Article

Idiosyncratic Masturbation Patterns: A Key Unexplored Variable in the Treatment of Retarded Ejaculation by the Practicing Urologist

Abstract

SMSNA ABSTRACT: # 120 MASTURBATION IS A KEY VARIABLE IN THE TREATMENT OF RETARDED EJACULATION, BY THE PRACTICING UROLOGIST Michael A. Perelman, Ph.D. New York, NY Introduction and Objectives: New pharmaceuticals have increased the number of patients presenting for treatment of sexual dysfunctions, including retarded ejaculation (RE). There are no FDA approved pharmaceutical treatments for RE, a reportedly difficult-to-treat dysfunction. A study was carried out to identify variables that could improve a practicing health care practitioner’s (HCP) capacity to understand and treat RE. Methods: A 6-year retrospective chart review was conducted of the 85 men diagnosed as REs, who had been referred for sex therapy by their urologists. Key variables previously unexplored by their urologists were identified. Results: Of 85 charts, 78 were adequately legible and capable of being fully categorized. The men, both partnered and single, ranged in age from 19 to 77 years; mean age 37. 51% had tried a PDE-5 inhibitor; many of the urologists had not differentiated ED from RE. Some men with concomitant ED improved their erections, but there was no improvement in their RE. Some men experienced RE as a treatment emergent symptom secondary to PDE-5 use. 23% of the men were diagnosed with a “global,” and “life-long” RE; the remainders were “situational.” 77% of the men could masturbate to orgasm. Of those who masturbated, a significant number did so at high frequency. Notably, almost 45 % of those men reported masturbating at least every other day or more. More than 43% reported masturbating 6-14 times per month. Less than 2% of the sample that masturbated did so less than 4 times per month on average. A robust pattern emerged: high-frequency masturbation correlated highly with the presentation of RE. Further, over 59 % of these men who masturbated, did so using an idiosyncratic style. An idiosyncratic style was defined as a technique not easily duplicated by their partner’s hand, mouth, or vagina. Almost universally, these men had failed to communicate their preferences to either their doctor or their partners, because of shame, embarrassment, or ignorance. Finally, 25% of these men used a variant sexual fantasy during masturbation, which was not usually incorporated into sex with their partner. Conclusions: The data strongly suggested that high frequency; idiosyncratic masturbation and fantasy/partner disparity predispose RE. Failure to assess these factors may account for much of the perceived difficulty in treating RE. Identifying and using counseling techniques to alter these patterns could enhance the practicing HCP’s ability to improve their patient’s orgasmic capacity. Once new drugs are developed to increase the ease and speed of ejaculatory latency, combination drug and sex therapy protocols may produce the best treatment outcome. References: • Perelman M. “Retarded Ejaculation.”], In Current Sexual Health Reports 2004 [Ed: Mulhall,J.]. Current Science, Inc., Philadelphia, Pennsylvania, 2004:1:3. • Rowland D. & Perelman M. “Inhibited or Retarded Ejaculation.” In Handbook of Premature Ejaculation, [Ed. O’Leary M]. Taylor & Francis, Philadelphia, Pennsylvania, 2006. In Press. RECOMMENDATIONS: The data strongly suggested that high-frequency, idiosyncratic masturbation predisposes RE. Failure to assess these factors may account for much of the perceived difficulty in treating RE. Which for me raises the issue of Combination treatment and leads to the following recommendations: Inquire about masturbatory frequency and technique when assessing patients with RE. Sex coaching can alter dysfunctional patterns, enhancing the HCP’s ability to treat RE. Once new drugs are developed to increase the ease and speed of ejaculatory latency, a combination treatment protocol of drugs and sex therapy.
Perelman M. “Idiosyncratic Masturbation Patterns: A Key Unexplored Variable in the
Treatment of Retarded Ejaculation by the Practicing Urologist.” Journal of Urology,
2005;173(4)supp:340.
ABSTRACT
Michael A. Perelman, Ph.D.
Co-Director, Human Sexuality Program
Clinical Associate Professor of Psychiatry, Reproductive Medicine and Urology
The New York Presbyterian Hospital, Weill Medical College of Cornell University
New York, NY, USA
IDIOSYNCRATIC MASTURBATION PATTERNS:
A KEY UNEXPLORED VARIABLE IN THE TREATMENT
OF RETARDED EJACULATION BY THE PRACTICING UROLOGIST
(AUA ABSTRACT # 1254)
Introduction and Objective:
New pharmaceuticals have increased the number of patients presenting for treatment of
sexual dysfunctions, including retarded ejaculation (RE). There are no FDA approved
pharmaceutical treatments for RE, a reportedly difficult-to-treat dysfunction. A study
was carried out to identify variables that could improve a practicing urologist’s capacity
to understand and treat RE.
Methods:
A 5 year retrospective chart review was conducted of the 80 men diagnosed as REs, who
had been referred for sex therapy by their urologists. Key variables previously
unexplored by their urologists were identified.
Results:
These 80 men, both partnered and single, ranged in age from 19 to 77 years; mean age
37. 50% had tried a PDE-5 inhibitor, as many urologists had not differentiated ED from
RE. Some men with concomitant ED improved their erections, but there was no
improvement of the RE for any. Some men experienced RE as a treatment emergent
symptom secondary to PDE-5 use. 25% of the men were diagnosed with a “global,”
“life-long” RE; the remainder were “situational.” 75% of the men could masturbate to
orgasm. A significant number of REs were high-frequency masturbators. Notably, over
35% reported masturbating at least every other day or more. More than 25% reported
masturbating 6-14 times per month. Less than 2% of the sample who masturbated, did so
PERELMAN, IDIOSYNCRATIC MASTURBATION PATTERNS:
A KEY UNEXPLORED VARIABLE IN THE TREATMENT
OF RETARDED EJACULATION BY THE PRACTICING UROLOGIST
(AUA ABSTRACT # 1254)
less than 4 times per month on average. A robust pattern emerged: high-frequency
masturbation correlated highly with the presentation of RE. Further, over 37% of the
men masturbated using an idiosyncratic style. An idiosyncratic style was defined as a
technique not easily duplicated by a female partner utilizing her hand, mouth, or vagina.
Almost universally, these men had failed to communicate their preferences to either their
doctor or their partners, because of shame, embarrassment, or ignorance. Finally, 19% of
the men used a variant sexual fantasy during masturbation that was not incorporated into
sex with their partner.
Conclusions:
The data strongly suggested that high-frequency, idiosyncratic masturbation and
fantasy/partner disparity predispose RE. Failure to assess these factors may account for
much of the perceived difficulty in treating RE. Identifying and using counseling
techniques to alter these patterns could enhance the practicing urologist’s ability to
improve their patient’s orgasmic capacity. Once new drugs are developed to increase the
ease and speed of ejaculatory latency, combination drug and sex therapy protocols may
produce the best treatment outcome.
References:
Perelman M. Letter to the Editor: “Regarding ejaculation: delayed and otherwise.”
Journal of Andrology, Volume 24, No. 4. July/August 2003:496
Perelman M. “Retarded Ejaculation.”], In Current Sexual Health Reports 2004 [Ed:
Mulhall, J.]. Current Science, Inc., Philadelphia, Pennsylvania, 2004:1:3.
Rowland D. & Perelman M. “Inhibited or Retarded Ejaculation.” In Handbook of
Ejaculation Disorders [Ed. O’Leary M]. Taylor & Francis, Philadelphia, Pennsylvania,
2006. In Press.
... In contrast, an Italian study of men seeking treatment at a sexological/ urological clinic for DE, Michetti et al. (2013) did not find patients to have alexithymia traits but the authors suggest hyper controlling behavior to be of importance. Rowland et al. (2004;2005) found men with DE to have low levels of sexual arousal. This could not be confirmed in the present study, where all were without other sexual dysfunctions and in good health. ...
... Despite the patients' difficulties in expressing themselves, particularly when it comes to emotions, some are seeking help. Given reasons for seeking treatment were mainly inability to conceive a child and/or partners' sexual distress and dissatisfaction, which are in agreement with others (Apfelbaum, 2000;Perelman, 2005;Ribner, 2010). Together with the fact that the great majority did not experience DE as distressing for themselves, these findings support the patient's wish to adapt to the partner. ...
Article
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There are a group of men with delayed ejaculation (DE) where the etiology as well as the consequences of the dysfunction are unclear. The aim of the present study was to explore, from a psychodynamic perspective, personality traits among men seeking treatment due to DE. During a 2.5-year period, a consecutive series of 14 men with DE were seeking help at Karolinska University hospital, Sweden. Full medical history and physical examination, sexological case-history and psychological assessments were performed by physicians and a psychotherapist. The results found all patients to be healthy. Mean age was 34 years (range 20–43 years). No other sexual dysfunction occurred. With one exception, they were sexually active. The psychological assessment (The Karolinska Psychodynamic Profile; KAPP) found patients to have difficulties in areas of dependency and separation, control and impulse control, regression in the service of the ego, coping with aggressive affects, alexithymic traits, sexual function, and satisfaction. The results add a deeper understanding of personality traits among healthy patients with DE, which may be a tool for the case history, and offer new treatment strategies. We suggest that DE can be the physical manifestation of some specific personality difficulties, and thus, ejaculation becomes the goal in itself and not the climax of an enjoyable adventure.
... 7 In addition, delayed ejaculation (DE) can be caused by "atypical" (idiosyncratic) masturbation that is a masturbation technique not easily duplicated by the partner's hand, mouth, or vagina. 8 PE and DE are seemingly unrelated two extremities of ejaculatory disorder; however, there is a relationship between them that the idiosyncratic masturbatory style can cause DE, thereby suggesting that this kind of unusual masturbation has the potential to treat PE. The specific mode of idiosyncratic masturbation is prone masturbation. ...
... There are multiple possible mechanisms for the acquired prolonged IELT, however, the most plausible mechanism might be attributed to autosexual orientation that could enable the patients to develop a specialized synergistic ability of the peripheral and central nervous systems to control the ejaculation. 8,11,15,16 It can be described as follows: (1) the sensate focus is shifted to the penile root which might reduce the feeling of irritation to the glans or decrease glans sensitivity during vaginal intercourse, and (2) the patients are getting used to this uncommon stimulation style that cannot be easily duplicated by their partner's vagina. ...
... This theory stated that some men with DE tend to prefer unusual methods of masturbation over heterosexual intercourse with their partner. Perelman and Rowland [14] and Perelman [30] identified 3 factors that disproportionately characterized patients with DE: a) high-frequency masturbation (age-dependent mean of greater than 3 times per week), b) idiosyncratic masturbatory style (masturbation technique not easily duplicated by the partner's hand, mouth, or vagina), and c) disparity between the reality of sex with a partner and their preferred masturbatory fantasy.; ...
... Paying special attention to psychogenic factors may additionally reinforce the therapeutic success of some patients. Many psychotherapeutic treatments have been described for the management of DE/AE, addressing known or suspected psychogenic causes [6,23,[30][31][32]45]. These include but not limited to: a) cognitive behavioral therapy and sex education; b) masturbatory retraining and adjustment of sexual fantasies; c) psychotherapy targeting the areas of conflict and sensate focus exercises; d) altering one's orientation from oneself to one's partner; e) sexual anxiety reduction by teaching the individual mindfulness and breathing techniques, progressive relaxation, and increasing sensory tolerance; f) couples' sex therapy and the use of interactional techniques; and g) the sexual tipping point model, which emphasizes the utility of a biopsychosocial-cultural perspective combined with special attention to the patient's narrative. ...
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Delayed ejaculation (DE) is a poorly defined and uncommon form of male sexual dysfunction, characterized by a marked delay in ejaculation or an inability to achieve ejaculation. It is often quite concerning to patients and their partners, and sometimes frustrates couples’ attempts to conceive. This article aims to review the pathophysiology of DE and anejaculation (AE), to explore our current understanding of the diagnosis, and to present the treatment options for this condition. Electronic databases were searched from 1966 to October 2017, including PubMed (MEDLINE) and Embase. We combined “delayed ejaculation,” “retarded ejaculation,” “inhibited ejaculation,” or “anejaculation” as Medical Subject Headings (MeSH) terms or keywords with “epidemiology,” “etiology,” “pathophysiology,” “clinical assessment,” “diagnosis,” or “treatment.” Relevant sexual medicine textbooks were searched as well. The literature suggests that the pathophysiology of DE/AE is multifactorial, including both organic and psychosocial factors. Despite the many publications on this condition, the exact pathogenesis is not yet known. There is currently no single gold standard for diagnosing DE/AE, as operationalized criteria do not exist. The history is the key to the diagnosis. Treatment should be cause-specific. There are many approaches to treatment planning, including various psychological interventions, pharmacotherapy, and specific treatments for infertile men. An approved form of drug therapy does not exist. A number of approaches can be employed for infertile men, including the collection of nocturnal emissions, prostatic massage, prostatic urethra catheterization, penile vibratory stimulation, probe electroejaculation, sperm retrieval by aspiration from either the vas deferens or the epididymis, and testicular sperm extraction.
... Although the common practice of masturbation has not been linked to any significant problems for the general population; the frequency, intensity, style, and fantasy associated with the practice has been attributed to ejaculatory problems. Idiosyncratic masturbation style refers to a technique that involves pressure, speed, duration, and intensity needed to achieve an ejaculation and orgasm which is not reproducible with a partner using hands, mouth, or vagina [84,89]. Men who practice this type of masturbation have more sexual dysfunction [88,90]. ...
Chapter
Ejaculation is a complex event that involves the autonomic, somatic, and central nervous systems working together with physiologic coordination of muscular contractions. With such a complex array of intricate processes, many things can go awry. Delayed ejaculation (DE) is overall a very poorly understood ejaculatory disorder with low quality data in terms of incidence, pathology, diagnosis, and treatment. In this chapter, we summarize the proper assessment of DE patients and highlight not only the medical conditions contributing to the disorder but also the psychologic ailments. Treatment is outlined based on pathology and an algorithm will be presented for treatment of ejaculatory disorders. With appropriate treatment many of those afflicted will be able to find relief. Nonetheless, ongoing DE research is still needed.
... Perelman identified three masturbatory factors associated with DE: frequency of masturbation, idiosyncratic masturbatory style, and unsettling disparity between masturbatory fantasy and reality (Perelman 2005). Although correlated with high frequency masturbation, the primary causative factor for many men was an "idiosyncratic masturbatory style," which Perelman defined as masturbation technique not easily duplicated with the partner's body, i.e., hand, mouth, or vagina. ...
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Introduction The “lost penis syndrome” (LPS) is a term often used in non-clinical settings to describe the subjective perception of the loss of cutaneous and proprioceptive feelings of the male organ during vaginal penetration. Although deserving clinical attention, this syndrome did not receive any consideration in the medical literature. Notwithstanding, it represents a relatively unexceptional condition among patients in sexual medicine clinics, and it is often reported together with other sexual dysfunctions, especially delayed ejaculation, anejaculation, male anorgasmia and inability to maintain a full erection. Objectives To draft a new conceptual characterization of the LPS, defined as a lack of penile somesthetic sensations during sexual penetration due to various causes and leading to several sexual consequences in both partners. Methods Based on an extensive literature review and physiological assumptions, the mechanisms contributing to friction during penovaginal intercourse, and their correlation to LPS, have been explored, as well as other nonanatomical factors possibly contributing to the loss of penile sensations. Results Efficient penile erection and sensitivity, optimal vaginal lubrication and trophism contribute to penovaginal friction. Whenever one of these processes does not occur, loss of penile sensation defined as LPS can occur. Sociocultural, psychopathological and age-related (ie, couplepause) factors are also implicated in the etiology. Four types of LPS emerged from the literature review: anatomical and/or functional, behavioral, psychopathological and iatrogenic. According to the subtype, a wide variety of treatments can be employed, including PDE5i, testosterone replacement therapy and vaginal cosmetic surgery, as well as targeted therapy for concomitant sexual comorbidity. Conclusion We held up the mirror on LPS as a clinically existing multifactorial entity and provided medical features and hypotheses contributing to or causing the occurrence of LPS. In the light of a sociocultural and scientific perspective, we proposed a description and categorization of this syndrome hypothesizing its usefulness in daily clinical practice. Colonnello E, Limoncin E, Ciocca G, et al. The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine. Sex Med Rev 2021;XX:XXX–XXX.
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The evaluation of delayed ejaculation (DE) is aided by a comprehensive understanding of the various factors that impinge on ejaculatory response. In this chapter, we first review the sexual response cycle, and then provide foundational knowledge about the definition and prevalence of DE, along with characteristics that describe and differentiate men with DE from other men. Emphasizing the need to take a holistic (biopsychosocial) approach, we discuss biologic, psychologic, and relationship risk factors. A final section provides step-by-step guidance through the process of evaluation for men suspected of having DE.
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Retarded Ejaculation In Current Sexual Health Reports
  • M Perelman
Perelman M. " Retarded Ejaculation. " ], In Current Sexual Health Reports 2004 [Ed: Mulhall, J.]. Current Science, Inc., Philadelphia, Pennsylvania, 2004:1:3.
Inhibited or Retarded Ejaculation In Handbook of Ejaculation Disorders
  • Rowland D Perelman
Rowland D. & Perelman M. " Inhibited or Retarded Ejaculation. " In Handbook of Ejaculation Disorders [Ed. O'Leary M]. Taylor & Francis, Philadelphia, Pennsylvania, 2006. In Press.