Clinical outcomes of a new cognitive-behavioural bibliotherapy for premature ejaculation

1. BibliothEPstudyClinical evaluation of a Bibliotherapy for Premature EjaculationPh. Kempeneers, R. Andrianne, S. Bauwens, I. Georis, J.F. Pairoux, S. Blairy Clinical outcomes of a new cognitive-behavioural bibliotherapy for premature ejaculation Study led in collaboration by the University of Liege (B) and the Province of Liege Department of Health and Quality of Life (B)

2. Introduction • Premature ejaculation (PE) is a common sexual disorder (prevalence ≈ 20-30%) • Effective treatments do exist, both at pharmacological as well as cognitive-behavioural levels. • However, only a few affected people consult professionals to overcome this problem (Bozon, 2008; Porst et al., 2007). Embarrassment regarding discussing this trouble, lack of information about the treatments, cost… • Reading didactical documents about their PE problem can be useful to men (Lowe & Mikulas, 1974; Trudel et al., 1985; De Sutter et al., 2002). Such approach is called “bibliotherapy”.

3. Objective To improve the bibliotherapy approach for PE on the basis of up to date techniques thought to be efficient (review by Kempeneers et al., 2004) • Evaluation of a new bibliotherapy for PE, thePractical Guide of Premature Ejaculation(Kempeneers, Andrianne & Bauwens) Expected benefits: • didactical manual shorter than previous ones (41 p. A5) • therapeutic principles easier to assimilate • method thereby made accessible to a large public which usually does not consult for PE • To obtain a preventive and curative instrument which is simple, efficient, cheap and available for mass circulation.

4. Practical Guide of Premature EjaculationKempeneers, Bauwens, & Andrianne (2008) CONTENTS INTRODUCTION I. DEFINITION 1. A subjective landmark: the person’s wish 2. Minimal stimulation of the penis 3. Frequency of the difficulty 4. Frequency of sexual activities with ejaculations 5. Newness of the sexual experience, newness of the partner Conclusion: the « official definition » II. THE CAUSES OF PREMATURE EJACULATION Preamble 1. In general 2. Special cases 3. In detail 3.1. Nature factor 3.2. Culture factor III. A TWO-STAGES BEHAVIOURAL TREATMENT 1. To look at the coitus in perspective and to enlarge the range of erotic behaviours 2. To thwart the reflexes contributing to a rapid growth of excitation 2.1. Masturbation “fixed wrist – mobile body” 2.2. “Abdominal” respiration 2.3. To synchronize the breathing with the copulating movement 2.4. To have breaks 2.5. Application in coital situations 2.6. In the end VI. EPILOGUE 1. The advantages of the booklet 2. Its limits 3. Do efficacious medications for premature ejaculation exist? GLOSSARY FOR FURTHER READING USEFUL ADDRESSES

5.  New prospects in the treatment of premature ejaculation Kempeneers, Bauwens, & De Sutter (2004), RFCCC, 9,4, 1-8 Assumptions • PE is often due to a lack of learning the sexual abilities that allow to free oneself from a natural copulating program. The main purpose of the Practical Guide is to help people to acquire such abilities. Learning targets two main kinds of abilities: • Abilities to move focus out of the coitus as way to get pleasure • Abilities to manage arousal without directly giving in to sensori-motor automatisms that hasten the ejaculatory reflex. (arousal regulation method- Desjardins, 1985; De Sutter et al., 2002; Kempeneers et al., 2004; De Carrufel & Trudel, 2006)

6. Trial design and population Pre-test(T0): 421 PE men (DSM-IV criteria) completed a pre-test questionnaire on-line (T0) and received the Practical Guide of PE 80 partners also completed a pre-test questionnaire Control group(Ti): among the 421 subjects, 67 were put on a waiting-listing for 2 months before completing a second pre-test questionnaire (Ti) and, then, receiving the Practical Guide Post-test 1(T1): 124 subjects completed a post-test questionnaire on-line (T1) 4-8 months after having received the Practical Guide Post-test2(T2): among them, 74 subjects completed a second post-test questionnaire on-line (T2) 4-8 months after T1

7. Measures Socio-demographic and psychometric data in pre-test • Age / educational level • Temperament and Character Inventory (TCI-R, Cloninger) – men only • Trait Anxiety Inventory (STAI-Y-B Spielberger) • Social Interaction Self-Statement Test (SISST, Glass et al.) – men only • Liebowitz’s Social Anxiety Scale (LSAS, Liebowitz) – men only Sexual functioning(comparisons pre-test/post-test/control) • Ejaculatory latency During the last months, what was the mean duration of your penetrations? 1. ej. before intromission → 8. > 10 minutes • Feeling of control During the last months, what was your feeling of control upon ejaculation? 1. no control → 7. total control • Sexual satisfaction During the last months, what was your general sexual satisfaction? 1. no satisfaction → 7. total satisfaction • Distress related to PE In what extent is your PE a problem for you now? 1. not a problem at all → 7. very important problem • Anxiety during sexual intercourses Scale adapted from the State Anxiety Inventory (STAI-Y-A, Spielberger) Sexual cognitions(comparisons pre-test/post-test) • Sexual Irrationality Questionnaire (SIQ, McCormick & Jordan) Feeling of improvement in post-test 1. no improvement → 7. very strong improvement + open question about the reasons in case of non-improvement

8. Demographics

9. Subtypes of PE

10. Efficacy of the bibliotherapySignificant improvements of the sexual functioning at post-tests 1 and 2 pre-test post-test

11. Efficacy of the bibliotherapySignificant improvements of state anxiety and sexual cognitions * Significant at .05

12. Feeling of improvement (post-test 1)

13. Commentaries in case of non-improvement • Exercises not done or not frequently enough Lack of time, insufficient intimacy conditions, reticence to masturbation • Lack of hindsight Sexual intercourse not frequent enough to appreciate the results • Holding the partner or the relationship responsible Partner opposed to change, relational difficulties, partner’s unwillingness or partner’s health problems incompatible with “practice”

14. Factors facilitating the response to treatment 1(Criterion: feeling of improvement at post-test 1) *significant at .05

15. Interpretative hypothesis The Practical Guide of PE probably tends to be more effective when the severity of PE is moderate

16. Factors facilitating the response to treatment 2(Criterion: subject’s feeling of improvement at post-test 1) * Valeurs significatives au seuil de .05

17. Interpretative hypothesis • A partner’s need for control of sexuality may facilitate the motivation to treatment and the compliance • Partners’ need for control of sexuality may be a morbid factor improving especially favourably with using the Practical guide of PE

18. Conclusions and prospects • The bibliotherapy produces a significant improvement of PE problems, especially when the severity of PE is moderate • Its cost/benefit ratio makes the bibliotherapy an ideal first line therapeutic tool • A large diffusion of a bibliotherapy such as the Practical Guide of EP might be useful in order to improve sexual health in populations • Some clinical pictures have complexities that exceed the therapeutic capacities of the bibliotherapy . Notably relationship factors may restrict its efficacy • In such cases, meeting with a professional remains indispensable for adjusting the treatment • Some severe forms of PE might benefit from a treatment combining bibliotherapy and drug therapy