Treating Premature Ejaculation: Why Medical Treatment Alone Isn't Enough

In our previous post, we introduced the question, “How Soon Is Too Soon to Cum?”

It’s a question asked by many men. If you are wondering whether you or your partner may be experiencing premature ejaculation (PE), we encourage you to read that post.

Once you’ve identified the presence of PE, it’s time to seek treatment. But how do you know which PE treatments are right for you or your partner?

In this post, we’ll take a close look at common medical treatments for PE — and why they should usually be supplemented by other therapy practices, such as our sex counseling services in Sioux Falls.

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Why a Multi-Modal Approach to PE Evaluation & Treatment Is Critical for Many Men

Most physicians are not educated throughout the course of their training on sexual medicine or sex therapy. That means when you see your primary care doctor or even a urologist for an assessment due to PE symptoms, they will likely only recommend medication management. While this can be very helpful (and necessary for clients who have biological predisposition to having PE), a one-size-fits-all approach to treating this condition will likely not prove optimal for all men.

Working with a sex therapist who is able to complete a thorough psychosexual assessment to determine a specific treatment plan is critical for many men to not only treat the symptom but also cure it. In addition, while taking medication may alleviate the physical symptom, any symptoms related to negative thought patterns, anxiety, and relational distress will remain untreated unless sex therapy and couples therapy are utilized. 

A comprehensive psychosexual evaluation is not separate from psychological treatment. The therapist can use the evaluation process for psychotherapy intervention.

In addition, this is likely the first time a man has told his complete sexual story or even felt comfortable opening up about the issue. This process of exposing himself to an otherwise shameful topic with another person, his therapist, leads to more acceptance and less shame.

Together, the man and his therapist can rewrite the narrative of his symptoms into a storyline that includes understanding, acceptance, and hope. The therapist will focus on the man’s reaction to the questions and the nature of their relationship during the process. Men will often transfer their own perceptions of men or women (depending on the gender of the therapist) onto the therapist. This process, known as transference, is critical to helping the man understand how this interpersonal dynamic helps maintain the symptoms in his relationships outside the therapeutic one.

The evaluation process is an opportunity to teach the man sex-positive communication and develop a man’s comfort overall with talking about sex. It is important than men understand what sex therapy is and isn’t during this process. For example, there will be no touching or watching involved throughout the evaluation or treatment process. It is helpful to see both partners if the man is in a relationship. 

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Common Medical Treatment Approaches for PE

Prior to the mid-1990s, psychotherapy or behavioral therapy was the primary treatment approach for premature ejaculation (PE).

Around 1995, physicians began using off-label selective serotonin reuptake inhibitors (SSRIs) to delay ejaculation. A common side effect of SSRIs is delayed ejaculation or orgasmic disorders, even in men without PE. While there is nothing currently approved by the FDA in the US for the treatment of premature ejaculation, SSRIs are routinely prescribed to treat this condition.

Paxil (Paroexotine) is the most commonly prescribed medication in this class used for the treatment of PE. Topical administration of lidocaine can also be used to dull sensations and inhibit ejaculation, but negative side effects (such as penile hypoanaesethia or transvaginal absorption, resulting in numbness or inability to orgasm) may not make this a viable treatment option. 

Given the scarcity of qualified sexual health professionals, especially outside of urban areas, sex therapy and psychotherapy are often not considered when a man presents with symptoms of PE in a medical setting. However, sex therapy and psychotherapy are extremely helpful in restoring men’s confidence, reducing negative cognitions, lowering overall anxiety, and reversing the negative impact on relationships. Psychotherapy is useful as a sole treatment for PE, or used in conjunction with psychopharmacology

What Does Psychosexual Treatment for PE Consist Of?

After a full psychosexual evaluation is conducted by a sex therapist, a treatment plan is written that conceptualizes the problem and offers treatment recommendations.

Usual treatment recommendations include:

  • Individual psychotherapy and/or sex therapy is recommended for one or both partners.

  • Couples therapy is preferable to address the contribution and impact of the dysfunction on both partners.

  • Pharmacology (with referral to the appropriate physician) is recommended with severe, lifelong PE.

  • Pelvic floor physical therapy can help a man gain awareness to the increase in pelvic floor muscle tone that occurs before ejaculation, and if possible back off from tensing these muscles.

  • Combined approaches using all of some of the above is useful for:

    • Medication can allow men to delay ejaculation while their build confidence.

    • Men can be taught to attend to their sexual sensations rather than on fear.

    • Men can be taught to pace their arousal and expand their sexual repertoire without fearing PE.

    • Over time, men can be weaned from their medication and a cure can be achieved.

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Ready to Start Treating PE?

In our next post, we’ll dive deeper into why sex therapy works as treatment for PE.

If you’re ready to start treating PE right away, we’re only a phone call or email away. Please reach out to see what is possible for you and your partner! You can also click below to learn more about our sex counseling services in Sioux Falls.