Premature ejaculation, delayed ejaculation, anejaculation, retrograde ejaculation, painful ejaculation, anorgasmia, ejaculatory anhedonia and post-coital illness syndrome are the ejaculatory disorders. One fourth of men have PE, but only 1 in 10 of these men seek medical help. Lifelong PE has genetic, neuroendocrine basis; acquired PE has organic, psychological basis; variable and subjective PE have psychological basis. Any PE results in psychological, relational problems. Pharmacotherapy alone, psychotherapy alone and combination treatments are used for PE. Psychoeducation, stop-start technic of Semans and sensate focus with behavioural therapy devised by Masters & Johnson and modified by Kaplan are the standard psychotherapeutic technics. Yoga, pelvic floor rehabilitation/relaxation, neuro-stimulation and masturbators are other non-organic methods of treating PE. Addition of psychoeducation to all cases of PE improves success and decreases discontinuation of treatment. DE/AE are less common. In young men, behavioural, intrapsychic, organic factors are the reasons for DE. In elder men DE is the result of ageing and organic diseases. Treatment of DE/AE is essential in young men to save a marriage and for fertility. Inability to ejaculate in coital sex, but able to ejaculate at masturbation is the presentation in more than 75% of young men with DE. Idiosyncratic masturbatory style is the commonest reason for DE in this group of men. Psychosexual education, masturbation retraining and sensate focus plus behavioural therapy are the treatments for DE.

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Psychological Approach to Ejaculatory Disorders

  • Alla Satyanarayana Reddy

摘要

Premature ejaculation, delayed ejaculation, anejaculation, retrograde ejaculation, painful ejaculation, anorgasmia, ejaculatory anhedonia and post-coital illness syndrome are the ejaculatory disorders. One fourth of men have PE, but only 1 in 10 of these men seek medical help. Lifelong PE has genetic, neuroendocrine basis; acquired PE has organic, psychological basis; variable and subjective PE have psychological basis. Any PE results in psychological, relational problems. Pharmacotherapy alone, psychotherapy alone and combination treatments are used for PE. Psychoeducation, stop-start technic of Semans and sensate focus with behavioural therapy devised by Masters & Johnson and modified by Kaplan are the standard psychotherapeutic technics. Yoga, pelvic floor rehabilitation/relaxation, neuro-stimulation and masturbators are other non-organic methods of treating PE. Addition of psychoeducation to all cases of PE improves success and decreases discontinuation of treatment. DE/AE are less common. In young men, behavioural, intrapsychic, organic factors are the reasons for DE. In elder men DE is the result of ageing and organic diseases. Treatment of DE/AE is essential in young men to save a marriage and for fertility. Inability to ejaculate in coital sex, but able to ejaculate at masturbation is the presentation in more than 75% of young men with DE. Idiosyncratic masturbatory style is the commonest reason for DE in this group of men. Psychosexual education, masturbation retraining and sensate focus plus behavioural therapy are the treatments for DE.