THERE IS ABSOLUTE PREMATURE EJACULAION MALE PARTNER IS UNABLE TO PENETRATE OR WITHIN FEW SECONDS EJACULATION TAKES PLACE BUT IN MOST CASES IT IS COUPLE ISSUE OUR AIM IS TO FIND Is it carpenter issue or issue of wood or both PME can be considered as a couple issue in most cases

1. PREMATURE EJACULATION
INDIVIDUAL THERAPY V/S COUPLE
THERAPY
DR : AJAYAN VARUGHESE
CHAIRMAN INTERNATIONAL ASSOCIATION OF SEXUAL MEDICINE PRACTITIONERS
(MODERN MEDICINE )IASMP (MM)
DIRECTOR ISRM
M.B.B.S,
M.Sc Applied Psychology
P.G.C.C (Psychiatry and Psychosexual Medicine)
P.G.D.H.Sc ( Reproductive and Sexual medicine)

2. PREMATURE EJACULATION
• Premature Ejaculation (PE) occurs when a
man ejaculates before he or his partner
want climax to happen.
• Primary PE- the problem starts with their first
sexual experience
• Secondary PE -it happens after a period of
normal sexual functioning.

7. A 2008 survey of Canadian and American
therapists stated that the average time
for heterosexual intercourse was 7
minutes.
1 TO 2 MINUTES SHORT
3 TO 7 MINUTES ADEQUATE
7 TO 13 MINUTES DESIRABLE
13 TO 30 MINUTES TOO LONG

8. Kindly note in
Germany women gets 7.4
minutes and men ejaculates at
6.9 minutes. Here women
doesn’t get sexual orgasm but
we cannot consider male
partner do have any problem.

9. • THERE IS ABSOLUTE PREMATURE EJACULAION MALE
PARTNER IS UNABLE TO PENETRATE OR WITHIN FEW
SECONDS EJACULATION TAKES PLACE
• BUT IN MOST CASES IT IS COUPLE ISSUE
• OUR AIM IS TO FIND
• Is it carpenter issue
• or issue of wood
• or both
PME can be considered as a couple issue in most cases

10. Limitations of Psychotherapy for PE
➢Lack immediacy
❖Therapy takes time to be effective
➢Efficacy
❖Good initially
❖Tends to diminish over time
➢More difficult to treat men not in stable relationships
❖Having a motivated and supportive partner is helpful
➢Time consuming and costly

11. Dapoxetine and Paroxetine are effective on demand
basis
OFF LABEL DRUG Tramadol is also effective (on
demand)
MAIN DRAWBACK IS ALL OF THESE DRUGS
INDUCES ED
SSRI

12. HOW TO SELECT THE COUPLE FOR THERAPY
PROPER DATA COLLECTION FROM THE COUPLE CAN HELP US
WHETHER INDIVIDUAL THERAPY OR
COUPLE THERAPY IS REQUIRED
ABSOLUTE PME CAN BE MANAGED BY INDIVIDUAL THERAPY
(Treating the Male partner)
If the female partner need TOO LONG time to achieve orgasm it
can be managed by treating female partner
(it cannot be considered as PME ..)
ALL OTHER PME CAN BE MANAGED BY COUPLE THERAPY

13. Instead of treating male partner alone we have
to treat female partner or we have to start couple
therapy.

14. If the male partner can attain 7 to
13 minutes we have to include
female partner also in therapy

15. Can sexual orgasm attained earlier by
any method?
There is no pharmacotherapy .
But there are some
behavioral techniques.

16. There is considerable
... difference between
male and female sexual drive

17. IMPROVING
Emotional intimacy
is a time consuming process
By improving
emotional
intimacy time
for attaining
sexual
orgasm Can
be reduced.

18. METHODS TO IMPROVE Emotional intimacy
1. Promotion
2. Nonsexual touch
3. Sexual touch
4. Clitoral and Nipple ...stimulation
5. Penetrate on demand only
6. Valedictory

19. PROMOTION
Women are different from men
Ask what she needs to be happy
and listen.
Women typically need listening,
not solutions (she is already competent).
Never ask a woman to get to the point.

20. She needs time,
talking,
and Intimacy
requires
attention on her
Go for shopping
with her
Go for picnic
with her

21. Never the spouse feel that
male partner is Lying, cheating
Male partner must be able to say sorry
even if he does not commit the mistakes
Do Not blame her for all the trouble
even if she commits a mistake

22. 1. Avoid pattern of bad relationships
2. She should not feel that
You are ambivalent
3. NO Physical Trauma
4. NO Emotional Trauma

23. Praise her
eg: The food You have prepared was So
tasty (of course the spouse must lie)

24. Physical Methods
A. Nonsexual touch
B. Sexual touch

25. NON SEXUAL TOUCH
Her skin is 10Xs more sensitive.
Touching is a subtle , powerful and
complex form of communication
correct touching helps to advance the
relationship

26. WHERE TO TOUCH
START with a light brief touch on the arm
to draw attention
Perform each touch at least twice before progressing
to the next level Advance in the following order
Hand squeeze, Holding brief knee touch Arm
over shoulder
PROGRESS TO HUGGING

27. Touching
gently on
toes and foot
can improve
the emotional
intimacy
BECAUSE GENITALS
ARE VERY CLOSE TO
BIG TOE IN BRAIN

28. Non sexual touch should
continue for 1-2 weeks
If the tuning is perfect
GO FOR SEXUAL TOUCH

29. Sexual touch

30. Clitoris and Vagina
the Queens of Female sex organ
Stimulation of clitoris
1 . simply rubbing the clitoris with one hand
palpating the breast with other hand
2 .“Masturbating” the clitoris with one hand
palpating the breast with other hand

31. start with breast and labium
soft touch is beneficial
duration 10-15 metes
during this period verbal
communication is advocated

32. 1) Simply rubbing the clitoris with one hand
palpating the breast with other hand
(Never do any painful activities)
During this method gradual mood elevation from
the female partner can be seen
Check the Vagina for Lubrication

33. • Clitoral stimulation
• Hold the clitoris with your two fingers
stimulate it with to and fro movement
ask the patient whether you are being
sexually excited
• After completing this check for the
Lubrication without putting the finger
inside
• if lubrication is there
-- it is a good sign

34. If she feels comfortable continue the clitoral
stimulation Now the male partner can penetrate the
finger in the vagina and stimulate her.

35. 2 “Masturbating” the clitoris with one
hand palpating the breast with other hand
Hold the shaft of the clitoris with thumb and
index finger “masturbate” as how male do
Erection of clitoris can be felt
Check the vagina for lubrication
CONTINUE THE SAME PROCESS of FIRST
METHOD

36. if the lubrication is present
Male partner can penetrate the
finger inside and
GO FOR
TO AND FRO MOVEMENTS

37. Finger insertion to vagina can be done at
the end of this stage if the vagina is wet
Go for clitoral stimulation

38. Penetrate on demand
If sexual arousal and sexual desire
is achieved female partner
will demand for penetration

39. By all this methods we can reduce the
time for attaining sexual orgasm in
female.
Thus paradoxical premature ejaculation
can be treated.

40. Secondary PME
IF PREMATURE EJACUTION OCCURS TO
NORMAL EJACULATING MALE
1 ) IT MAY BE INTIAL STAGE OF DEVELOPING
ED( CAN BE DIAGNOSED BY
ADMINISTRATION OF PDE5 INHIBITORS
2)PROSTATE PATHOLOGY
(By proper investigation ,Usg ,PSA )

41. THANK YOU