Treating premature ejaculation in the multi-modal therapeutic framework: a single case study.

Generally, premature ejaculation is caused by organic, psychological, interpersonal factors and lay beliefs. It is defined as a lack of adequate voluntary ejaculatory control with the result that a patient climaxes involuntarily. An ejaculatory control may be said to be established when the patient can tolerate high levels of excitement which characterise the plateau stage of the sexual response cycle without ejaculating reflexly. The most effective treatment for premature ejaculation so far is the stop-start exercises that aim to help patients tolerate a prolonged period of intense pleasurable arousal and to enjoy sexual sensation before ejaculation. However, the stop-start exercises would be more effective if they are employed in a multi-modal therapeutic framework. This is because cases of premature ejaculation differ in terms of the aetiology, pathological patterns, and the patients' personal characteristics and background. A case is presented to illustrate how the conventional stop-start exercises are prescribed in this multi-modal framework.