The (Too) Fast Lane
Breaking the Pattern
Reviewed By Gary Vogin
The party was winding down, so Bill and Ann -- who had begun to date recently -- decided to go back to her place. "He was shy and totally self-conscious," says Ann about Bill (not their real names). "But he was a great kisser."
One great kiss led to another, and soon they were in bed. In a matter of minutes, it was over. Way too soon.
"He was so quick," Ann recalls. "And so embarrassed. He looked like a little boy who had broken his mother's favorite dish. He kept saying, 'I'm sorry, I'm sorry.'" And then he cried.
Millions of men likely can relate -- although they're not usually eager to say so. Premature ejaculation is the most common male sexual problem, studies suggest. In a survey published in 1999 in the Journal of the American Medical Association, 21% of the 1,410 men (ages 18 to 59) who responded said they had premature ejaculation. (In comparison, only 5% reported an inability to get or maintain an erection, and another 5% reported low desire.) Other studies have put the percent of men with premature ejaculation as high as 75%.
Every man will probably experience premature ejaculation at least once, says Jon L. Pryor, MD, associate professor of urology at the University of Minnesota Medical School and a veteran researcher in the field who recently published a report on the problem in the Journal of Sex & Marital Therapy. Despite the frequency with which it occurs, the problem is relatively overlooked, Pryor says, especially in comparison to erectile dysfunction (ED), which has been intensely researched (and widely discussed, thanks partly to former U.S. Sen. Bob Dole, who appeared in commercials touting drug treatment for that problem.) "There's no drug specifically for premature ejaculation," Pryor notes. "You'd think the pharmaceutical companies would pursue this."
But recently, premature ejaculation has gotten more attention, with Pryor and others zeroing in on what tends to cause the problem and testing various treatments. While legitimate researchers like Pryor don't promise a guy he can go on and on indefinitely, they are discovering that if tailored to the cause, various options can at least improve his sex life. But premature ejaculation is not always simple to treat, says Pryor's co-author, Michael E. Metz, a St. Paul, Minn., psychologist.
The Definition Dilemma
The issue of premature ejaculation can be frustrating for researchers not only because of the havoc it can wreak on relationships but also because the medical community hasn't come to agree on the definition. "Some researchers define it by the number of thrusts [after penetration]," Pryor says. Most often mentioned is about 8 to 15.
Pryor prefers the definition he and Metz cite in their review, calling premature ejaculation "the inadvertent and unsatisfying rapid speed of male ejaculation."
Laundry List of Causes
Behind the inability to endure can be many factors. Some men ejaculate too quickly due to an innate "reflex" or physiological predisposition of the nervous system. Sometimes, too-fast ejaculation can be a side effect of taking certain drugs -- even over-the-counter ones such as cold pills. Stress on the job or in a relationship can set up a guy to climax too fast, too.
In other men, the condition is caused by a serious psychological condition such as obsessive-compulsive disorder, or the result of a physical problem, such as a urinary tract infection. Still others haven't learned to manage their bodies' reactions properly during sexual arousal.
Solving the Problem
When the cause is physical, the treatment can be simple and swift. Such was the case with a 31-year-old man who was receiving counseling from Anthony Jerome Brown, CSW, a New York social worker. The man told Brown he had an infected prostate gland (prostatitis) and had been given the antibiotic Cipro. What he hadn't told the physician who diagnosed the infection -- but did tell Brown -- was that he also suffered from premature ejaculation.
After taking the antibiotic twice daily for a month, his three-year bout with the ejaculation problem was over. Brown wrote up the case report for the Journal of Sex & Marital Therapy, suggesting that more research might be conducted on how often the infectious condition and premature ejaculation might coexist.
Other medical treatments are even simpler, says Pryor. He and others have had success prescribing antidepressants, taking advantage of a known side effect of the drugs to balance the problem: in some men they can block ejaculation. The most thoroughly studied of these, Pryor says, is Anafranil. A man can take a single dose 12 hours before planning to have sex, he says, and "you don't have to take it continuously." But it doesn't work for everyone, either.
If an antidepressant doesn't do the job, Pryor recommends other measures. "Condoms can help a lot, too," he says. "They dull the sensation." Lidocaine jelly, a topical anesthetic available by prescription, can be used to numb the skin of the penis. But that numbness can be transferred to the partner and quickly zap the romance, he says.
If a man focuses too much on his partner's reactions -- thus ignoring his own -- Pryor often will recommend sensual awareness training to learn to better keep his state of arousal under control and last longer. (Forget the old "think about football" distraction. This works better, Pryor says.)
Some remedies that have been mentioned for years are often not effective, or not effective on their own without some behavioral retraining, too, says Metz. The squeeze technique -- in which the man's partner squeezes the tip of the penis when the man is on the verge of orgasm -- has limited effectiveness, Metz and Pryor say. And a pacing strategy known as the stop-start technique is best used with other techniques, Metz says.
Not surprisingly, the internet is full of quick-fix products with promising names (such as Super Power and Stud 100) designed to be sprayed or rubbed on the penis to slow down ejaculation. Pryor urges caution in using any products that don't have scientific research to back them up.
But he says there may be something to a Velcro-type device called a testicular restraint, sold through mail-order erotic magazines. The idea is to restrain the testicles from their natural tendency to move during sex, which helps some men delay ejaculation. "You [would probably] have a hard time hurting yourself with this," he says. "It's probably one of the safer things to try."
A Little Sympathy
An understanding partner can lessen the trauma, too, since thinking about the last episode of too-fast sex might make a guy anxious yet again, and fostering a vicious cycle.
Ann, the disappointed date, made the best of the situation. "I didn't want to make a big deal out of it," she says of the long-ago night. "I hugged him. And he thanked me for being so nice to him about it."
Kathleen Doheny is a Los Angeles health journalist and a regular contributor to WebMD. Her work also appears in The Los Angeles Times, Shape, and Modern Maturity magazines.
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