Premature Ejaculation: Breaking the Silence (cont.)

PRYOR:
Using off-label therapies, such as putting numbing medications on the penis, has been tried and there's no particular one that's better than any other. The one that I tended to use in the past is viscous lidocaine. Viscous lidocaine is like Novocaine but it's thicker and more like a lotion or paste -- a sticky substance that you can rub on the penis. It doesn't work very well because it causes numbness in the penis and also in the vagina. People don't like to be numb down there when they are having sex, so that's the problem with that therapy.

MEMBER QUESTION:
Is there any common reason for its onset in men who have not had a problem with PE in the past?

PRYOR:
No. Part of the problem is we don't understand why people get premature ejaculation -- we don't understand the biology behind it. So, we don't know why someone would not have it and then all of a sudden get it. Certainly in some of these men it may be due to some distress or anxiety in their lives, but there could be also something biologically going on that we just don't know.

MEMBER QUESTION:
There's no delicate way to say this, but if a man experiences PE with one partner, does it mean he will with another partner or by himself? Is it considered PE if it only happens in one type of scenario or with one specific partner only?

PRYOR:
People who have premature ejaculation tend to have it with any partner. If you have it with one partner and then have sex with another, you are likely to have it with that person as well -- if it's real premature ejaculation. Even when they are by themselves and masturbating, they tend to ejaculate sooner than normal.

MODERATOR:
Could you tell us more about the prevalence of PE in American men?

PRYOR:
There are different surveys that have been done, so we tend to get different results. Probably the most famous one is one by Lauman, published in JAMA (Journal of American Medical Association) in 1999. He found that around 31% of all men had premature ejaculation.

There have been other surveys and studies where the figure has been lower -- somewhere between 10% and 20%. I think that somewhere around the 27% to 34%, somewhere in that range, is probably the most accurate number. It is a very common problem.

MEMBER QUESTION:
Is PE subjective? By this I mean, is it simply ejaculating before you want to, or is there a specific point experts define as premature?

PRYOR:
For the most part, we follow the criteria called the DSM4 that comes from the Psychiatric Association. It is subjective using that criteria -- which is that you ejaculate sooner than you want and it causes distress.

However, when we do studies on this, it's important to have some objective - "something you can hang your hat on" kind of data. So, we time ejaculation in those studies. We did what was called an observational study and when we looked at people in society, surveyed them and found a group of people without premature ejaculation and a group of people with premature ejaculation. We found that people with premature ejaculation did have significantly shorter times to ejaculate than the men without PE. In other words, they ejaculated much quicker than people that claimed they did not have premature ejaculation.

In doing these studies we have defined premature ejaculation in saying that, for these particular studies looking at dapoxetine, you had to have ejaculated less than two minutes in 75% of intercourse attempts.

The two-minute cut-off tends to be a good one, but I have to say that it's not a definition. In other words, somebody can come in to my office and say they ejaculate at one and a half minutes, and not have premature ejaculation -- it may be just when they want, when their partner wants and it may not cause any distress so that person does not have PE. On the other hand, you may have somebody who comes in and ejaculates four minutes after penetration and it may be causing a tremendous amount of distress for both the patient and the partner. So, there's no rigid time cut-off in real life. We use the two minutes, although somewhat artificial, because we needed to have some definition for the study so that the FDA could look at the results with some sort of objectivity.

In addition, in the observational study that we did, people who tended to ejaculate sooner claim that they didn't have control and people who did not the have PE claimed that they feel like they did have control.

There's also some data that we have to suggest that if you ejaculate and it's over a minute, that you're going to be much more satisfied with your sexual experience than if it's less than a minute. There's numerous data out there to suggest, in general, that if ejaculation is in less than two minutes, people are not happy with that.

MODERATOR:
What should men do to find good information and helpful treatment for PE?

PRYOR:
I think they should go to your chat line. Actually, I do believe that getting information from credible sources on the web is really good.

I think that they should also go to a knowledgeable physician in this area. This tends to be urologist, though not all of them will know about PE, but many of them do.

My suggestion is -- don't suffer, try to get some treatment. Today, in May of 2005, there's no therapy specific for premature ejaculation. They are going to have to try things like numbing medications or other medications that may have some side effects. Hopefully in the near future there will be something that's indicated specifically for premature ejaculation.