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May 18, 1993
Psychoanalysts have long been thought of by the public as experts on sexual matters. However, this presumed level of expertise does not seem to be warranted for most analysts when it comes to the handling of certain common sexual disorders. For a considerable period of time I have been disenchanted with what I perceive to be the general analytic approach to two specific varieties of sexual disorder: premature ejaculation and the type of penile erectile impotence associated with the actual act of penetrating the vagina. I am referring to individuals who have had these problems for long periods of time (duration being measured in years rather than months).
During my own analytic training, and in the schooling of most middle-aged or older analysts, analysis was generally thought to be the first line of treatment for the disorders mentioned. However, there are no analytic statistical studies as to the efficacy of analytic treatment. In my own experience, and in that of a number of other analysts whom I have spoken with about these conditions, the long-term treatment results have generally been unfavorable (success rates anecdotally reported as being 20–25 percent).
As a result of these impressions, I have come to believe that analysis should generally be combined with other therapeutic modalities in the treatment of these disorders. To wit, premature ejaculation should be treated in conjunction with visits to a sex therapist, and chronic erectile penetration impotence is often best treated by concomitant visits to a urologist for intracavernosal injections.
The spouse of one of my analysands was in analysis with a colleague for many years for his long-standing premature ejaculation. After