For the treatment of ejaculatory disorders, most commonly premature ejaculation, a specific type of psychotherapy, called the sex therapy, is commonly used.
Sex therapy is a specialized form of psychotherapy that focuses on issues regarding human sexuality. Sex therapy can be used to address concerns surrounding sexual arousal, performance, and satisfaction (i.e. reaching an orgasm). Sex therapy has also been found to help people who’ve experienced sexual trauma, have medical conditions that cause sex to be painful, are confused about their gender/sexual identity, and/or whom have sexual addictions.
Sex therapy focuses on perceptions and feelings, improving communication between partners, increasing sexual skills and self-confidence, and reducing anxiety associated with sexual activity. Short-term improvement with these behavioral approaches was observed; however, there are limited data concerning the efficacy of these methods in the long run. Sex therapy may be either individual, involving only the male patient, or for couples, which can involve both partners in solving the issue.
Sex therapy requires rigorous evaluation that includes a medical and psychological examination. The reason is that sexual dysfunction may have a somatic base (based in the body) or a psychogenic basis (based on the patient´s thoughts, emotions and feelings). Sex therapy is frequently short term, with duration depending on the causes for therapy. Sex therapy can be provided by licensed psychologists or physicians, who have undergone training and become certified. Any licensed mental health counselor can practice sex therapy. Certified sex therapists do not have sexual contact with their clients.
More recently, sex therapists combined psychotherapy with behavioral exercises with more success. Behavioral approaches generally focused on the physical aspect of PE (premature ejaculation) including the “squeeze” technique and the “stop-start” method. These involve engaging in sexual foreplay until just before the point of ejaculation and then either squeezing the head of the penis or stopping sexual activity until the urge to ejaculate subsides, at which point sexual activity may be resumed and the techniques repeated as necessary. Therapy focuses on the emotional implications of PE in relationship dynamics, and in performance anxiety management.
Psychological intervention alone as the treatment for ejaculatory disorders is recommended for patients with clearly psychological origin of the condition. Such causes may include depression or performance anxiety. For different causes, symptoms and simultaneous relationship issues, either individual or couples psychotherapy may be more suitable.
Individual psychotherapy may be useful for single men to help them overcome their difficulties with entering relationships, or even fear of entering a relationship, caused by the disorder. Psychotherapy may be also beneficial for men whose condition appears to be caused by childhood experiences.
Psychotherapy involving both partners may be beneficial in addressing both the possible causes of the disorder and simultaneous negative emotions experienced by the partner.
Sex therapy sessions are focused on the individual's symptoms rather than on underlying psychodynamic conflicts. A therapist's misunderstanding of these conflicts can lead to resistance or serve as a barrier to improving sexual dysfunctions that are directly or indirectly related to sex.
The outcomes of psychotherapy in the treatment of ejaculatory disorders are generally not sufficiently documented by large-scale studies with adequate control groups. However, the presently available data demonstrate that the duration of the sexual intercourse prior to ejaculation increased by approx. eight times in men treated with psychological intervention for premature ejaculation, compared to an untreated control group. However, long-term studies suggest that most patients will experience some form of relapse. A combined use of drugs and psychotherapy appears to have the best and lasting effect. The drugs serve to immediately improve the condition, which in turn boosts the man´s confidence and enables him to deal with psychological underlying factors. But overall, more research with larger sample groups and better controls still needs to be conducted regarding the topic.