Journal Article Page
European UrologyVolume 52, issue 4, pages 939-1280, October 2007
Words of Wisdom
Re: Effects of a New Functional-Sexological Treatment for Premature Ejaculation
pages 1259 - 1261
De Carufel F, Trudel G
J Sex Marital Ther 2006;32:97–114
De Carufel and Trudel present a new approach for the nonpharmacologic treatment of premature ejaculation. This concept is based on the sexocorporal approach developed by a group of sex therapists from Montreal, Canada. In this functional-sexological treatment the therapeutic strategy is directed at the modulation of sexual excitement by teaching the patients to focus on and modify their muscular tension and breathing style without having to interrupt the sexual activity. Other components include information about sexual responses and sensuality education. In the present study, the authors compared the functional-sexological approach to (a) traditional sex therapy consisting of squeeze and stop-start techniques and (b) a waiting list control condition. Measures included stopwatch intravaginal ejaculatory latency time (IELT) and various questionnaires addressing domains such as perceived ejaculatory control, sexual satisfaction, couple sexual interaction, and treatment satisfaction. Statistical analyses for both treatment conditions showed significant improvements in almost all relevant parameters including duration of intercourse. These changes proved to be relatively stable at follow-up. Significant differences between the treatment conditions were not found, indicating that the functional-sexological therapy is as effective as traditional interventions, thus providing clinicians with a new option for helping couples affected by this disorder.
Rapid or premature ejaculation (PE) is one of the most prevalent male sexual dysfunctions affecting as many as 20–30% of men of all age groups . Compared to erectile dysfunction, however, it is only in the past several years that this sexual disorder has found increasing attention. The profound negative impact chronic PE exerts on the man's life and on his partnership has been impressively demonstrated in recent studies  and . Despite the high prevalence and the associated distress caused by this condition, its full clinical significance is probably veiled by the fact that only a very small percentage of patients receive treatment for this dysfunction. Besides the reluctance of patients and physicians to discuss this issue, this discrepancy may be due to a lack of easily available and effective therapy options. Current treatment choices include behaviorally oriented sex therapy including the well-known stop-start and squeeze techniques for improving ejaculatory control as well as pharmacotherapy involving the off-label use of common antidepressants. However, both treatment approaches entail significant drawbacks that limit their acceptance by patients and their large-scale use. With respect to sex therapy, one of the main problems of the traditional treatment approach is that patients, and particularly their female partners, often experience the behavioral interventions as mechanical or technical interference with sensuality and eroticism, requiring the couple to interrupt sexual activity. The functional-sexological treatment makes a fresh attempt at enabling the man to achieve better ejaculatory control by setting a new focus on modulating sexual arousal through the management of muscular tension and breathing style, which, unlike the ejaculatory reflex itself, are under voluntary control. By teaching the couples a number of specific skills and by providing detailed information on how muscular and respiratory reactions influence sexual excitement, they are able to monitor and identify the body signals associated with the different levels of sexual arousal and to adjust their sexual activity accordingly by reducing muscular tension or breathing more slowly and abdominally. The second major treatment goal is the enhancement of sensuality and mutual sexual pleasure, which tend to be significantly reduced in PE couples.
The functional-sexological approach seems to have the potential to advance the psychological therapy of PE and to add a new option to the hitherto insufficient treatment armamentarium of this sexual dysfunction. Considering that the development of sex therapy has largely stagnated since the pioneering work of Masters and Johnson and Kaplan, it has to be appreciated that the authors developed their approach not only on a theoretical and clinical basis but also took the trouble to test its efficacy in a controlled study. The fact that the new approach proved to be equally effective as traditional sex therapy may not appear very spectacular but, taking the high posttreatment success rates of the common sex therapy interventions into account, must actually be viewed as very promising. This approach will probably have a special appeal to patients and couples who like to master certain physical skills and understand more about their sexual reactions. Recent studies have shown that in PE the subjective experience is more important than the pure time factor  and , which corresponds well to the rationale of the functional-sexological approach. More studies are needed with respect to the long-term stability of treatment effects and on the feasibility of using this approach as one component of a multimodal therapy. However, what is ultimately needed to improve the situation of patients with PE and their partners are innovative strategies combining psychological and pharmacologic treatment options.
Hannover Medical School, Germany
© 2007 Published by Elsevier B.V.
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