1. MFT 719 Fall, 2007 Sexual Issues in MFT: Premature Ejaculation Kim Rogers

2. Diagnosis DSM IV-R (302.75) –Ejaculation before, upon, or shortly after penetration (before a person wishes) –Persistent, Recurrent –Minimal sexual stimulation –Marked distress –Not medical or substance abuse related –Life-long or Acquired –Generalized or Situational

3. Prevalence Intravaginal ejaculatory latency time (IELT) –30% of men (faster than they wish) –16% see as a problem –10% report to a physician –Co-morbid symptoms stress, anxiety, depression –Relationship issues frustration, guilt, embarrassment

4. Diagnosis/Treatment Models Medical –pharmaceutical Psychological –behavioral Psychosocial –relational Intersystem –behavioral, psychoanalytic, systemic, medically aware

5. Medical Topical Anesthetics –lidocane, prilocane Off-Label Antidepressants –SSRIs: Paxil, Zoloft, Prozac Advantages: –fast, simple, inevitable Disadvantages: –must continue indefinitely –side effects –unaddressed psychological and relational issues

6. Psychological/Behavioral Physical Awareness PE, Couples Exercises –Squeeze technique –Start Stop technique –Quiet Vagina technique –Monitor and adjust stimulation

7. Intersystem Behavioral –PE Exercises Systemic –Power struggles –Fear of commitment –Fear of intimacy –Unclear expectations Awareness –Environmental effectors –Pharmaceutical issues