Integrating psychotherapy and pharmacotherapy in the treatment of premature ejaculation

Abstract

Objectives: To describe the different approaches to the treatment of premature ejaculation (PE), with a final focus on integrated treatment, as conventional theories and therapies for PE are based on an organic or psychogenic dichotomy.

Methods: We list the principal hypotheses of the causes and therapy of PE on the basis of psychological and medical perspectives, after identifying all relevant studies available on Medline up to 2012.

Results: The cognitive feedback from PE can lead to a 'performance anxiety', which can combine with other conditions to further impair ejaculatory control. For these reasons, a psychological approach is always useful in treating PE, the most useful of which are sex therapy and behavioural therapy. For pharmacological treatment, reports suggest that dapoxetine (60 mg) significantly improves the control of the ejaculatory reflex, and it thus represents the first-line officially approved pharmacotherapy for PE.

Conclusions: A holistic approach which considers the biological, psychological and relational aspects is the advised treatment for PE. Integrated medical and psycho-sexological therapy requires a mutual understanding of and respect for the different disciplines involved in sexology. In this aspect two very important roles are those of the physician and the psychologist.

Keywords: Dichotomy; ED, erectile dysfunction.; Holistic approach; IELT, intravaginal ejaculation latency time; Integrated model; PE, premature ejaculation; Premature ejaculation.

Figure 1

The squeeze technique to treat PE. When ejaculation seems inevitable, the man’s partner applies pressure, using the thumb of the first two fingers, just below the glans penis. This pressure should inhibit ejaculation and should be done several times before ejaculation is allowed. As a step in the learning of ejaculation control, the squeeze technique is generally no longer needed after therapeutic success.

Figure 2

The pathophysiology of PE. Stress from sexual failure and subsequent anxiety have a positive feedback during PE (Panel A). Pharmacological and/or psychological therapies destroy this vicious circle, transforming it into a virtuous circle (Panel B). Note that during the vicious circle, other couple’s pathologies can arise.