. If he knows he cannot have intercourse he is able to relax and focus on the exercises. The first stage is called "sensate focus" and involves his concentration on the process of sexual arousal and climax. He should learn to recognize each step in the process, most particularly the moment just before the "point of no return." Ideally, ally, this stage of treatment requires the man's partner to be devoted to his sensations. In order to regain equality, he should in turn spend separate time stimulating and pleasing his mate, without intercourse.

At this point the techniques diverge. The original "squeeze technique" requires that the partner become expert at squeezing the head of the penis at intervals to prevent orgasm. The modified procedure, described by Dr. Ruth Westheimer, calls upon the man to instruct the partner when to stop stimulating him to give him a chance to draw back. A series of stages follows, each offering greater stimulation as the couple gains greater control over his arousal. This whole process has been called "outercourse." After a period of weeks, they will have together retrained his response and gained satisfactory control over it. In addition, they will each have learned much about the other's unique sexuality and ways to increase each other's pleasure.

With either technique, the emphasis is on the mutual goal of satisfactory sexual relations for both partners.

However, the 1990s ushered in a new era in the treatment of premature ejaculation when physicians discovered that certain antidepression drugs had a side effect of delaying ejaculation. Clinical studies have shown that a class of antidepressants called selective seratonin reup-take inhibitors (SSRIs) can be very effective in prolonging the time to ejaculation. The individual drugs and the average amount of time they delay ejaculation are fluoxetine (Prozac), one to two minutes with doses of 20-40 milligrams per day (mg/day) and eight minutes with 60 mg/day; paroxetine (Paxil), three to 10 minutes with doses of 20–40 mg/day; and sertraline (Zoloft), two to five minutes with doses of 50–200 mg/day.

— Ken R. Wells



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