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.