Clinical and therapeutic studies in premature ejaculation.

Abstract

Abstract Thirty male subjects, who presented in a psychiatric outpatient department with a primary complaint of premature ejaculation, were studied prospectively to provide clinical and psychological data. Clinically, three main types of premature ejaculation were recognized. “Type 1” was habitual premature ejaculation with strong erections, present constantly since adolescence. “Type 2” was acute onset premature ejaculation generally with erectional insufficiency, occurring in young males, usually in response to a specific psychological or psycho-physical stress. “Type 3” was insidious onset premature ejaculation generally with erectional insufficiency and other evidence of declining sexual responsiveness occurring in generally older males. Treatment, which was practically oriented, aimed to remove psychological factors that the therapist judged might be contributing to the prematurity. It was applied for a minimum of one year (20 sessions) and consisted in the individual case of an optimum permutation of training in relaxation, sexual education, provision of optimum sexual stimulation, Semans' maneuver,9 and psychotherapy. At the time of assessment, 43 per cent of the patients were improved, while 57 per cent remained unchanged or were worse. “Type 1” premature ejaculation had the worst outcome of treatment and “Type 2” the best. “Type 3” occupied an intermediary position. Although the present series is small on the basis of developmental history, clinical description and treatment response, it is suggested that there are at least three etiologically discrete types of premature ejaculation.