Can sex therapy help?
In sex therapy, the possible psychological causes of premature ejaculation are treated – as well as problems like self-doubt or relationship conflicts. Sex therapy is based on your willingness to actively participate. There's hardly any research on how much it helps, though.
Premature ejaculation can be influenced by both psychological and biological factors – and they can affect each other as well. Some experts believe the causes tend to be biological in men who have always had trouble with premature ejaculation. They think that psychological causes are more likely if the premature ejaculation first developed over the course of the man's life.
So far there has hardly been any research on whether psychological factors are actually responsible for premature ejaculation and, if so, which factors. One possible cause of premature ejaculation could be a man's fear of not being able to satisfy his partner. Intense anxiety could lead to the problem becoming worse, and set off a “vicious circle.”
Purely biological causes could also result in psychological stress or relationship problems. So regardless of the causes, it’s worth looking into the effects it has on a man’s own wellbeing, on his partner and the relationship.
How can premature ejaculation cause problems in a relationship?
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 women or men find that hard to do because they don't want to hurt their partner, whose self-confidence might be low anyway. 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 relationships at some point because they're afraid of not being able to satisfy their partner enough.
What are the goals of sex therapy?
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.
What does sex therapy involve?
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. Sex therapy is offered by specialized psychotherapists, for example. Another option is to seek support from an organization that specializes in sex counseling, such as pro familia.
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: “Women 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 replaced with other perspectives.
What can be expected from sex therapy?
It's difficult to be sure how many people benefit from sex therapy because there has hardly been any good-quality research in this area. The success of 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, it might turn out that one of the partners has a deeper psychological problem.
Therapy can even have side effects: Conflicts between the partners 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.
Althof SE, McMahon CG, Waldinger MD, Serefoglu EC, Shindel AW, Adaikan PG et al. An Update of the International Society of Sexual Medicine's Guidelines for the Diagnosis and Treatment of Premature Ejaculation (PE). Sex Med 2014; 2(2): 60-90.
Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A. Interventions to treat premature ejaculation: a systematic review short report. Health Technol Assess 2015; 19(21): 1-180, v-vi.
Cooper K, Martyn-St James M, Kaltenthaler E, Dickinson K, Cantrell A, Wylie K et al. Behavioral Therapies for Management of Premature Ejaculation: A Systematic Review. Sex Med 2015; 3(3): 174-188.
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