Premature ejaculation has always been considered a purely psychological dysfunction and, for many years, has been treated effectively with behavioral therapy coupled with sexual psychotherapy. The very first treatment in 1956 was designed by the urologist Dr James Semans, who developed the stop-start technique. This was a behavioral training system that required help of the man's partner. She would give him manual stimulation to the genitals until just before the instant of ejaculation and then pause until his arousal fell. Then she resumed stimulation and stopped again just before the point of his ejaculation. This cycle was continually repeated until the man had gained adequate control of his orgasm.
This still remains one of the most effective techniques in use. Masters and Johnson created a similar technique, which involved squeezing the shaft of the penis at the level of the frenulum just before the man was ready to ejaculate. It proved an extremely effective treatment as the need to ejaculate dissipates when the penis is pressurized, and the erection declines. When timed properly, the impulse to ejaculate is considerably reduced, and the man can prolong sex further.
Some people criticize this technique saying that the effects are not long-lasting. This is probably because those men who undergo training to overcome premature ejaculation are not motivated to maintain any improvement they make. Naturally the strength of the urge to reach orgasm and the feelings of gratification of the climax overcome the consideration of the partner's need for sexual satisfaction.
About three quarters of the men who initially benefit from these behavioral techniques find that three years later they are back to square one. This suggests that they had not been following the training techniques after finishing the initial training. If there were a follow up procedure, it might improve matters, but there are insufficient research figures to support this idea.
Control of ejaculation is like controlling the urine flow: an action which appears to be involuntary at first but over which control can be learned. The physiological mechanism of ejaculation is just a spinal reflex modulated by part of the brain. So control comes from learning and experience. Also, control can be influenced by the context in which sex takes place, for example a man may have more control with a long-term partner than when he encounters a woman he's just met.
Marcel Waldinger has demonstrated by statistics that men with a serious case of premature ejaculation are a very small minority. One interpretation of this fact is that there is a genetically inherited trait which determines a physiological brain response, probably concerning the serotonin receptor.
This conclusion is not universally accepted nor does it present an obvious treatment strategy. But it has led to great deal of speculation and some research on the idea of modifying serotonin levels in the brain, using artificial methods such as selective serotonin uptake inhibitors or SSRIs like Dapoxetine. The results of experiments, however, tend to indicate this is a blind alley, not least because of undesirable side-effects, and no positive results have really come from it. In particular, the drug has not been licenced for use in the USA by the FDA as a treatment for premature ejaculation. The better approach is obviously a combination of therapy including behavioral therapy using traditional methods, together with counseling and psychotherapy in order to reduce anxiety and find solutions for relationship issues.
This still remains one of the most effective techniques in use. Masters and Johnson created a similar technique, which involved squeezing the shaft of the penis at the level of the frenulum just before the man was ready to ejaculate. It proved an extremely effective treatment as the need to ejaculate dissipates when the penis is pressurized, and the erection declines. When timed properly, the impulse to ejaculate is considerably reduced, and the man can prolong sex further.
Some people criticize this technique saying that the effects are not long-lasting. This is probably because those men who undergo training to overcome premature ejaculation are not motivated to maintain any improvement they make. Naturally the strength of the urge to reach orgasm and the feelings of gratification of the climax overcome the consideration of the partner's need for sexual satisfaction.
About three quarters of the men who initially benefit from these behavioral techniques find that three years later they are back to square one. This suggests that they had not been following the training techniques after finishing the initial training. If there were a follow up procedure, it might improve matters, but there are insufficient research figures to support this idea.
Control of ejaculation is like controlling the urine flow: an action which appears to be involuntary at first but over which control can be learned. The physiological mechanism of ejaculation is just a spinal reflex modulated by part of the brain. So control comes from learning and experience. Also, control can be influenced by the context in which sex takes place, for example a man may have more control with a long-term partner than when he encounters a woman he's just met.
Marcel Waldinger has demonstrated by statistics that men with a serious case of premature ejaculation are a very small minority. One interpretation of this fact is that there is a genetically inherited trait which determines a physiological brain response, probably concerning the serotonin receptor.
This conclusion is not universally accepted nor does it present an obvious treatment strategy. But it has led to great deal of speculation and some research on the idea of modifying serotonin levels in the brain, using artificial methods such as selective serotonin uptake inhibitors or SSRIs like Dapoxetine. The results of experiments, however, tend to indicate this is a blind alley, not least because of undesirable side-effects, and no positive results have really come from it. In particular, the drug has not been licenced for use in the USA by the FDA as a treatment for premature ejaculation. The better approach is obviously a combination of therapy including behavioral therapy using traditional methods, together with counseling and psychotherapy in order to reduce anxiety and find solutions for relationship issues.
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