Can sex therapy help with premature ejaculation?

Premature ejaculation not only affects sexual intercourse. The intimacy between the two partners may suffer as well when a very special moment is so unexpectedly and suddenly interrupted.

An honest and trusting talk is the basis for finding a solution to the problem together. It can be difficult for both men and their partners to talk openly about premature ejaculation. Some people find this difficult because they don't want to hurt their partner's feelings, whose self-esteem may already be low. Others may get upset if their partner isn't ready to talk about the problem.

Some men have the feeling that their partner isn’t aware that they feel frustrated. Or they might worry that their partner could cheat on them. And others stop having intimate relationships at some point because they're afraid of not being able to satisfy their partner enough.

Sex therapy starts by looking at possible psychological causes of premature ejaculation while also examining its psychological effects. Depending on the situation, the goals of the therapy may vary:

• Learning techniques and strategies that help to delay ejaculation.
• Identifying and getting rid of thoughts that could lead to premature ejaculation.
• Giving a man or couple more self-confidence in order to reduce anxiety.
• Expanding the couple's idea of sexuality and how people can be intimate together. The aim is to place less importance on ejaculation and to increase satisfaction in their love life.
• Recognizing obstacles to intimacy in the relationship in order to grow closer again.
• Helping couples to speak more openly about their needs and problems.
• Learning to accept some problems and finding ways to better cope with them.
• Solving conflicts in the relationship.

Sex therapy can be done with individuals or couples. The most suitable type and focus of sex therapy will depend on various individual factors, including whether both partners are open to the idea of therapy and what the main problems are.

After the therapist meets and gets to know the man or couple, they will introduce problem-solving strategies, techniques or exercises.

One example of a method used in couples therapy is sensate focus. This approach consists of a series of exercises in which the couple undress each other while touching, embracing, kissing, petting and talking. Genitals and breasts should remain “off limits” at first. The focus shouldn't be sex, and initially the exercises shouldn’t lead to sex either. It’s more about being more aware of experiencing your partner’s whole body. The exercises are then expanded step by step over the course of several weeks. Only in the last step is sex also an option.

Men who are in individual therapy and are mainly dealing with anxiety and self-doubt may be offered cognitive behavioral therapy. The main goal of this approach is to identify and get rid of harmful thoughts. Typical unhelpful thoughts might include:

• All-or-nothing thinking: “I’m a loser because I don't have control over my ejaculation.”
• Emotional reasoning: “I feel like a bad lover so I must be one.”
• Disqualifying the positive: “Partners only say that they’re satisfied because they don't want to hurt my feelings.”
• Catastrophizing: “My girlfriend is going to leave me because I always come too fast.”

Thoughts like these are negative oversimplifications and are harmful. They can keep men from trying to find solutions. In cognitive therapy, these assumptions and thoughts are reformulated to be positive or they are gradually replaced with other perspectives.

It is difficult to be sure how many people benefit from sex therapy on its own because there has hardly been any good-quality research in this area. There are more studies on the combination of sex therapy and medication. This combination is more effective than taking medication alone. In the studies, it was able to prolong the time until ejaculation. In addition, the participants were more satisfied with their sex lives.

The success of sex therapy also depends on how it is measured: Is the goal only to increase the amount of time it takes to reach ejaculation or does the therapy have other aims as well?

Having therapy always means working a lot on yourself, and you have to be willing to do that. What's more, any therapy can result in unexpected insights. For instance, in couples therapy it might turn out that one of the partners has a deeper psychological problem.

Therapy can even have side effects: Conflicts might first come to light or get worse through therapy. For instance, that could happen if it turns out that one partner has been dishonest with the other or has been putting on an act.

Whether or not you would like to try out sex therapy is ultimately a very personal decision. It is also worth considering that in Germany the costs are often not covered by statutory health insurers. So it’s a good idea to find out in advance whether they are covered or not.