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

Youtube is an unreliable source of information about delayed ejaculation treatment

BACKGROUND

Social platforms such as YouTube have become sources of information about diseases as they can be easily and rapidly accessed. However, this also has the risk of ill-intentioned content and misleading information.

OBJECTIVE

To evaluate the reliability of YouTube video content about delayed ejaculation treatment.

MATERIAL AND METHODS

YouTube videos were searched using the terms "delayed ejaculation," "retarded ejaculation," "inhibited ejaculation," and "anejaculation." Videos were excluded if they were not in English, were not related to the subject, or did not have audio and visual content. In accordance with the scientifically proven accurate information, the videos were separated as reliable (Group 2, n: 112) and unreliable videos (Group 1, n: 94). The groups were compared in respect of the video characteristics, and the scores obtained in the DISCERN-5, Global Quality Scale, the Patient Education Materials Assessment Tool Audiovisual, and the Journal of the American Medical Association scales. Intraclass correlation test was used to evaluate the level of agreement between the two investigators.

RESULTS

Of the 1200 videos, 994 were excluded. No significant difference was determined between the Group 1 and Group 2 in respect of the median number of views [1672 (4555) vs 1547 (28,559), p = 0.63] and likes [10 (42) vs 17 (255), p = 0.07]. There was a greater number of videos in the Group 2 (54.4%) and the points obtained on the scoring scales were significantly higher than the Group 1 (p < 0.001). The videos originating from universities/professional organizations/non-profit physician/physician group were comprised the majority of the reliable videos (55.3%) and the unreliable videos had more content related to treatment (71.4%) (p < 0.001).

CONCLUSION

Although there was a greater number of reliable videos related to the problem of delayed ejaculation, the content could be misleading and should be avoided by patients seeking treatment without consulting a physician.

Traumatic masturbation and erectile dysfunction: A matched case-control study

OBJECTIVE

To identify atypical masturbatory behaviors (AMB) and to reveal their effects on both sexual and masturbational erection hardness in men with erectile dysfunction (ED).

METHODS

Patients with ED and healthy controls were questioned about their masturbation habits. Accordingly, "rubbing in a prone position," "pressure on penis," and "masturbation through clothes" were included in the traumatic masturbation syndrome (TMS) group. Erection hardness score (EHS) is used to measure the erectile functions during masturbation (mast), foreplay (presex), and sexual intercourse (sex), separately.

RESULTS

The data of 448 participants, 266 (59%) from the patient group, and 182 (41%) from the control group were analyzed. The mean ages were 30 years in both groups (p = 0.734). The rate of "rubbing in a prone position" and "penile pressure" while masturbating was higher in patients than the controls (10.2% vs. 6%, p = 0.024 and 8.6% vs. 3.3%, p = 0.0002, respectively). Patients had 2.2-fold (odds ratio, 2.21; 95% confidence interval, 1.40-3.47; p = 0.001) increased risks of having at least one AMB, compared with controls. In the secondary analysis, the patient group was divided into 2 subgroups according to having TMS (ED + TMS) or not (ED). The percentage of patients with EHS≥3 during masturbation was higher than those during sex and presex in the "ED + TMS" group (60.2%, 38.8%, and 37.2%, respectively, p = 0.0001; n = 98). Comparing the percentage of patients with EHS≥3 during mast, presex, and, sex was found to be similar in the "ED" group (58.9%, 56.5%, and 56%, respectively, p = 0.753; n = 168).

CONCLUSION

Atypical masturbatory behaviors are more common in young men presenting with erectile dysfunction. These patients have higher erection hardness scores during masturbation compared to partnered sex.

Do pornography use and masturbation play a role in erectile dysfunction and relationship satisfaction in men?

Both masturbation frequency and pornography use during masturbation have been hypothesized to interfere with sexual response during partnered sex as well as overall relationship satisfaction. However, results from prior studies have been inconsistent and frequently based on case studies, clinical reports, and simple binary analyses. The current study investigated the relationships among masturbation frequency, pornography use, and erectile functioning and dysfunction in 3586 men (mean age = 40.8 yrs, SE = 0.22) within a multivariate context that assessed sexual dysfunctions using standardized instruments and that included other covariates known to affect erectile functioning. Results indicated that frequency of pornography use was unrelated to either erectile functioning or erectile dysfunction (ED) severity in samples that included ED men with and without various sexual comorbidities or in a subset of men 30 years or younger (p = 0.28-0.79). Masturbation frequency was also only weakly and inconsistently related to erectile functioning or ED severity in the multivariate analyses (p = 0.11-0.39). In contrast, variables long known to affect erectile response emerged as the most consistent and salient predictors of erectile functioning and/or ED severity, including age (p < 0.001), having anxiety/depression (p < 0.001 except for a subset of men ≤ 30 years), having a chronic medical condition known to affect erectile functioning (p < 0.001 except for a subset of men ≤ 30 years), low sexual interest (p < 0.001), and low relationship satisfaction (p ≤ 0.04). Regarding sexual and relationship satisfaction, poorer erectile functioning (p < 0.001), lower sexual interest (p < 0.001), anxiety/depression (p < 0.001), and higher frequency of masturbation (p < 0.001) were associated with lower sexual and lower overall relationship satisfaction. In contrast, frequency of pornography use did not predict either sexual or relationship satisfaction (p ≥ 0.748). Findings of this study reiterate the relevance of long-known risk factors for understanding diminished erectile functioning while concomitantly indicating that masturbation frequency and pornography use show weak or no association with erectile functioning, ED severity, and relationship satisfaction. At the same time, although verification is needed, we do not dismiss the idea that heavy reliance on pornography use coupled with a high frequency of masturbation may represent a risk factor for diminished sexual performance during partnered sex and/or relationship satisfaction in subsets of particularly vulnerable men (e.g., younger, less experienced).

Orgasm and Related Disorders Depend on Neural Inhibition Combined With Neural Excitation

INTRODUCTION

Prevalent models of sexual desire, arousal and orgasm postulate that they result from an excitatory process, whereas disorders of sexual desire, arousal and orgasm result from an inhibitory process based on psychosocial, pharmacological, medical, and other factors. But neuronal excitation and active neuronal inhibition normally interact at variable intensities, concurrently and continuously. We propose herein that in conjunction with neuronal excitation, neuronal inhibition enables the generation of the intense, non-aversive pleasure of orgasm. When this interaction breaks down, pathology can result, as in disorders of sexual desire, arousal, and orgasm, and in anhedonia and pain. For perspective, we review some fundamental behavioral and (neuro-) physiological functions of neuronal excitation and inhibition in normal and pathological processes.

OBJECTIVES

To review evidence that the variable balance between neuronal excitation and active neuronal inhibition at different intensities can account for orgasm and its disorders.

METHODS

We selected studies from searches on PubMed, Google Scholar, Dialnet, and SciELO for terms including orgasm, neuronal development, Wallerian degeneration, prenatal stress, parental behavior, sensorimotor, neuronal excitation, neuronal inhibition, sensory deprivation, anhedonia, orgasmic disorder, hypoactive sexual desire disorder, persistent genital arousal disorder, sexual pain.

RESULTS

We provide evidence that the intensity of neuronal inhibition dynamically covaries concurrently with the intensity of neuronal excitation. Differences in these relative intensities can facilitate the understanding of orgasm and disorders of orgasm.

CONCLUSION

Neuronal excitation and neuronal inhibition are normal, continuously active processes of the nervous system that are necessary for survival of neurons and the organism. The ability of genital sensory stimulation to induce concurrent neuronal inhibition enables the stimulation to attain the pleasurable, non-aversive, high intensity of excitation characteristic of orgasm. Excessive or deficient levels of neuronal inhibition relative to neuronal excitation may account for disorders of sexual desire, arousal and orgasm.

An innovative approach to lifelong delayed ejaculation: does attachment style play a role?

PURPOSE

To examine whether there is a correlation between attachment styles, which is a developmental psychology theory, and lifelong DE.

METHODS

The research was planned as prospective, multi-centric and cross-sectional study. Thirty patients who were consecutively admitted to the urology outpatient clinic and diagnosed with lifelong DE and 30 age-matched healthy controls were included in the study. All participants gave a detailed medical history and underwent a complete physical examination, and their laboratory and endocrine (prolactin and testosterone) results were evaluated. Additionally, all patients had to fill out socio-demographic information form, the Experiences in Close Relationships-Revised (ECR-R) Questionnaire, Arizona Sexual Experiences Scale (ASEX), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI).

RESULTS

The mean age of the DE patients was 33.5 ± 7.5 years. In the DE group, insecure attachment (both anxious and avoidant attachment), anxiety and depression scores were found to be significantly higher (p < 0.001, effect size medium or large) than the control group. Ejaculation times (both for vaginal intercourse and masturbation) were correlated with both insecure (anxious and avoidant) attachment types, as well as their anxiety and depression scores (p < 0.001). The ASEX satisfaction, ejaculation and total scores were found to be higher in DE patients (higher scores indicating greater sexual dysfunction) than in the control group.

CONCLUSION

The large and significant relationships found between lifelong DE and attachment insecurities point to childhood developmental processes. The findings may help us better understand lifelong DE. There is a need for further extensive research on this subject.

Delayed ejaculation in men with depressive disorders

Delayed ejaculation belongs to the group of sexual disorders in men. The causes of delayed ejaculation or anejaculation are not exactly known. It is assumed that it can be caused by psychogenic or organic influences or their combinations. One of the causes of delayed ejaculation may be elevated prolactin levels, which may be increased by psychosocial stress, pituitary disorders or also treatment with selective serotonin reuptake inhibitors in the treatment of depression. We tested a selected group of 50 men who were diagnosed with a depressive disorder and whose antidepressant treatment lasted for at least 24 weeks. These patients reported long-term delayed ejaculation or, in some cases, anejaculation as comorbidity. The results showed significant Spearman's correlation between elevated prolactin levels and intravaginal ejaculation latency values (R = 0.45), as well as between Beck's Depression-II inventory and intravaginal ejaculation latency and latency values (R = 0.48).

Do Pornography Use and Masturbation Frequency Play a Role in Delayed/Inhibited Ejaculation during Partnered Sex? A Comprehensive and Detailed Analysis

The role of masturbation frequency and pornography use on sexual response during partnered sex has been controversial, the result of mixed and inconsistent findings. However, studies investigating this relationship have often suffered from methodological shortcomings. We investigated the role of masturbation frequency and pornography use on both the occurrence and severity of delayed/inhibited ejaculation (DE), an increasingly common sexual problem among men. We did so in a large (nonclinical) multinational sample of cisgender men (N = 2332; mean age = 40.3, SE = 0.31) within a multivariate context that relied on multiple (and, when possible, standardized) assessments of sexual dysfunctions while controlling for possible confounding variables. Results indicated a weak, inconsistent, and sometimes absent association between the frequency of pornography use and DE symptomology and/or severity. In contrast, both poorer erectile functioning and anxiety/depression represented consistent and strong predictors of DE and, to a lesser extent, DE severity. Other factors, including relationship satisfaction, sexual interest, and masturbation frequency, were significantly though moderately to weakly associated with DE. In conclusion, associations (or sometimes lack thereof) between masturbation frequency, pornography use, and delayed ejaculation are more clearly understood when analyzed in a multivariate context that controls for possible confounding effects.

Prevalence of sexual dysfunctions and associated risk factors in Poland

INTRODUCTION

Many biological, psychological and sociocultural factors influence the prevalence of sexual dysfunctions and sexual behavior. The purpose of the study was to evaluate the prevalence of sexual dysfunctions and sexual behaviors.

MATERIAL AND METHODS

The study was the third edition of a general population-based, cross sectional survey, evaluating sexual attitude, sexual behaviors within and outside relationships and type of sexual dysfunctions present in the Polish population. The survey consisted of 82 questions, grouped into five blocks that contained open- and closed-ended general questions, inquiries about early sexual contacts, sex life, relationships, sexual behaviors and preferences. A standard questionnaire was used to obtain data on age, education, marital status, religious beliefs, medical history, disabilities and other illnesses. A total of 1054 responders aged from 18 to over 70 years participated in the study. Risk factors and other causes contributing to certain sexual dysfunctions defined in the DSM-5 and in the available literature were analyzed.

RESULTS

In this research, 40% of women and 36.5% of men had at least one sexual dysfunction. Analysis of the total population showed that decreased sexual desire (29.0%), occasional climaxing (28.5%) and anorgasmia (21.0%) were the dysfunctions most frequently reported by women. In men, premature ejaculation (23%) and excessive sexual needs (16.3%) were most prevalent. Both men and women with arousal problems reported significantly more comorbid sexual dysfunctions (p < 0.001).

CONCLUSIONS

Sexual dysfunctions are highly prevalent in the Polish population. Of note, it is alarming that only very few patients seek professional help when sexual problems occur.

Sexual Response Differs during Partnered Sex and Masturbation in Men With and Without Sexual Dysfunction: Implications for Treatment

BACKGROUND

It is unclear whether men who experience sexual difficulty during partnered sex experience similar difficulty during masturbation.

AIM

To determine whether sexual functionality and dysfunctionality were similar or different during masturbation vs partnered sex.

METHODS

We compared sexual responsivity during masturbation vs partnered sex in a multinational sample of 4,209 men with and without a sexual dysfunction to determine whether dysfunctionality was greater, less, or about the same during these 2 types of sexual activity.

OUTCOMES

Consistently lower impairment of sexual function was found during masturbation compared with partnered sex for all 3 sexual problems assessed: erectile dysfunction, premature ejaculation, and delayed ejaculation.

CLINICAL TRANSLATION

These findings reiterate the potential value of assessing sexual responsivity during masturbation as well as melding masturbation strategies with couples therapy in order to attenuate impaired response during partnered sex.

STRENGTH & LIMITATIONS

Although this study provides the first empirical evidence based on a large multinational sample indicating that sexual functionality is consistently higher during masturbation than partnered sex, it does not provide an empirically-derived explanation for this difference.

CONCLUSION

Understanding a man's response potential during masturbation may be important to improving sexual response during partnered sex, with the need for more targeted research that more directly evaluates the use of such strategies in the treatment of men's sexual problems. Rowland DL, Hamilton BD, Bacys KR et al. Sexual Response Differs during Partnered Sex and Masturbation in Men With and Without Sexual Dysfunction: Implications for Treatment. J Sex Med 2021;18:1835-1842.

The Lost Penis Syndrome: A New Clinical Entity in Sexual Medicine

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.

When Ejaculation Becomes the Goal in Itself: A Psychodynamic Approach to Delayed Ejaculation

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.

The Potential Associations of Pornography Use with Sexual Dysfunctions: An Integrative Literature Review of Observational Studies

This paper reviews the associations between pornography use and sexual dysfunction based on evidence from observational studies. The existing data in this regard mostly derive from cross-sectional investigations and case reports. There is little if no evidence that pornography use may induce delayed ejaculation and erectile dysfunction, although longitudinal studies that control for confounding variables are required for a full assessment. The associations between pornography use and sexual desire may differ between women and men although the existing data is contradictory and causal relationships cannot be established. The strongest evidence is available for the relation of pornography use with decreased sexual satisfaction, although the results of prospective studies are inconsistent. The paper outlines future research prospects beneficial in understanding the nature of associations between pornography use and sexual dysfunctions in men and women.

What is sober sex and how to achieve it?

Purpose

The purpose of this paper is to provide the first definition of sober sex and recommendations for health care professionals who work therapeutically with patients who struggle with intimacy after experiencing chemsex.

Design/methodology/approach

The recommendations are based on the clinical experience of a psychosexual therapist working with men having sex with men (MSM) in a Sexual Health clinic in central London.

Findings

The paper concludes that having a clear definition of sober sex and specific tools, such as healthy masturbation exercise, could prove helpful for health professionals who work with this cohort of patients.

Originality/value

This paper provides the first definition of sober sex and a clear set of guidelines for health professionals based on the clinical experience of the author.

Successfully treatment of intercourse anejaculation with psychosexual counseling: A very rare case of situational anejaculation specific to penetrative sex with the wife

Situational anejaculation means that a man can ejaculate in some situations but not in others. Intercourse type of anejaculation means existence of ejaculation by masturbation, but not during sexual intercourse. In some cases, men may be able to ejaculate and attain orgasm with one partner but not with another. Performance anxiety, hostility toward the partner, dysfunctional psychosexual development, and unconscious desire to avoid pregnancy are the possible underlying conditions. We herein reported a case of wife-specific intercourse anejaculation succesfully treated with sexual therapy. According to our best knowledge, this is an important case study in literature about intercourse type of situational anejaculation specific to the patient's wife that was treated with psychosexual counseling. The authors conclude that this clinical course of situational intercourse anejaculation suggests a psychological problem in these patients and sexual therapy is effective.

Delayed Ejaculation: Pathophysiology, Diagnosis, and Treatment

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.

Reexamining the Definitions of PE and DE

Evidence-based definitions improve clinical practice and research. Nonetheless, the International Society of Sexual Medicine (ISSM) and the American Psychiatric Association's (DSM-5) definitions regarding lifelong and acquired premature ejaculation (PE) and delayed ejaculation (DE) require reexamination. Existing Intravaginal Ejaculation Latency Time (IELT) evidence, the ISSM position papers, and articles both supporting and critiquing the ISSM's definitions were reviewed. Disproportionately, the findings from those studies document that the majority of men's IELT range is approximately 4 to 10 minutes. Such robust quantitative evidence should become the basis for determining the temporal criterion when defining both PE and DE. Any bilateral deviation from that majority's ∼4- to 10-minute IELT range should meet the qualification for the temporal diagnostic criterion. However, for a man to be diagnosed with a disorder, a licensed health-care clinician (HCC) must also determine that the man suffers from "lack of control" and "distress." Diagnosis would include subtyping Lifelong or Acquired, Global or Situational, similar to the ISSM guidelines and specifying mild, moderate, or severe-similar to DSM-5 requirements. "Control" and "distress" should trump latency and convey greater weight in the diagnostic process. Loosened latency criteria could result in false positive diagnoses; however, requiring a licensed HCC to evaluate control and distress reduces that risk.