The psychology of premature ejaculation: Therapies and consequences

Introduction. Premature ejaculation (PE) is a common male sexual dysfunction characterized by the loss or absence of ejaculatory control, marked distress or interpersonal difficulty and by a short intravaginal ejaculatory latency time (IELT). PE can impact both the patient's and his partner's quality of life. Aim. To review evidence concerning the psychologic influences of PE on the self-esteem and self-confidence of men with PE and the impact on their partners. To review the role of psychotherapy in the management of men with PE. Methods. The Sexual Medicine Society of North America hosted a State of the Art Conference on Premature Ejaculation on June 24-26, 2005 in collaboration with the University of South Florida. The purpose was to have an open exchange of contemporary research and clinical information on PE. There were 16 invited presenters and discussants; the group focused on several educational objectives. Main Outcome Measure. Peer-reviewed medical literature was reviewed concerning management of men with PE by psychologic and sexual therapy. Results. Premature ejaculation has long been viewed as a psychological concern involving psychological interventions, although recent research also focuses on the neurobiological underpinnings of the dysfunction. Psychosexual therapies combine behavioral interventions to help the patient learn to control or delay his ejaculation and to assist him in regaining confidence and lessening performance anxiety. Psychosexual therapy can be combined with pharmacotherapies to provide an improved prognosis to the patient with PE. Conclusions. Healthcare providers do not manage the majority of patients with PE with the same consideration and attention provided men with erectile dysfunction (ED). PE has been perceived as a psychological concern, either a learned behavior or a response to a meaningful event/interaction or sexual anxiety. Primary treatment has involved psychosexual therapy. Regardless of etiology, psychological/sexual therapy can play an important role in the management of PE.