Room 517-D | Premature Ejaculation: Towards a Consensus on Definition, Etiology and Treatment- Part I Thursday, July 14, 2005 Time: 8:30 AM-10:30 AM |
Premature Ejaculation: What is its Etiology? An Integrative, Biopsychosocial, Multidimentional Approach.
Metz, Michael *,1, 1 Meta Associates, St. Paul, MN, USA
ABSTRACT- Premature or Rapid Ejaculation (PE) is the inadvertent and unsatisfying, rapid speed of male ejaculation. Studies suggest that PE is the most common male sexual problem, affecting approximately 29% of all men (Lauman, Paik, & Rosen, 1999). PE is complicated. It is a biopsychosocial personal problem with multiple causes, multiple effects and involving multiple personal and relationship dimensions. Real-life human problems rarely have a simple cause and a simple cure in spite of people longing for quick fixes. Although by observation, PE is one phenomenon, poor control over ejaculation, there are many possible causes for PE (Metz & Pryor, 2000). In the medical and psychological sciences literature (Metz et al, 1997), the possible causes of PE cluster or group into 9 types or groups of causes: 4 Biogenic or Physiological Types of PE determined by bio-neurologic system, physical illness, physical injury, or from drug side-effect; and 4 Psychogenic or Psychological Types determined by an innate psychological system, acute psychological distress, relationship distress, and deficits in the psychosexual skills of sexual arousal. The ninth type in the literature is a Mixed PE type, PE concomitant with another sex dysfunction such as erectile dysfunction. There are interactions between these physical, psychological, relational, and psychosexual skills dimensions. PE caused by any of the types may also precipitate multiple effects or consequences. These effects, in turn, may become maintaining and complicating causes of PE, making it chronic and severe. It is a vicious cycle. For example, lifelong PE that is caused by neurologic hard-wiring (Neurologic System PE), or acquired PE that is initially caused by a prostate problem (Physical Illness PE), may interact with partner distress and negatively affect couple cooperation (Relationship Distress PE), and also precipitate depression (Psychological Distress PE) which exacerbates the situation. In addition to understanding the multiple causes and effects of PE, it is important to appreciate that PE is also multidimensional. The subtle intermingling of each of the partners cognitions (e.g., spectatoring, negative expectancies like failure), emotions (e.g., performance anxiety, frustration), and behaviors (e.g., arguing or avoiding) adds to the complexity. Comprehensive assessment and effective treatment must adequately determine and address the role and severity of all the specific causes, effects, and dimensions of PE. To overlook a contributing or maintaining cause, a detrimental effect, or a significant dimension, will sabotage treatment effectiveness and frustrate both the couple and the clinician. Utilizing an Integrative, biopsychosocial, multidimensional approach for evaluating and treating PE offers the best strategy for helping men and couples to sexually function and enrich emotional and sexual satisfaction (Metz & McCarthy, 2003).
Key words: male sexual dysfunction, couple sex therapy, premature ejaculation, biopsychosocial approach, Sex therapy