The Effectiveness of Cognitive-Behavior Therapy (CBT) and Drug Therapy in Treating Premature Ejaculation Men Referred to Ahvaz city Therapy Centers

Document Type : Original


1 Associate professor, Department of Counseling, martyr Chamran University of Ahvaz, Iran

2 Assistant Professor, Dept of Counseling , Shahid Chamran University of Ahvaz, Ahwaz, Iran

3 Associate professor, Dept of Counseling, University of Shahid Chamran, Ahwaz, Iran

4 Assistant Professor, Dept of Orology, University of Jundishapur, Ahwaz, Iran


Purpose: The present study was carried out in order to comparison and investigation of the effectiveness of cognitive-behavior therapy and drug-therapy in treating premature ejaculation men referred to Ahvaz city therapy centers.
Methods: 39 men with premature ejaculation were selected using structured clinical interview for DSM-TV-TR based on premature ejaculation dysfunction and cut of point in Premature Ejaculation Diagnostic Tool (PEDT). Subjects were assigned groups (cognitive-behavior therapy, drug therapy and control) through sampling random method. Data were collected in three stages (pretest, post test and follow-up) through Premature Ejaculation Diagnostic Tool (PEDT), Sexual Quality of Life Questionnaire-Male and stopwatch.
Findings: Results of ANCOVA in post-test stage by controlling pre-test showed that cognitive-behavior therapy and drug therapy are significantly efficient on treatment of premature ejaculation. But there is not difference between cognitive-behavior therapy and drug therapy in treatment of premature ejaculation. Results of follow-up stage showed that the effects of cognitive-behavior therapy were stable but effects of drug therapy were not stable. Also, the effects of cognitive-behavior therapy were more stable than drug therapy.
Conclusion: Cognitive-behavior therapy and drug therapy have appropriate efficacy in the treatment of men suffering from premature ejaculation significantly but effects of Drug Therapy are not stable.


Abdel-Hamid, A., Naggar, E. A., & Gilany, A. H. (2001). Assessment of as needed use of pharmacotherapy and the pause-squeeze technique in premature ejaculation. International Journal of Impotence Research, 13, 41-45.
Abraham, l., Psychol, C., symond, T., & morris, F. M. (2008). Psychometric validation of a sexual quality of life questionnaire for use in men with premature ejaculation or erectile dysfunction. Journal of Sexual Medicine, 5, 595-601
Akgul, T., Karakan, T., Ayyıldız, A., & Germiyanoglu, C. (2008). Comparison of sertraline and citalopram for treatment of premature ejaculation. Urology Journal, 5, 41-45.
Althof, S. (2005). Psychological treatment strategies for rapid ejaculation: rationale, practical aspects and outcome. World Journal of Urology, 23, 89-92.
Althof, S. (2007). Treatment of rapid ejaculation: psychotherapy, pharmacotherapy, and combined therapy. In S. Leiblum (Ed.), Principles and practice of sex therapy (4th ed., pp. 212–240). New York: Guilford.
Althof, S., Levine, S. B., Corty, E. W., Risen, C. B., Stern, E. B., & Kurit, D. M. (1995). A double-blind crossover trial of clomipramine for rapid ejaculation in 15 couples. Journal of Clinical Psychiatry, 56, 402-407.
Arafa, M., & Shamloul, R. (2006). Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire. International Journal of Impotence Research, 18, 534-538.
Baker, C. D., & De Silva, P. (1988). The relationship between male sexual dysfunction and belief in Zilbergeld’s myths: an empirical investigation’, Sexual and Marital Therapy, 3(2), 229–238.
Barlow, D. H. (1986). Causes of sexual dysfunctions: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140-148.
Beck, A. T., Rush, A., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression, New York: Guilford Press.
Beck, A. T., Emery, G., & Greenberg, R. (1985). Anxiety disorders and phobias: A cognitive perspective, New York: Basic Books.
Betchen, S. (2001). Premature ejaculation as symptomatic of age difference in a husband and wife with underlying power and control conflicts. Journal of Sex Education and Therapy, 26, 34–44.
Biri, H., Isen, K., Sinik, Z., Onaran, M., Kupeli, B., & Bozkirli, I. (1998). Sertraline in the treatment of premature ejaculation: a double-blind placebo controlled study. International Urology and Nephrology, 30, 611-615.
De Carufel, F., & Trudel, G. (2006). Effects of a new functional-sexological treatment for premature ejaculation. Journal of Sex and Marital Therapy, 32, 97-114.
DeLamater, J., & Sill, M. (2005). Sexual desire in later life. Journal of Sex Research, 42(4), 138-149.
Eaton, H. (1973). Clomipramine in the treatment of premature ejaculation. Journal International Medicine Research, 1, 432-434.
Feldman, H. A., Goldstein, I., Hatzichristou, D. G., Krane, R. J., & McKinlay, J. B. (1994). Impotence and its medical and psychosocial correlates: results of the Massachusetts male aging study. Journal of Urology, 151, 54–61.
Gottman, J. (1994). What predicts divorce? The relationship between marital processes and marital outcomes. Hillsdale, Lawrence Erlbaum Associates.
Hatzimouratidis, K., Amar, E., Eardle, E., Giulian, F., Hatzichristo, D., Montorsi, F., Vardi, Y &., Wespes, E. (2010). Guidelines on male sexual dysfunction: erectile dysfunction and premature ejaculation. European Journal of Urology, 14, 361-371
Hawton, K., Catalan, J., Martin, P., & Fagg, J. (1986). Long-term outcome of sex therapy. Behavior Research Therapy, 24, 665-675.
Kaplan, H. S. (1982). The new sex therapy. New York: Brunner/Mazel.
Kaplan, H. S. (1974). The new sex therapy. New York: Brunner/Mazel.
Katherine, M., Hertlein, G. R., & Weeks, N G. (2009). Systemic sex therapy. Taylor & Francis Group. New York.
Kim, S. C., & Seo, K. K. (1998). Efficacy and safety of fluoxetine, sertraline and clomipramine in patients with premature ejaculation: a double-blind, placebo controlled study. Journal of Urology, 159, 425-427.
Laumann, E. O., Nicolosi, A., Glasser, D. B., Palik, A., Gingell, C., & Moreira, E. (2005). Sexual problems among women and men aged 40–80 years: Prevalence and correlates identified in the global study of sexual attitudes and behavior, International Journal of Impotence Research, 17, 39–57
Laumann, E.O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: prevalence and predictors. Journal of the American Medical Association, 1, 537-544.
Li, P., Zhu, G. S., Xu, P., Sun, L. H., & Wang, P. (2006). Interventional effect of behavior psychotherapy on patients with premature ejaculation. Zhonghua Nan Ke Xue, 12, 717-719.
Masters, W., & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown.
McCabe, M. P. (2001). Evaluation of a cognitive behavior therapy program for people with sexual dysfunction. Journal of Sex and Marital Therapy, 27, 259-271.
Metz, M., & McCarthy, B. (2003). Coping with premature ejaculation: How to overcome PE, please your partner and have great sex. Oakland, CA: New Harbinger Publications
Obler, M. (1973). Systematic desensitization in sexual disorders. Journal of Behavior Therapy and Experimental Psychiatry, 4, 93-101.
Rosen, R. C., & Leiblum, S. R. (1995). Treatment of sexual disorders in the 1990s: An integrate Lazarus, group treatment for impotence and frigidity. Sexology, 36, 22-25.
Rosen, R., Leiblum, S., & Spector, I. (1994). Psychologically based treatment for male erectile disorder: A cognitive-interpersonal model. Journal of Sex and Marital Therapy, 20, 67-85.
Rosen, R., Wing, R., Schneider, S., & Gendrano, N. (2005). Epidemiology of erectile dysfunction: The role of medical comorbidities and lifestyle factors. Urological Clinics of North America, 32, 403-417.
Spector, I. P., & Carey, M. P. (1990). Incidence and prevalence of the sexual dysfunctions: A critical review of the empirical literature. Archives of Sexual Behavior, 19, 389-408.
Symonds , T., Perelman, M. A., Althof, S., Giuliano, F., Martin,M., May, M., Abraham, L., Crossland, A., & Morris, M. (2007). Development and validation of a premature ejaculation diagnostic tool.European Urology. 5, 565-573.
Symonds, T., Roblin, D., Hart, K., & Althof, S. (2003). How does premature ejaculation impact a man’s life? Journal of Sex and Marital Therapy, 3, 361-370.
Tang, W., Ma, L., Zhao, L., Liu, Y., & Chen, Z. (2004). Clinical efficacy of Viagra with behavior therapy against premature ejaculation. Zhonghua Nan Ke Xue, 10, 366-370.
Trudel, G., & Proulx, S. (1987). Treatment of premature ejaculation by bibliotherapy: An experimental study. Sexual and Marital Therapy, 2, 163-167.
Ussher, J. M., & Baker, C. D. (2002). Psychological perspectives on sexual problems. New York. Routledge.
Waldinger, M. D. (2002). The neurobiological approach of premature ejaculation. Journal of Urology, 168, 2359-2367.
Waldinger, M. D. (2003). Rapid ejaculation. In S. Levine, C. Risen., & S. Althof (Eds.), Handbook of clinical sexuality for mental health professionals (pp. 257–274). New York: Brunner/ Routledge.
Waldinger, M. D. & Olivier, B. (2000). Selective serotonin reuptake inhibitors (SSRIs) and sexual side effects: differences in delaying ejaculation. In Sacchetti, E., Spano, E. P. eds, Advances in Preclinical and Clinical Psychiatry, Vol. I. Fluvoxamine: established and emerging roles in psychiatric disorders(pp.117-130). Milan: Excerpta Medica.
Waldinger, M. D., Hengeveld, M. W., & Zwinderman, A. H. (1994). Paroxetine treatment of premature ejaculation: a double-blind, randomized, placebo- controlled study. American Journal of Psychiatry, 151, 1377-1379.
Waldinger, M. D., Hengeveld, M. W., Zwinderman, A. H., & Olivier, B. (1998). An empirical operationalization study of DSM-IV diagnostic criteria for premature ejaculation. International Journal of Psychiatry in Clinical Practice, 2, 287- 293.
Wincze, J. P., Bach, A. K., & Barlow, D. H. (2008). Sexual Dysfunction. In D. H. Barlow (Eds.), Clinical Handbook of Psychological Disorders (pp. 615-662). New York: Guilford Press.