Sex Techniques and Positions
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Controlling Premature Ejaculation
If you happen to have a problem with ejaculating too quickly, you'll be very interested to know which are the most effective treatments for this condition.
It's true that many of the therapies that are offered on the Internet are completely bogus, in particular herbal concoctions from the Far East, whether in lotion, spray or herbal pill form, tend to be completely useless.
As you may well imagine there is little or no scientific testing of such products, most of which are not even regulated by the FDA or equivalent medical licensing authorities in other countries.
However, a number of evidence-based medical studies have demonstrated that there are certain psychological and medical treatments for premature ejaculation which are somewhat effective. To be really compelling, such studies require large sample sizes, with the design of the study being randomised, double-blind, placebo-controlled.
Unfortunately, investigation of counseling or therapy as a treatment for premature ejaculation has resulted in studies which are certainly uncontrolled, unblinded, and often impossible to adapt to placebo controls. It's fair to say that almost none of these studies meet the requirements for high-level evidence-based information.
Furthermore, since the literature on psychological treatment for premature ejaculation consist of reports on small to moderately sized samples, and active treatment is rarely compared to any kind placebo or control group, these studies are worth very little.
Masters and Johnson reported on 186 men who were seen in their workshop setting, which was a quasi residential therapy workshop, and who were treated with the squeeze technique and sensate focus as well as individual and couple counseling.
Masters and Johnson reported extremely low failure rates of only 2 to 3% after the therapy and five-year follow-ups.
Regrettably it's not been demonstrated since in any clinical investigation that these claimed failure rates were repeatable, though Helen Singer Kaplan reported an 80% success rate in overcoming premature ejaculation immediately after therapy.
It is also true that the majority of long-term studies on the psychotherapeutic treatment of premature ejaculation noted a tendency for men to suffer relapses.
A couple of researchers have reported that most couples find it difficult to continue with the therapy prescribed for premature ejaculation, indeed 75% of couples report they have difficulty in continuing treatment and that the problem recurs.
When success is maintained it is because the couple have discussed the difficulty with each other, practiced techniques learned during therapy, and accepted difficulties were indeed likely to occur again.
They also tend to be well-informed about sexual positions on sexual techniques, and in these cases, although premature ejaculation may begin to occur (in that the intravaginal ejaculatory latency time begins to diminish), the satisfaction of the couples tends to remain very high.
What this demonstrates to me is that in therapeutic techniques that depend on talking or manipulative techniques such as the squeeze or stop start technique, relapse prevention has to be discussed right from the beginning of therapy.
Indeed, it's been suggested by McCarthy that therapists dealing with premature ejaculation should actually schedule periodic "booster" sessions following the termination of the main therapy.
Men and women have reported that knowing they will be seeing a therapist again in six months' time serves to keep them on target because they have, in effect, to report on their progress. Follow-up sessions can be used to iron out any difficulties that they may be experiencing.
Pharmacotherapy for premature ejaculation is accomplished by using SSRIs developed for this purpose – indeed, the only SSRI developed for this purpose that has been approved anywhere in the world is dapoxetine, marketed as Priligy in Europe.
Ejaculation delays are observed soon after taking the medication, and tend to improve over several weeks. There may be side effects from SSRIs, although these tend to be dose-related. They include fatigue, nausea, yawning, excessive sweating, and gastrointestinal upsets.
There is actually some controversy over whether SSRIs can cause impulsive behavior and suicidal ideation.
Although these may not apply as much to dapoxetine as earlier generations of SSRIs such as Paxil, Zoloft and Prozac, it's certainly necessary for any therapist who is prescribing these drugs to closely monitor the side-effects on men who are receiving treatment for premature ejaculation.
Also, whilst the effect is infrequent, some men do report diminished libido and even erectile dysfunction after starting on SSRI medication.
Greater success has actually been achieved with on demand dosage them with daily dosage, and this is actually a good thing, because it's well observed that men who are seeking a remedy for premature ejaculation do prefer "as needed" schedules for several reasons – not least, cost and convenience, but in addition of course sexual activity is not a daily event for the majority of men.
It's also important to note that many men object to the idea that they are taking psychiatric medication on a daily basis to treat a sexual problem.
Pharmacotherapy delays ejaculation by 6 to 20 times, so that in effect a man who ejaculates in 30 minutes before treatment with Dapoxetine might be expected to achieve an IELT of between three and ten minutes afterwards.
Strangely enough, although
men tend to be satisfied with the effectiveness of the intervention,
they often stop using it within a year, and then return to their
original baseline of ejaculatory latency.
Combined psychological and medical treatment is different from psychotherapy alone: it's more directive, advice oriented, educational, and technique focused.
These interventions target not only the psychosocial obstacles created after the onset premature ejaculation – which may include avoidance of foreplay, restrictive sexual patterns, limited sexual positions, and resentment from the partner because of the limitation of sexual expression – but also an unwillingness to discuss the problem.
By reducing psychosocial obstacles that are getting in the way of treatment for premature ejaculation, and offering men a way to delay their natural climax, the effect of pharmacotherapy can be enhanced.
Unfortunately, not everybody will benefit from the treatment of rapid ejaculation. Indeed, for some men, psychotherapy or pharmacotherapy or combined treatment will not overcome early trauma, the aftermath of years of harmful sexual interactions, or limited resources of either intelligence or technique.
It's possible that deep psychotherapy may help, but very few men would be willing to undertake group therapy and declare to a group of co-attendees that they were doing so because of their premature ejaculation. Indeed it's also important to remember that not all patients want the problem resolved.
However, the majority of men and women will make at least modest gains in improving their sexual technique and be able to enjoy a greater variety of sexual positions including the man on top and rear entry sex positions for long enough to make it worthwhile for the couple to undertake treatment.