Stop over-emphasizing coitus!

Through his research, Philippe Kempeneers considers that this should be the first phase of treatment for premature ejaculation. “Better sexual education could reduce the suffering felt by premature ejaculators”.

Doctors who want to find a quick solution to their patient’s problem will not generally ask him about his sexual rituals and quickly recommend medication- which is heavily advertised. But they remain locked into this idea of over-estimated coitus, without looking at sexuality in all its forms. As for the question as to who benefits more from prolonged coitus, we have seen that women do not particularly demand this aspect alone…

Other more informed therapists place more emphasis on behaviour during the sexual act. It would be necessary first of all to restore a certain diversity to peoples’ erotic gestures. It would then be possible for behavioral techniques to help an individual to regain control. This is the case for example with the ‘stop and start’ method, a behavioral technique created in the 50s, and which involves a sexual partner. It involves stimulation of the man until he reaches a state of excitement close to ejaculation, and then stopping just before ejaculation in order to relieve the tension; the stimulation is repeated several times. The goal is to identify the point of no return in order to be able to control this in the long term. In the 70s, other specialists added the ‘squeeze technique’ which consisted of applying pressure to the penis under the glans, during phases of pausing sexual stimulation in order to reduce the level of tension. “The success rate of these techniques was good in the short-term but decreased over time. Then the idea to focus not on the reflex but on the psychophysiology of the preceding excitement came about: the regulating (regulation ?)approach. This is based on the idea that prolonging ejaculation needs to be taught and is not a malfunction that has been learned. It is particularly based on the psychology of emotions. This approach can be relayed by booklets containing practical advice aimed at regulating excitement: this is known as ‘bibliotherapy’- therapy through reading. This is what we put in place in our research program ‘BibliothEP’ (Bibliotherapy for premature ejaculation) which, as its name suggests, aims to assess the effect of bibliotherapy. In this program, we have included different exercises in a small booklet with some explanations. 120 to 150 people have already tested it and according to our first study on the effectiveness of this ‘bibliotherapy’, 85% report an improvement, even if the improvement is only slight; the level of suffering decreases for most individuals involved and the quality of their sex life improves overall. The obstacles or problems that reduced their efficiency are the lack of repetition of the exercises recommended, an insufficient frequency of sexual relations to be able to assess its effectiveness, or reticence on the part of the man or his partner to embrace new techniques. In order to increase adhesion to this program, we suggest using this booklet coupled with professional care which could clarify some points, answer questions, support motivation…But there are not many specialists, it will be difficult to monitor everybody. First-line carers (GPs, urologists, psychologists…) could be trained in the use of bibliotherapy to guide their patient and not to rely totally on referral to a sex therapy specialist or medication as the only solutions. We have already tested this possibility, and bibliotherapy plus care by a carer who is not a sex therapy specialist but is specifically trained as an adjunct to bibliotherapy yields better results than bibliotherapy alone…”

The work that inspired the bibliotherapy is available, the wider public have direct access to it in bookshops. This study, which has no agenda for recommending any kind of medication is financed by public money from the Province of Liege and led by the University of Liege.