Psychosexual therapy for delayed ejaculation based on the Sexual Tipping Point model

Abstract

The Sexual Tipping Point® (STP) model is an integrated approach to the etiology, diagnosis and treatment of men with delayed ejaculation (DE), including all subtypes manifesting ejaculatory delay or absence [registered trademark owned by the MAP Educational Fund, a 501(c)(3) public charity]. A single pathogenetic pathway does not exist for sexual disorders generally and that is also true for DE specifically. Men with DE have various bio-psychosocial-behavioral & cultural predisposing, precipitating, maintaining, and contextual factors which trigger, reinforce, or worsen the probability of DE occurring. Regardless of the degree of organic etiology present, DE is exacerbated by insufficient stimulation: an inadequate combination of “friction and fantasy”. High frequency negative thoughts may neutralize erotic cognitions (fantasy) and subsequently delay, ameliorate, or inhibit ejaculation, while partner stimulation (friction) may prove unsatisfying. Assessment requires a thorough sexual history including inquiry into masturbatory methods. Many men with DE engage in an idiosyncratic masturbatory style, defined as a masturbation technique not easily duplicated by the partner’s hand, mouth, or vagina. The clinician’s most valuable diagnostic tool is a focused sex history (sex status). Differentiate DE from other sexual problems and review the conditions under which the man can ejaculate. Perceived partner attractiveness, the use of fantasy during sex, anxiety-surrounding coitus and masturbatory patterns require meticulous exploration. Identify important DE causes by juxtaposing an awareness of his cognitions and the sexual stimulation experienced during masturbation, versus a partnered experience. Assist the man in identifying behaviors that enhance immersion in excitation and minimize inhibiting thoughts, in order to reach ejaculation in his preferred manner. Discontinuing, reducing or altering masturbation is often required, which evokes patient resistance. Coaching tips are offered on how to ensure adherence to this suspension, manage resistance and facilitate success. Depending on motivation level, masturbation interruption may be compromised and negotiated. Encourage a man who continues to masturbate to alter style (“switch hands”) and to approximate the stimulation likely to be experienced with his partner. Success will require most men to be taught to learn bodily movements and fantasies that approximate the thoughts and sensations experienced in masturbation. Fertility issues, as well as patient/partner anger are important causational factors, which often require individual and/or conjoint consultation. Drug treatment would benefit men particularly with severe DE, regardless of concomitant psychosocial-behavioral and cultural complications. When and if a safe effective medication for DE becomes available, this author’s transdisciplinary perspective supports appropriate medication use when integrated with counseling. This approach emphasizes the utility of a biopsychosocial-cultural perspective combined with spe...

Prevalence of sexual dysfunctions and associated risk factors in Poland

“…Moreover, psychological and interpersonal factors such as performance anxiety, conditioning factors, fear of impregnation, and lack of desire or arousal have also been implicated as risk factors in the development of DE [13][14][15]. Irrespective of the contribution the organic etiology has in the development of DE, this condition is exacerbated by insufficient stimulation or excessive sexual expectations displayed by the partner, for instance not properly duplicated masturbation technique by the partner [16]. Moreover, there is a growing body of evidence suggesting that excessive exposure to alternative sexual stimuli such as pornography or engaging in idiosyncratic masturbation may produce sexual dysfunction as a consequence of desensitization [16,17].…”

“…The pathoetiology of sexual dysfunctions involves various factors such as anatomical, biological or physiological. These in turn can be affected by environmental variables [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Interpersonal, sociocultural factors such as the attitude to sex, religious views, previous sexual experience and education level could also contribute to the development of sexual impairments [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

“…Accordingly, life-long (primary) DE with a very high set point, like lifelong PE, is considered to be primarily a neurobiological variant. Presumably, affected individuals suffer from a susceptibility that interacts with a variety of psychosocial, environmental, cultural, and medical risk factors to result in DE [ 6 ]…”

“…And 8) success depends on the patient's willingness and capacity to follow various interventions [ 6 ].…”

“…However. Perelman [ 6 7 ] criticized this time frame for ignoring 2 important findings: a) most men seeking help for DE pursue treatment because of its impact on coitus, and b) most men's IELT range is approximately 4 to 10 minutes [ 8 9 10 ]. Any bilateral deviation from the ~4- to 10-minute IELT range of the majority of men should meet the qualification for the temporal diagnostic criterion.…”